MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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SLIMMING & SHAPING nonrandomized clinical study was initiated to evaluate the effects of cryolipolysis on fat layer reduction of the flanks and back in humans. Results demonstrated an average reduction of 22.4% in the thickness of the subcutaneous fat layer, with the best results occurring in those patients with modest fat bulges as opposed to obese patients or individuals with excess skin laxity. Ultrasound assessments revealed a 33% reduction in superficial fat layers with no significant changes to the animals' lipid counts. Cryolipolysis In the 1960s, a pediatrician noticed that kids who were put to sleep with popsicles in their mouths were losing fat in their cheeks as a result of cold panniculitis, an inflammation of the subcutaneous adipose tissue that occurs with cold exposure and results in fat loss. Ten years later, another group of researchers observed that long-distance equestrians who rode at least two hours a day in the winter were losing fat on the outside of their thighs, while the inner thighs, warmed by the saddle, remained unchanged. A team of Harvard researchers put the two findings together and theorized that a very specific cold temperature might just kill fat without having a negative impact on the rest of the body. Their concept relied on the premise that fat is more sensitive to cold than the surrounding muscle, tissue and skin. The research team first tested their theory on pigs in a study published in Lasers in Surgery and Medicine (November 2008). In a followup study, ultrasound assessments revealed a 33% reduction in superficial fat layer thickness with no significant changes to the animals' lipid counts. Following the animal studies, Zeltiq Aesthetics (zeltiq.com) introduced its cryolipolysis device for humans known as CoolSculpting, which features a cupshaped applicator and a moderate vacuum to draw tissue between two cooling panels. A multicenter, 32 SEPTEMBER/OCTOBER 2013 | MedEsthetics The exact mechanism of action is unknown, but the prevailing theory is that a specific proprietary temperature causes apoptosis of the adipocytes followed by an inflammatory response, which results in the ruptured adipocyte cells being digested and eliminated from the body over the next 90 days. In his own medical spa, Grant Stevens, MD, FACS, a board certified plastic surgeon and medical director of The Stevens Institute, Marina del Rey, California, (thestevensinstitute.com) has observed an average 25%-30% reduction in fat in those areas treated by the Zeltiq CoolSculpting applicator. He describes the immediate aftereffect on the skin as looking like "the world's biggest hickey." "It gets really cold and then an hour later, the fat looks like a cube of butter," he says. The treated area is then massaged flat, and the numbing and redness quickly dissipate. Side effects include temporary erythema, bruising and numbness at the treatment site. As with most of these noninvasive therapies, the most effective area for the cryolipolysis treatment is the abdomen and flanks, or "love handles." Dr. Stevens has observed an average loss of two inches and even up to four inches in one male patient. The fat loss is gradual—over a three-month period—and is best indicated for patients with modest fat bulges versus obese individuals. "This is really for contouring the body," says Dr. Stevens. "It should not be used as a primary means of losing weight." UPSIDE DOWNSIDE Freezes fat with an average 20%-30% fat reduction and no downtime. Only works on areas of the body that can fit into cold-plate applicators. IMAGE COURTESY OF ZELTIQ The marketing messages are consistent, but the technologies behind these device vary widely. Following is a review of the most popular fat reduction devices now on the market and the mechanisms of action behind them.