Noninvasive body contouring continues to generate enormous interest among patients, allowing them to lose fat, tighten skin and reduce circumference without any scarring or downtime. One of the key benefits to practices offering these procedures is that they appeal to a wide range of patients and generate a high rate of repeat visits.
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 finding makes it to clinical trials, RF energy is primarily touted as offering skin tightening, due to volumetric 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 Thermage, 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 CoolSculpting to his patients and is also a member of the company’s scientific advisory board. “In terms of efficacy, 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 efficient in terms of staff utilization.”
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