laura pietrzak coolsculpting treatment technique - new york
TRANSCRIPT
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Treatment to TransformationAssessment and Treatment Techniques To Optimize Patient Satisfaction from
Cryolipolysis
Laura K. Pietrzak, MSHS, PA-CManager, The Institute at Marina Plastic Surgery
Marina del Rey, California
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Disclosures
• Laura Pietrzak is an investigator for ZELTIQ research studies
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Off-Label Treatments
• In the US, CoolSculpting is cleared for non-invasive fat reduction on the flank and abdomen.
• This presentation contains off-label treatments to additional areas.
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THE SCIENCE AND ART OF COOLSCULPTING
"With our new comprehensive and customized patient treatment plans, our patients have been ecstatic with their CoolSculpting results. In the last 3 years, our practice has seen a dramatic increase in patients requesting non-surgical body contouring, many of which are men. In my opinion, CoolSculpting should be a part of every plastic surgeon's practice" - Grant Stevens, M.D., F.A.C.S., Marina Plastic Surgery Associates
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The SCIENCE of Cryolipolysis for Fat Elimination
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Cryolipolysis
• Derived from two case reports– 1970 - Popsicle panniculitis1
– 1980 - Equestrian cold panniculitis2
• Key findings– Fat cells are more susceptible to cold than
Skin, Nerve, Muscle
– Possible to trigger (apoptosis) natural cell death by delivering cooling through the skin surface
1. Epstein EH, Jr., Oren ME. Popsicle panniculitis. N Engl J Med 1970;282(17):966–967.
2. Beacham BE, Cooper PH, Buchanan CS, Weary PE. Equestrian cold panniculitis in women. Arch
Dermatol 1980;116(9):1025–1027.
Developed from breakthrough research from Dieter Manstein, MD, PhD
and R. Rox Anderson, MD at Massachusetts General Hospital
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Proven Evidence of Fat Layer Reduction1
UltrasoundPre-treatment and 3-month post-
treatment images of subcutaneous
fat showed 0.7 cm or >40%
decrease in thickness of fat layer
occurred over a 90-day period
Gross PathologyGross pathology from the same
treatment site showed superficial
fat layer at the center of treatment
site reduced 1 cm or 50% at 90
days post-treatment compared to
untreated region
Skin
Fat layer
Fascia
Pre-treatment 3 months post-treatment
1.6 cm0.9 cm
1.2 cm
1.3 cm
Pre-Treat 3 Months Post-Treat
1 Zelickson, et al., Cryolipolysis™ for Noninvasive Adipocyte Cell Death: Initial Results from a Pig Model, Derm Surg, 35: 10: 1462 – 1470 10/09
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The CoolSculpting System
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The CoolSculpting Applicator
Vacuum
Applicator
Uniform
Treatment
Cooling Panel with
Freeze-Detect
TechnologyTM
Treated Area
Natural
Feathering
• Each cooling cycle is 60 minutes
• The applicator contains 2 opposing cooling
panels that perform a precise energy extraction
(cold) optimized to injure only adipocytes
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Post-Treatment Massage
• On average, at two months post-treatment, the fat layer reduction was 68% greater in the massaged side than in the non-massaged side
Boey et al. Effect of Post-Treatment Manual Massage on Efficacy Following a
Cryolipolysis Procedure. Presented at 2012 ASLMS Conference.
Subject BOEYMAS008
Pre-Procedure 2 Month Follow-Up
Non-massage Massage Non-massage Massage
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Evidence of Long-Term Efficacy with
CoolSculpting
8 WEEKS AFTER
(Single side treatment)
2 YEARS AFTER
(Single side treatment)
(+10 pounds)
Procedure by Eric Bernstein, MD
BEFORE
2X
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5 YEARS AFTER
(Single side treatment )
(-10 pounds)
BEFORE
Evidence of Long-Term Efficacy with
CoolSculpting
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Clinical Publications
• More than 30 published
clinical papers and
abstracts
• Findings conclude:
• No rise above normal levels
for triglycerides or cholesterol
• Histologic evidence shows skin &
surrounding structures are safe
• MD observable reduction in
80% of subjects
• Overall patient satisfaction
from self-assessment“Cryolipolysis is a very low risk, no downtime procedure
that produces consistent observations of modest, gradual
fat layer reduction in properly selected patients.”
A.J. Burns, et al, abstract accepted for 2010 ASLMS: Analysis of Side Effects of
Noninvasive Cryolipolysis for Subcutaneous Fat Layer Reduction – Interim Report
from Controlled Clinical Trials
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Clinical Publications• Largest cryolipolysis study published to date, presenting a retrospective
review of 528 patients.
August 2013
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CoolSculpting Safety MechanismsThermal Coupling Gel Pad
• Unique patented formula
• Applied to the skin surface before placement of applicator
• Ensures consistent thermal contact
• Insulates skin during treatment
Freeze DetectTM Sensors and Software
• Patented technology detects changes in skin temperature
• If freeze is detected, treatment stops immediately
Thermal Coupling Gel Pad
Freeze DetectTM Sensors
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The ART of Treatment to Transformation
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Reflecting on the Approach with Fillers Today
• With experience, physicians have changed the approach with fillers
– One syringe does not equal full correction
– Full correction can take 3+ syringes
Old Method New Method
vs.
