Physician Spotlight

What options did patients have before the recent influx of non-invasive body slimming devices?

Up until recently, the only effective treatments for fat reduction were surgical. Liposuction is still highly effective and the results are reproducible in expert hands, but it is a surgical procedure with all of the limits of surgery including risks and side effects. Some surgeons perform liposuction while the patient is under general anesthesia which has its own risks associated with it. Liposuction is a big surgery. It’s expensive and it takes a certain amount of skill to achieve artistic results. Abdominoplasty is another big surgery with a big scar, and it only treats redundant skin. It is not a fat-reduction procedure. All day long, my patients say “I am not having surgery” or “anything but surgery.”

So what changed?

Things have come and gone over the years, but they either didn’t work well or the results weren’t reproducible. The development of Zeltiq® Coolsculpting changed all of that. It gave us a safe, effective and reproducible non-surgical body contouring procedure to offer our patients. It is not a weight loss technique, it’s for localized fat reduction. CoolSculpting is very well tolerated. There is some post-treatment bruising and some numbness. You can watch TV while being treated. The results appear gradually over time through apoptosis. Patients will see a fat removal of about 22 percent in the treated area with each visit. It works in 80 percent to 90 percent of our patients and is best suited for ‘pinchable’ fat. In my practice, patients are ecstatic with the results. If you lose weight and fat, you will have some sagging, and we need to improve on the technologies that address sagging and laxity. That said, my Coolsculpting patients don’t typically complain of skin laxity after treatment, which suggests there may be some residual tightening following cryolipolysis.

There will be other ways to skin the cat of localized fat reduction in the future including the most recent addition to this category, Cynosure’s Sculpsure®. Yes, we know heat works, but will it be tolerable and reproducible? Time and evidence-based studies will answer these questions.

So that leaves cellulite reduction, right?

Cellulite is incredibly common. About 90 percent of women older than 18 have some cellulite. The treatments for body contouring don’t work for cellulite and vice versa. Some patients just have fat, others just have cellulite, and others have both. Cellfina™ produces reliable and durable results. Two years out, our patients still look good. Dimples and divots go away and stay away. It’s really simple, straightforward and relatively easy to teach. For dimpling cellulite, we have an answer. Unfortunately, this still leaves the more common type of cellulite—the fine, rippling type.

What does the future of non-invasive body contouring portend?

The future looks even brighter. New CoolSculpting protocols cut the treatment time in half. There are different applicators for different body parts. We will soon be able to fit any area of the body and perform dual-sculpting on both sides of the body at the same time. CoolSculpting patients will spend just a couple of hours in the office instead of half the day. There is room for improvement in other realms. We really need skin-tightening devices that work off the face and a treatment for garden-variety fine-rippling cellulite. n

Jeffrey S. Dover, MD, FRCPC is co-director of SkinCare Physicians in Chestnut Hill, MA. He has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Cutera, Inc.; Cynosure, Inc.; Allergan, Lumenis; ZELTIQ;, Revance, Shaser, SkyBiodevices, Syneron Candela, Topokine, Valeant. His practice received grants for clinical research from: Allergan, Inc.;; AOBiome, Kythera Biopharmaceuticals, Inc.; Lumenis; Valeant, Cynosure, Cutera, ,Cabochon, Galderma; Merz Pharmaceuticals;; Revance , Shaser; Syneron Candela; Strathspey Crown ,Topokine, Valeant, ; and ZELTIQ.