In Demand: Non-invasive Body Contouring

A look at what’s driving growth and important factors in managing patient expectations for non-invasive fat reduction treatments.

By Jeanine Downie, MD

Non-invasive body contouring is growing rapidly—both in terms of new and improved devices continuing to come to market and in the number of patients seeking treatment. According to the American Society for Plastic Surgery, there was an 18.7 percent increase in the number of these procedures performed from 2014 to 2015, and a 58 percent increase in the number of non-surgical skin tightening procedures. Jeanine Downie, MD recently spoke to Practical Dermatology® magazine about the growing market, the improving technology, and what patients can expect from treatment.

What do you think is driving the growth in the non-invasive body contouring market?

Dr. Downie says that companies certainly see this as a growing market that they want to be part of and profit from. And, for patients, it’s appealing because there little to no downtime or side effects with good results.

“I think that the technology has improved in recent years significantly, and I think that that’s one of the reasons that’s moving it forward. Beyond that, people are not happy with their weight—they are exercising more, they are dieting more, but it’s hard. We have a lot of preservatives in our food that they don’t have in Europe. From what they say the preservatives alone can really influence weight gain, especially in people over the age of 40 in both men and women. It’s just more and more and more difficult to try to keep the weight off,” Dr. Downie says. “If you look at the average American in 1970 versus the average American in 1990 versus the average American today in 2017, our weight, unfortunately, just keeps trending up. That’s not a good thing because so does diabetes and heart disease and all the other things that come with it. People are aware of the health benefits to try to get some of the weight off. Psychologically, I believe non-invasive fat melting boosts people’s metabolism. It jogs them into, “Oh, well I can do this.” They start to get a can-do attitude rather than an, ‘Oh, this is impossible for me’ attitude.”

In addition to new devices, new applicators have been introduced to target smaller areas, such as the thighs, neck, and arms. For example, Vanquish (BTL Aesthetics) now has a Flex applicator, CoolSculpting (Zeltiq) has a CoolAdvantage Petite applicator to treat the arms and the the CoolSculpting Mini to treat the chin, and Kybella (Allergan) is also FDA-approved to for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat in adults. Dr. Downie says she anticipates the technology will continue to improve as these areas are frustrating for patients and difficult to improve with exercise and diet.

Kybella Beyond the Chin

FDA cleared for the treatment of submental fat, Kybella (Allergan) has become a popular treatment among patients and physicians. And physicians have begun to treat patients off-label in areas beyond the chin, Dr. Downie says. Dr. Downie who was one of the investigators for the clinical trials, says she’s been a fan for its indicated use under the chin as well as for off-label uses.

“At this point, as a physician, I’m also using it off-label to treat between the thighs. I’m using it for the pre-axillary fat pad by the bra. Some of my patients are requesting that we do little tiny dollops of stomach fat they have, and yet others are requesting that we do back fat around their bras.”

She says patients should be warned about bruising that may last three to four days post treatment, but adds that the first treatment is always the worst. “After that it gets better, in terms of bruising and in terms of swelling. Every time it gets better after the first time,” Dr. Downie says.

Are these treatments bringing men into the office?

“Yes, I do think that these treatments are bringing more men into the offices, and that’s only a good thing,” Dr. Downie says, explaining that many men are also bothered by expanding waistlines and need the help as well.

Has the ideal patient for treatment changed at all as technology has improved?

While it would be ideal for patients for patients to be around their ideal weight, there are options for patients who need to lose weight. For example, devices with large spot sizes can be used to treat heavier patients. Dr. Downie says she uses the Vanquish device for these patients. “Women over 200 or 250 pounds or men over 300 pounds can still be treated and it will still de-bulk their fat,” Dr. Downie adds.

In terms of the patient experience, what do you tell patients to expect?

The comfort level depends on the treatment the patient is receiving. Some are more uncomfortable than others. It’s important to tell patients what to expect post-treatment, if they’ll be slightly sore or should expect to have to urinate frequently.

“With the Vanquish, it’s just heat so I make them drink a ton of water,” Dr. Downie says, explaining that she tells her patients to drink a significant amount of water, which will help the patients have to urinate frequently to get rid of their fat cells faster. “With the Exilis and with the Vanquish Flex for the thighs, it’s the same thing. If a patient weighs 140 pounds, they should be drinking roughly about nine and a half glasses of water to 10 glasses of water a day. If they are 151 pounds, they need 11 glasses of water a day. If a patient is 151 pounds and should be drinking 11 glasses of water a day, then I’d like them to up it one so they’re drinking at least 12. They’re drinking a little bit more water than their body volume requires.”

When treating patients with her Futura Pro device (Perigee Medical), Dr. Downie tells patients they’ll be sore because after ultrasound treatment, patients are treated with muscle stimulation pads. “We put them on and crank that machine up. We try to put it up as high as possible. If you’re doing your abdomen, for example, it feels like you’ve done 1,500 sit ups,” Dr. Downie explains.

Not all patients experience the same result. How do you measure success and manage expectations?

Dr. Downie says she takes photographs to track results and makes sure that patients are weighed and measured at every appointment and recommends that all physicians offering non-invasive body contouring do the same.

“A lot of patients come every two weeks for appointments. Some patients who are in more of a rush come every week for appointments. The women tell us, ‘Oh, I have my period.’, ‘Oh, I was cheating a little bit.”, or something,” Dr. Downie says. “Sometimes their weight can fluctuate, but if there’s a steady decrease in inches and a steady gain of pounds, I let them know they’re eating too much and this is not a get out of free from jail card that allows them to eat whatever they want. Some patients make that mistake, too, and that’s very frustrating.”

How do results compare to surgery?

“It’s not liposuction, but you can get significant results and people are happy with that,” Dr. Downie says. “They don’t want the downtime of liposuction. They don’t want the anesthesia of liposuction. They don’t want a lot of the risks.” Dr. Downie says it’s exciting to be able to offer patients a non-invasive alternative for fat reduction.

Dr. Downie is founder and director of image Dermatology in Montclair, NJ. She is on staff at Mountainside and Overlook Hospitals.





Interest in tattoo removal is increasing as the public learns more about advancements in terms of what laser surgeons can do. It is easier now to treat different colors and sizes of tattoos. Additionally, the PFD patch is an innovative addition to tattoo removal that speeds treatment.

Manjula Jegasothy, MD has been able to to improve efficacy of tattoo removal and decrease the number of treatments by up to 50 percent. She discusses her technique for expediting tattoo removal by varying spot size, wavelength, and joules with each pass to make sure she’s hitting the tattoo at several different depths and getting different gradients of color.




Contact Info

For advertising rates and opportunities:
Ali Kinnie
(917) 589-4160

Rick Ehrlich
Associate Publisher
(609) 922-0337

About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.