Dr. W. Grant Stevens calls it his fire andice room. Stocked with lasers, skin-tighten-ing devices, fat-zapping machines and, on arecent Wednesday, a 65-year-old womannamed Helen, the brightly lighted corner ofthe Marina del Rey medical facility is asmorgasbord of the latest nonsurgical cos-metic procedures.

In one corner, there’s an Exilis electronicwand not much bigger than a pen, pluggedin and ready to roll over Helen’s face, tight-ening her skin. Two boxy Zeltiq machines,which are used as a nonsurgical alternativeto liposuction, sit in another corner. Theroom also holds the newest version of theradio-frequency skin tightener Thermage,a Xeo hair removal device, the Zerona laser,which is supposed to get rid of fat, and aFraxel — a so-called fractionated laser usedto resurface and smooth the skin.

“When I was younger, my husband calledme yafah. He said I was beautiful,” saidHelen, an Israeli socialite who’d flown toL.A. from Miami the day before to embellisha surgical body lift she had received fromStevens, a cosmetic plastic surgeon, threemonths earlier. “For many, many years, heforgot to call me yafah.... Now he asks, ‘Doyou have a boyfriend? You look so good itdoesn’t make sense anymore.’ ”

Helen, who asked that her last name notbe used for privacy reasons, was having thisconversation while the Zeltiq machineswere attached to her legs and her cheekswere coated with numbing gel in anticipa-tion of Exilis and Fraxel treatments. A bookwas propped open in her lap. Her iPhonewas at the ready. Smiling as much as onecan when one’s face is losing all sensation,Helen is evidence of a major trend: thegrowth of nonsurgical cosmetic devices andtreatments.

Eighty-three percent of all cosmetic pro-cedures performed in the offices of cos-metic plastic surgeons in 2010 were nonsur-gical, according to the American Society forAesthetic Plastic Surgery. The AmericanSociety of Cosmetic Dermatology and Aes-thetic Surgery reports a similar trend. Whatdoes that mean in terms of volume? Almost8 million nonsurgical cosmetic procedureswere performed last year at a cost of $4.1bil-lion.

“There’s a huge demand for nonsurgicalprocedures,” said Dr. Jeffrey Kenkel, a cos-metic plastic surgeon in Dallas.

The reasons are simple, said Kenkel,who is president of the American Society forAesthetic Plastic Surgery. “Some patientsonly want a little bit of change,” he said.Others “just aren’t interested in a surgicaloption.” They’re seeking procedures thatare less expensive, less painful and less dis-ruptive than, say, a face-lift, which costs anaverage of $6,600 and takes weeks of recov-ery time.

FDA approvalsIn the last year alone, the Food and Drug

Administration has approved two new de-vices — Zerona and Zeltiq — used for thenonsurgical removal of fat. The latter isquickly gaining favor as a surgery-free alter-native to liposuction.

Zeltiq is a device that vacuum-attachesto the body and delivers precise and con-trolled cooling through the skin to targetsubcutaneous fat deposits. The one-hourtreatment is designed to freeze and kill fatcells without damage to the skin or internalorgans. If the treatment is successful, overthe course of several weeks, the fat cells arebroken down and processed by the liver,and ultimately expelled as excrement.

“The typical candidate needs one to two

exposures on an average love handle,” saidDr. Dieter Manstein, co-inventor of Zeltiqwith Dr. Rox Anderson. (Both of them workwith the Wellman Center for Photomedi-cine at Massachusetts General Hospital in

Boston, a teaching affiliate of the HarvardMedical School.)

“The ideal candidate is somebody who’sin reasonably good shape, somebody whohas some love handles or a post-pregnancy

pouch or back fat that doesn’t want to dis-appear,” said Manstein, who also co-devel-oped, with Anderson, a fractional laser skinresurfacing technique popularized by a de-vice known as Fraxel.

FDA spokeswoman Erica Jefferson saidthe agency does not track the rate of appli-cations for medical devices. But she addedthat the agency has cleared “tons” of devic-es for skin tightening, body contouring andwrinkle reduction in the last decade.

The number of FDA-approved skin-tightening devices, in particular, has dra-matically increased in recent years, includ-ing products such as Exilis and Pearl.

The Exilis device uses radio frequencywaves in an attempt to stimulate andstrengthen collagen (and to reduce fat).About 100 Exilis devices are in use in theU.S., including in Stevens’ fire and ice room.

Comprehensive in options“We try to be very comprehensive,” said

Stevens, a board-certified cosmetic plasticsurgeon who practices at Marina PlasticSurgery Associates in Marina del Rey andalso runs the aesthetic plastic surgery fel-lowship at USC.

Dr. Sanjay Grover, a cosmetic surgeonwith practices in Newport Beach and Bev-erly Hills, says patients want options.

“The interesting thing these days is[that] if you watch TV or look in magazines,the drug companies are bypassing doctorsand going straight to the consumer,” Grov-er said. “They’re creating a lot of awarenessof their products among consumers.

“I offer a number of different productsand services in my practice. Today’s cos-metic surgeon or medical provider needs tobe able to offer a full-service shop to the pa-tient… [and] you want to tell them what toexpect with any of these modalities becausefor some patients it won’t be worth payingthe money for some things until they gothrough certain [other] procedures.”

