Global Perspectives: Body Contouring

dr_stevensGLOBAL PERSPECTIVES: BODY CONTOURING

Cool Trends for Non-Surgical Body Contouring in the United States

W. Grant Stevens, MD, FACS


The ISAPS Biennial Global Survey revealed that liposuction is the most popular cosmetic surgery procedure, representing 18.8% of all cosmetic surgery procedures and projected to reach 1.6 million procedures worldwide. The ASAPS 16th Annual Cosmetic Surgery National Data Bank Statistics report showed that non-surgical procedures increased by 461% since 1997. Accordingly, the demand for non- surgical fat reduction procedures has increased as patients seek alternatives without surgical downtime and without risks inherent to anesthesia. As a result, device manufacturers have developed numerous systems for non-surgical body contouring.

My practice, Marina Plastic Surgery (MPS), has evaluated at least 11 medical device systems for non-surgical fat reduction, skin tightening, and cellulite minimization. MPS has evaluated, often bought, and sometimes returned the following systems: CoolSculpting, Exilis Elite, i-Lipo, Liposonix, SmoothShapes, Thermage, truSculpt, Vanquish, VelaShape, Venus Freeze, and Zerona. I’ve tried nearly all of them on myself and subsequently treated my staff, friends, and family. The systems with proven safety and efficacy were used to treat my patients. CoolSculpting has easily proven to be the most popular system, accounting for approximately 99% of the non-surgical body contouring at MPS.

Thus, this article focuses on cryolipolysis (CoolSculpting). Cryolipolysis employs controlled cooling to selectively damage fat cells. Fat cells are uniquely sensitive to cold and crystallize at a warmer temperature than water in surrounding tissues. Consequently, cryolipolysis can freeze fat cells without inducing damage to overlying skin and surrounding muscles, nerves, and blood vessels. The exposure to cold induces apoptosis in the fat cells and an inflammatory response in the treated tissue. Over the course of two to four months, the damaged fat cells are cleared by the body, resulting in gradual, permanent fat reduction in the treated region.

We have found cryolipolysis to be a very safe and effective procedure for non-surgical reduction of subcutaneous fat. In addition to safety and efficacy, cryolipolysis has high tolerability, excellent patient satisfaction, and brings potential for tremendous business growth to a plastic surgery practice. Cryolipolysis has been successfully integrated into my practice, attracting new patients who are interested in body contouring but not yet ready for invasive procedures. The first CoolSculpting system at MPS was installed in December 2009. Since then, five additional systems have been installed one by one to meet patient demand. With six CoolSculpting systems in steady usage, an average of more than 80 treatment cycles are currently delivered each week.

Representative clinical efficacy is demonstrated in Figures 1 to 3. In Figure 1, a 47 year-old female presented for treatment of “bra roll” fat in her back (Figure 1a). The patient was treated with one cryolipolysis cycle on each side, followed by a second treatment one month later and a third treatment two months later, for a total of three cycles on each side. At six months from baseline, the “bra roll” was minimized and skin laxity was visibly reduced (Figure 1b). For the treatment of abdomen and flanks in Figure 2, multiple cryolipolysis treatments were delivered, producing significant volume reduction. The 50 year-old patient was in good physical health but had some excess fat in her abdomen and flanks pre-treatment (Figure 2a). After receiving two cryolipolysis cycles to her abdomen and two cycles to each flank, the patient achieved noticeable fat reduction two months post-treatment (Figure 2b). As illustrated by the flank treatment in Figure 3, a single cycle treatment to localized fat can result in a noticeable, aesthetically pleasing outcome. The 34 year-old patient wanted to get rid of his “love handles” (Figure 3a). Three months after being treated with one cryolipolysis cycle on each flank, the patient was pleased with his fat reduction (Figure 3b). Whether a single treatment cycle is used to minimize a discrete bulge or multiple cycles are delivered to yield significant debulking and body sculpting, cryolipolysis has proven to be a safe and efficacious non-surgical body contouring procedure.
 
 
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Figure 1: The patient underwent cryolipolysis treatment of “bra roll” fat on her back. Pre-treatment (a) and post-treatment six months from baseline (b). Procedure by Dr. W. Grant Stevens at Marina Plastic Surgery.
 
 

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Figure 2: This 50 year-old female was physically fit but still unable to reduce excess fat in her midsection prior to cryolipolysis treatment. Pre-treatment (a) and two months post-treatment (b). Procedure by Dr. W. Grant Stevens at Marina Plastic Surgery.
 
 

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Figure 3: This 34 year-old male wanted to non-surgically reduce his “love handles.” Pre-treatment (a) and three months post-treatment (b). Procedure by Dr. W. Grant Stevens at Marina Plastic Surgery.

Over less than four years, more than 6,000 cryolipolysis treatment cycles have been delivered at MPS and the procedure has reliably produced visible fat reduction and significantly contributed to our non-surgical practice; safety, efficacy, and patient satisfaction are consistently high. This non-surgical procedure has brought in new patients to the practice, such as men normally averse to cosmetic treatments and aesthetic neophytes reluctant to undergo invasive procedures. Following successful cryolipolysis results, many patients have subsequently sought secondary minimally-invasive aesthetic procedures and tertiary cosmetic surgeries.

Non-surgical body contouring is embraced at Marina Plastic Surgery and we have evaluated them all. At least 11 different non-surgical body contouring systems have been evaluated and many have been returned. Cryolipolysis is our non-surgical body contouring procedure of choice because of its high safety, tolerability, efficacy, and business growth potential.

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