noninvasive modalities in lipolysis · lecture objectives •introduction and overview of the...
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Noninvasive Modalities in
Lipolysis
Michelle W. Foley, DO, FAOCD, FAAD
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Disclosure
Relevant Financial Relationship:
• Compensated speaker for Syneron Candela
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Lecture Objectives
• Introduction and overview of the noninvasive
options for in-office treatment of unwanted fat
• Discuss use of these modalities in your office
• Review treatment hazards and possible
complications
• Live demonstration of a few available modalities
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Why this Market Matters
According to the American Society for Aesthetic Plastic Surgery:
Americans spent 13.5 billion in 2015 on both surgical and non-surgical aesthetic procedures, 42% of that was non-surgical
Due to the risks associated with invasive body contouring, non-invasive procedures have increased 521% from 1997 to 2013
Non-surgical fat reduction saw an increases from 2015-2016 of 18.7%
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Why this Market Matters
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Reasons for this growth
Aging population
More men seeking treatments
Avoidance of surgical procedures: cost, downtime, fear
Technological breakthroughs and scientific advancements
Media, social media, celebrity culture
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The Technology: FDA Cleared
Cryolipolysis
Radiofrequency
Low-Level Laser Therapy
High-Intensity Focused Ultrasound
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The Major PlayersTECHNIQUE TECHNOLOGY PROVIDER *AVERAGE PATIENT COST *DURATION OF SESSION
CoolSculpting® Cryolipolysis. ZELTIQ $2000-2,250 1 hour/ area
BTL Vanquish® Radiofrequency BTLaesthetics $500-750/ session 45 mins/ area
BTL Exilis Ultra™ Focused RF + Ultrasound BTLaesthetics $1,375 average cost 20-30 mins/ session
SculpSure® 1060nm laser Cynosure $300-350/treatment applicator 25 mins/ area
UltraShape® Ultrasound waves. Syneron Candela $800-1,000/ session 45 mins -1 hour/ area
Liposonix® High- intensity focused ultrasound Solta medical $150-300/ square 1 hour / session
TruSculpt®. Radiofrequency Cutera $1,700 average price 30 mins-1 hour/ session
Venus Freeze™ Radiofrequency and magnetic pulses Venus treatments $1,225 average price 15-40 mins/ session
i-Lipo™. Low level laser (600- 650 nm laser). i-Lipo $3,650 average cost 20-30 mins
Invasix BodyFX™ Vacuum, Radiofrequency Invasix $2,000-2,250 average cost 30 mins-1 hour/ session
Verju™ 532 nm laser diodes. Erchonia $60-280 average cost 20-40 mins
vShape Ultra Ultrasound/Focused Radiofrequency Alma Lasers $600-1,100 per area average cost 30-60 mins/ session
Strawberry Laser Lipo Low Level Laser Laser Lipo Ltd. $1,600 per area average cost 10 mins/ area
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Cryolipolysis
Exploits temperature sensitivity of adipocytes as compared to other
water-rich cells
Between 1940-1970, case reports showed gradual fat reduction in
the lower cheeks of children that sucked on popsicles - “Popsicle
panniculitis”
Cold necrosis
Gradual reduction over 3 months
Erythema, numbness and bruising most common
No change in lipids , LFTs
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Before and After
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Radiofrequency
Electromagnetic wave that can increase deeper
skin temperature and lead to adipocyte damage
Effective in skin tightening and fat reduction in
repetition
Exact protocols unknown and vary with each
device
Smoothing cellulite noted
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Before and After
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Before and After
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Before and After
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Low-Level Laser Therapy
635nm and 532nm
Cold red laser
Reduces size of adipocyte via photoexcitation and
release of FFAs, not cell necrosis
SculpSure* - 1060nm - hyperthermic apoptosis of
fat cells
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Before and After
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Before and After
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Before and After
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Before and After
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High Intensity Focused Ultrasound
Used since the 1940s to treat organ tumors,
uterine fibroids, kindness stones
External transducer
Ultrasonic energy to focal areas making molecular
vibrations that increase temperature causing
coagulative necrosis
No change in LFTs or lipids
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Before and After
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Before and After
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Before and After
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Minimally Invasive
Kybella/deoxycholic acid
FDA approved for the treatment of submental fat
Series of injections done 4-6 weeks apart
MANY off-label applications :
Back fat, bra fat, knee fat, banana rolls, abdomen, jowls, lateral neck
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Before and After
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In Practice
These modalities can operate as stand alone or adjunct therapies for
treating unwanted fat, loose skin, and cellulite of both face and body
Many of the non-invasive modalities discussed do NOT have to be
operated by a physician on PA/NP
Most treatments take at least 30 min of face to face time and this builds
relationships, rapport, and brand loyalty
You can offer the patient something they have already read about or
watched on Dr Oz, The View, The Doctors.
Part of a multi-modality, all encompassing aesthetics practice
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Possible Pitfalls and Perils
Knowing your contraindications
• Hernias, Metal, Old Scars, Pacemakers, Cold-Sensitive Disorders
Be aware of side effects
• Pain, Swelling, Bruising, Numbness
• Nerve damage (Marginal Mandibular etc)
Patient selection must be appropriate
Patient expectations must be reasonable
Remaining fat can ALWAYS hypertrophy
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References
1. Nestor MS, Newburger J, Zarraga MB. Body contouring using 635-nm low level laser therapy. Semin Cutan Med Surg. 2013;32(1):35–40.
2. Adatto MA, Adatto-Neilson RM, Morren G. Reduction in adipose tissue volume using a new high-power radiofrequency technology combined with infrared light and mechanical
manipulation for body contouring. Laser med sci. 2014;29(5):1627–31. doi: 10.1007/s10103-014-1564-x.
3. Afrooz PN, Pozner JN, DiBernardo BE. Noninvasive and Minimally Invasive Techniques in Body Contouring. Clin Plast Surg. 2014;41(4):789–804. doi:
10.1016/j.cps.2014.07.006.
4. Kennedy J, Verne S, Griffith R, Falto-Aizpurua L, Nouri K. Non-invasive subcutaneous fat reduction: a review. J Eur Acad Dermatol Venereol. 2015 Sep;29(9):1679–88. doi:
10.1111/jdv.12994.
5. Avram MM, Harry RS. Cryolipolysis™ for subcutaneous fat layer reduction. Laser surg med. 2009;41(10):703–8. doi: 10.1002/lsm.20864.
6. Cosmetic Surgery National Data Bank Statistics , Cosmetic Surgery National Data Bank Statistics. US: American Society for Aesthetic Plastic Surgery; 2014. [cited 21 July 2014].
Available from:http://www.surgery.org/media/statistics
7. Mulholland RS, Paul MD, Chalfoun C. Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level laser therapy. Clin Plast Surg. 2011;38(3):503–
20. doi: 10.1016/j.cps.2011.05.002. vii-iii.
8. Janda K, Tomikowska A. Cellulite-causes, prevention, treatment. [in Polish] Ann Acad Med Stetin. 2014;60(1):29–38.
9. Soares JL, Miot HA, Sanudo A, Bagatin E. Cellulite: poor correlation between instrumental methods and photograph evaluation for severity classification. Int J Cosmet
Sci. 2015;37(1):134–40. doi: 10.1111/ics.12177.
10. Hamishehkar H, Shokri J, Fallahi S, Jahangiri A, Ghanbarzadeh S, Kouhsoltani M. Histopathological evaluation of caffeine-loaded solid lipid nanoparticles in efficient treatment
of cellulite. Drug Dev Ind Pharm. 2015;41(10):1640–6. doi: 10.3109/03639045.2014.980426.