JAN-FEB 2015

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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38 JANUARY/FEBRUARY 2015 | Med Esthetics CONTOURED CURVES Current ptions There are three key technologies in the noninvasive body contouring arena. They include cryolipolysis, high- intensity focused ultrasound (HIFU) and radiofrequency (RF). Only two—cryolipolysis and HIFU—are FDA- cleared for fat destruction, but that may soon change. A recent study by David McDaniel, MD, et al, published in the Journal of Drugs in Dermatology (November 2014), revealed that monopolar RF energy causes apoptosis of adipose cells in porcine models. Until this fi nding makes it to clinical trials, RF energy is primarily touted as offering skin tightening, due to volu- metric heating of the deep dermis, resulting in a reduced circumference of treated areas. "Patients really like the RF-based BTL Exilis, and the upgraded Elite system delivers even better results," says Lisa A. Zdinak, MD, chief surgeon at Precision Aesthetics NYC in New York City. "Patients can feel the increased power while simultaneously having a more comfortable experience that feels something like a hot stone massage." Initially introduced as a facial skin-tightening device, the RF-based Thermage from Valeant/Solta Medical now includes the Thermage 16.0 Body Contouring Tip for skin tightening on the arms, abdomen, anterior thighs, posterior thighs, buttocks and hands. Dr. Zdinak notes that the treatment provides instant, visible improvement due to the immediate contracture of the existing collagen in the dermis, as well as progressive improvement over a period of two to three months as the body makes more collagen in response to the initial treatment. Flor Mayoral, MD, founder of Mayoral Dermatology, Coral Gables, Florida, offers seven different RF-based devices in her practice. "Most are for skin tightening on the face," she says. "The ones I use primarily for the body are the Alma Accent, EndyMed Pro and Ther- mage, and they work very nicely—tightening the skin and offering some fat reduction to help improve the patients' contours." In the fat destruction category, CoolSculpting from Zeltiq has become the most recognizable brand. The device is placed directly on the targeted areas, and the chilled handpieces cause apoptosis of the fat cells without damaging the epidermis. Christopher B. Zachary, MBBS, FRCP, a dermatologist at University of California Irvine Health, offers CoolSculpt- ing to his patients and is also a member of the company's scientifi c advisory board. "In terms of effi cacy, it is the most effective device," he says. "There is little evidence showing side effects or complications. Nursing staff can set it up, so it's quite effi cient in terms of staff utilization." CURRENT OFFERINGS The popularity of noninvasive body contouring has spurred the development of new devices that promise to shrink, tighten and improve the contours of the body. Following are some of the current options for aesthetic practices: "It's sort of like doing liposuction piecemeal. We do a little here, you wait and see how it looks." ALMA ACCENT ULTRA Combines Ultrasound Shear Waves and RF energy to tighten skin, reduce fat, and improve the appearance of cellulite and stretch marks. ( ECLIPSE SKINFINITY RF The fractional RF-based device improves the appearance of stretch marks and tightens skin. ( ELLMAN PELLEFIRM Tightens skin and improves the appearance of cellulite with RF energy. ( INMODE BODY FX RF energy combined with negative pressure tight- ens skin and reduces cellulite. ( LUTRONIC INFINI The device's minimally invasive microneedles deliver high-intensity RF energy under the skin to tighten and contour. ( SCITON SKINTYTE II Uses infrared energy to cause soft tissue coagulation and stimulate collagen production. ( VALEANT/SOLTA MEDICAL LIPOSONIX High-intensity ultrasound energy destroys fat cells, which are eliminated by the body. ( VALEANT/SOLTA MEDICAL THERMAGE Delivers focused RF energy to the face and body to heat tissue and remodel collagen. ( VIORA REACTION AND V30 PLATFORM Incorporates bi-polar, multi-RF energy and vacuum therapy to tighten skin. ( ZELTIQ COOLSCULPTING Uses cryolipolysis to destroy fat cells without damaging skin. ( ZIMMER ZWAVE Utilizes high-energy radial shockwaves and mechanical massage to stimulate collagen and disrupt fat cells. (

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