Kenkel says some of the devices can beunpredictable. “That’s the frustrationmany clinicians like myself have. It’s greatto have a device that tightens skin, but canit do so [again and again]? Can it tightenskin or remove fat consistently and reli-ably? If a device tightens skin only 20% butdoes so 90% of the time, a patient can relateto it. A patient can’t relate to a device that insome people gives good results and in oth-ers doesn’t because you don’t know whichgroup you’ll fall into.”

Many cosmetic plastic surgeons test de-vices on themselves or offer new proceduresto their patients free or at a reduced cost.

Kathy Weatherwax, a 48-year-oldmother of four wanted her skin “to lookbrighter and younger and fresher,” withoutsurgery. “I wanted maximum results withminimum down time because I have two lit-tle ones,” she said. “I want to save surgeryfor when I really need it, when I’m 70 orsomething,” said Weatherwax, who paid$1,500 for an ultrasound face tighteningtreatment and was comped the CO2 frac-tionated laser therapy by her doctor.

Weatherwax was hoping to reduce theever-deepening groove in her forehead andthe sun damage on her lower face fromwhen she worked as a lifeguard as a teen-ager and used her breaks to lie in the sunand deepen her tan. Presented with a menuof options including microdermabrasion,fillers and a brow lift, Weatherwax choseultrasound therapy to lift and smooth herbrow, and a fractionated laser to deal withthe sun damage.

Weatherwax says she got the results shewanted.

“I think I could pass for 40,” she said.

susan.carpenter@latimes.com

Photographs by Katie Falkenberg For The Times

OFFICE: Dr. W. Grant Stevens of Marina Plastic Surgery Associates uses a Zeltiq machine, right, to zap fat. The device freezes fat cells, which the body later expels.

NO KNIFE NEEDEDMany cosmetic treatments performed today are surgery-free. The options are growing.

Susan Carpenter

P6 SUNDAY, JULY 24, 2011 LATIMES.COM/IMAGE

{ B E A U T Y }

Devices that tighten, smooth, shape and slim

Doctors’ offices are full of brochures listing new nonsurgical procedures that promise totighten skin, eliminate redness or brown spots and get rid of fat. Though the machineshave been approved by the Food and Drug Administration, the clearances don’tencompass all the cosmetic procedures that are popping up in doctors’ offices; physicianscan use approved products for off-label procedures. What follows is a sampling of some ofthose devices and cosmetic procedures that are associated with them.

ZELTIQWhat it is: A device that contains a freezingunit that is used to freeze and kill fat cellswithout damage to the skin or internalorgans. The procedure is known asCoolSculpting. Who makes it: Zeltiq, in Pleasanton, Calif.FDA-approved: 2010Length of treatment: One hourDowntime: NoneCost: $700 to $1,500 per treatment

EXILISWhat it is: A device that uses radiofrequency waves to stimulate andstrengthen the skin’s collagen. The goal ofthe procedure is to tighten skin, shape bodycontours and smooth wrinkles.Who makes it: BTL Aesthetics, in Prague,Czech RepublicFDA-approved: 2009Length of treatment: About 20 minutes Downtime: None, though redness andswelling may last a few hours aftertreatmentCost: $400 to $600 per treatment

EXCEL V LASER What it is: A laser used to target the red inblood vessels, heating them to the point ofcollapse and disappearanceWho makes it: Cutera, in Brisbane, Calif.FDA-approved: 2010Length of treatment: 15 minutesDowntime: NoneCost: $1,000 or less

FRAXEL LASERWhat it is: A laser used to treat a portion ofthe skin without affecting surroundingtissues. It’s used to stimulate collagenproduction, diminish fine lines and age

spots, and resurface skin.Who makes it: Solta Medical, in Hayward,Calif.FDA-approved: 2004Length of treatment: 80 minutes (60 minutesto numb the skin, 20 to 30 minutes for lasertreatment)Downtime: Two or three daysCost: $750 to $1,000 per treatment

PEARL LASERWhat it is: A laser used to resurface andtighten skin and reduce wrinkles and sunspotsWho makes it: Cutera, in Brisbane, Calif.FDA-approved: 2007Length of treatment: 45 minutesDowntime: Five daysCost: $2,500 to $4,000

THERMAGE What it is: A radio frequency device designedto smooth the skin and soften wrinkles. Itheats the deepest layers of skin to helptighten existing collagen and stimulatecollagen renewal.Who makes it: Solta Medical, in Hayward,Calif.FDA-approved: 2002Length of treatment: 20 minutes to twohours, depending on location of treatmentDowntime: NoneCost: $1,000 to $5,000

ZERONAWhat it is: A low-level laser scanner used toemulsify and remove fat nonsurgicallyWho makes it: Erchonia, in McKinney, TexasFDA-approved: 2010Length of treatment: 40 minutesDowntime: NoneCost: $1,700 to $2,500 for six sessions

— Susan Carpenter

CHILLING OUT: A device that freezes and kills fat cells, used on a patient atMarina Plastic Surgery in Marina del Rey, is an alternative to liposuction.

LABroadsheet_ 07-24-2011_ P_ 6_ P6_ LA_ 1_CMYKTSet: 07-22-2011 14:34