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Transformation Through
Customized CoolSculpting® Treatments
• Wide range of CoolSculpting® applicators available
• Applicators are essential tools for customized body sculpting
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Where We’ve Been: Localized Bulge Reductions
• Excellent results following our original protocols
• Single treatment in as little as one hour
• Diet and exercise-resistant fat
• Well defined fat bulges with borders
• Treat at the peak of the bulge
8 Weeks After CoolSculpting
Procedure by Madeline Krauss, MD
Before
12 Weeks After CoolSculpting
Procedure by Edward Becker, MD
(No weight change)
Before
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BEFORE FOUR MONTHS AFTERProcedure by Laura K. Pietrzak, PA-C
Effective Treatment of Discrete Bulges
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BEFORE THREE MONTHS AFTERProcedure by Laura K. Pietrzak, PA-C
Effective Treatment of Discrete Bulges
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Treatment to Transformation
• Global body assessment of all potential treatment areas
• Customized treatment plan based on individual patient’s shapes, needs, and goals
• Set expectations upfront for follow-up visit to re-assess, re-plan and re-treat
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Treatment to Transformation (T2T)
T2T is an advanced concept that allows our practices to successfully
treat patients that they may have previously turned away
• What is Treatment to Transformation?
– An advanced treatment plan focusing on enhancing CoolSculpting® outcomes
– A global approach to assessing the body; addressing all potential treatment areas
– Prescribing a sufficient number of hours in a given treatment area to achieve
desired results
– Re-assessing, re-planning, and re-treating
• Why is it important?
– It leads to more pleasing outcomes
– It’s likely to create the “wow” factor
– It results in greater patient satisfaction and word-of-mouth referrals
T2T Treatment
Plan Example
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Treatment to Transformation (T2T) is an advanced
CoolSculpting® concept
• What are the risks of under-treatment?
– Can lead patients to believe that the treatment did not meet expectations
– Increased chance of demarcation or step off
– Non-cosmetically pleasing outcomes that require correction
Treatment to Transformation (T2T)
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Example of Under-Treatment
Better Treatment
Plan
Applicator placed too low
Actual Treatment
Plan
1. Under treated
2. Highlights importance of accurate
applicator placement
Key Takeaways:
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Optimized Treatment Plan
Anterior
Optimized Treatment Plan
Posterior
Actual Treatment Plan
Example of Under-Treatment
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Treatment to Transformation (T2T):Patient Assessment Techniques
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Treatment to Transformation (T2T):Patient Assessment Techniques
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Treatment to Transformation (T2T):Patient Assessment Techniques
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Tools for Success
• With CoolSculpting, you can debulk and sculpt the body
Debulk Sculpt
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T2T Patient Assessment
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Debulking and Sculpting: Creating Beautiful Outcomes
BEFORE
FIRST TREATMENT SECOND TREATMENT
8 WEEKS AFTER
First CoolSculpting Treatment
9 WEEKS AFTER
Second CoolSculpting TreatmentProcedure by Edward Becker, MD
(No weight change)
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ANTERIOR TREATMENT
4 MONTHS AFTERProcedure by John B. Fasano, MD
(No weight change)
BEFORE
POSTERIOR TREATMENT
Debulking and Sculpting: Creating Beautiful Outcomes
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ANTERIOR TREATMENT
4 MONTHS AFTER
Procedure by John B. Fasano, MD
(No weight change)
BEFORE
POSTERIOR TREATMENT
Debulking and Sculpting: Creating Beautiful Outcomes
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3 MONTHS AFTER
Procedure by Laura K. Pietrzak, PA-C
(-4 pounds)
BEFORE
Debulking and Sculpting: Creating Beautiful Outcomes
FIRST TREATMENT SECOND TREATMENT
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FIRST TREATMENT SECOND TREATMENT
1 Year AfterFirst CoolSculpting® Treatment
(No weight change)
2 Years AfterSecond CoolSculpting® Treatment
(No weight change)
Procedure by Laura K. Pietrzak, PA-C
Before
Treatment to Transformation (T2T):Multiple Treatments in the Same Area
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FIRST TREATMENT SECOND TREATMENT
CoolSculpting the Abdomen and Flanks
FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE TWO MONTHS
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CoolSculpting the Abdomen and Flanks
FIRST TREATMENT SECOND TREATMENT
FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE TWO MONTHS
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CoolSculpting the Abdomen
FIVE MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
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CoolSculpting the Abdomen and Flanks
TWO MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
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BEFORE
THREE MONTHSProcedure by
Laura K. Pietrzak, PA-C
ANTERIOR TREATMENT POSTERIOR TREATMENT
CoolSculpting the Abdomen and Flanks
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THREE MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Back
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TWO MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Chest
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FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE TWO MONTHS
CoolSculpting the Arms
FIRST TREATMENT SECOND TREATMENT
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FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Buttocks
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TWO MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Inner Thighs
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TWO MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Inner Thighs
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FOUR MONTHSProcedure by
Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Outer Thighs
Unilateral treatment
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FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C
BEFORE
CoolSculpting the Legs
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CoolSculpting Formula for Success
• Assess the whole body globally
• Look at the body through the eyes of a surgeon
• Review expectations and timing of results
• Ensure proper placement of the applicator
• Be sure to take consistent before / after photos
• Post-treatment massage to enhance outcomes
• Schedule a 4-8 week follow-up to reassess and establish
retreatment protocol
• Have a well trained CoolSculpting® team
– Treat yourself and your staff as part of training
– Staff enthusiasm – “walking CoolSculpting billboards”
– Staff will want to share success stories and personal results!
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DualSculptingTM
• Patients can take advantage of shorter treatment times
• It increases profit potential per hour
• Opportunity for complementary services during treatment
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Summary
• Tremendous business growth opportunity
• Backed by science
• Proven clinical efficacy
• Technique matters!
• Treatment to Transformation achieves non-surgical body contouring results that rival liposuction
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The Marina Plastic Surgery Team