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 High-Intensity Focused Ultrasound For years, physicians have been using low-intensity ultrasound as a diagnostic tool to gain insight into the body's internal functions. More recently, researchers have discovered that high-intensity focused ultrasound creates pressure waves that can have an impact on objects in their path—like fat. Using a broad to narrow funnel of pressured, focused energy, the technician can create a focal zone of heating in the fat layer. The result is twofold: destruction of targeted fat cells and contraction/thickening of subcutaneous collagen. 2011), the application of the high-intensity focused ultrasound energy appeared to provide a safe and effective means for ablating fat with no clinically significant changes to serum liver function, free fatty acids or cholesterol levels. While some of Dr. Kaminer's patients say the treatment gives them little discomfort, others may feel some pain, cold, prickling, tingling or warmth. Much depends on the energy settings, which can range from 30J/cm2 to 60 J/cm2. The goal, Dr. Kaminer says, is to achieve a total of 140J/cm2-150 J/ cm2, which can be also achieved with five passes using 30 J/cm2 or four passes using 40 J/cm2 in a single treatment session. UPSIDE DOWNSIDE Patients can drop 1 inch in one treatment in one hour with little downtime. Some patient discomfort can arise, depending on the treatment area, energy setting and patient's pain tolerance level. 1319nm Laser In the late 1990s, mechanized and suction roller devices attracted lots of attention for softening the look and feel of cellulite. While many of these devices help increase circulation and decrease trapped interstitial fluid, they do little to separate the tight fibrous septa that connects the superficial fascia to the dermis, a main factor leading to cellulite's dimpled effect. 34 SEPTEMBER/OCTOBER 2013 | MedEsthetics While other devices focus on fat reduction, this device smooths the bump in places like the saddlebags. The emergence of laser therapy changed all that with combination ablative and non-ablative laserbased devices that heat up the fibrous septa and cut the septa tether with an ablative wavelength using a high-peak energy pulse at a lower frequency, while a lower energy, higher-frequency nonablative laser tightens and synthesizes collagen. Marc Salzman, MD, FACS, a board-certified plastic surgeon and director of the Salzman Institute of Cosmetic Surgery, Louisville, Kentucky (itbecomesyou.com), says he can improve the appearance of cellulite between 30% and 70% © ISTOCKPHOTO.COM "By funneling the energy to a certain focal zone, the ultrasound kills whatever fat cells are there. Then, over several months, the body naturally recognizes the fat as something foreign and clears it as debris. This is a permanent, noninvasive way to eliminate fat cells," says Michael S. Kaminer, MD, managing partner of SkinCare Physicians, Chestnut Hill, Massachusetts. Dr. Kaminer, who uses Solta Medical's Liposonix (solta.com), has observed an average loss of 1 inch in one treatment, with best results occurring around the abdomen and love handles. Clinical studies back up his findings. An October 2010 study published in the Aesthetic Surgery Journal found that the Liposonix treatment decreased the waist circumference in 85 men and women by an average of 4.6cm after three months. The treatments lasted 60 to 90 minutes using a mean energy level of 134.8 J/cm2. In a separate Aesthetic Surgery Journal report (May