Fat Reduction and Tissue Tightening: Front-Line Accounts

In the world of non-invasive procedures, fat reduction and tightening devices have sparked much interest in recent years and have also soared in popularity. Fortunately, technology is keeping up with demand. A wide variety of procedures is available for the choosing, all depending on each patient’s profile of demands. With several technologies now on the market, from cooling devices to lasers, clinicians now have multiple choices in terms of what procedures to offer patients. Ahead, Marguerite German, MD and Michael Gold, MD share insights on devices that they integrated into their respective practices.

Cryolipolysis with CoolSculpting: A Novel Approach to Treating Fat

A Q&A With Marguerite Germain, MD

How does cryolipolysis fit into the current profile of fat reduction technologies?

The CoolSculpting procedure using Cryolipolysis is fundamentally different from other non- or minimally-invasive modalities. Other methods of fat removal primarily involve necrotic cell death by damaging fat with heat, high-intensity focused ultrasound, or chemical injections. Each approach poses potential technical challenges, particularly with respect to targeting the right tissue depth and unintended damage to other structures close to or within the fat layer. Predictability of efficacy using these other techniques is also uncertain. In contrast, the CoolSculpting (Zeltiq) procedure using Cryolipolysis induces apoptosis only in fat cells to gently and gradually reduce the fat layer while preserving all other tissue. This reduction of fat is permanent.

Who is the ideal CoolSculpting patient and how do you set appropriate expectations?

CoolSculpting is ideal for patients that have already gone through extensive weight loss but want assistance with small, persistent bulges. Expectations are extremely important with anything in cosmetic dermatology, and this is no exception. CoolSculpting is indicated for people who are relatively fit but want to reduce distinct fat bulges by about 25 percent, and that’s really the maximum. I have successfully used it on the abdomen, love handles, upper arms, inner thighs, outer thighs, and right under the buttocks on the posterior thighs. Women are particularly interested in losing their “muffin top,” post-pregnancy pouch, or back fat bulges at the bra line.

Can you describe the patient experience with CoolSculpting, both during and after the procedure?

Some patients experience mild discomfort during the procedure. In addition, there is a “pins and needles” feeling and a dullness of sensation that can last for up to two months following the procedure. It is important to adequately inform your patients so they are prepared for these possibilities. Despite any discomfort, they can resume normal activity immediately.

When it comes to results, weighing and measuring the patients is important but imprecise, as it is difficult to get the tape measure in the exact same place to produce a true comparison. That is why I rely mainly on photos. Interestingly, I have found that many patients lose weight, not solely because of the physical effects of the procedure but more of a psychological effect. When a patient is trying hard to lose a bulge and can’t, they get very discouraged. Although the results aren’t immediate, the improvement from therapy is encouraging, which motivates them to work harder at their fitness plan. Patients are often excited to have the procedure performed, and are happy afterwards that there is no recovery time, as well as being pleased with the results.

How has Coolsculpting impacted your practice?

CoolSculpting has been beneficial for my practices in a number of ways. First, there are minimal risks and complications. In addition, CoolSculpting doesn’t result in an increase in malpractice rates, as any type of invasive liposuction does. Furthermore, there is little demand on the physician’s time. After the patient consultation, the actual procedure may be delegated to a trained assistant. Although I have dedicated exam rooms for the CoolSculpting machine, it is portable and physicians can move it between exam rooms as needed.

How has your overall experience been with using CoolSculpting?

When I began to offer CoolSculpting, it was newly approved by the FDA and Cryolipolysis was relatively unknown. Now the national media has increased public awareness and patients are always intrigued by new and innovative procedures. Once they come in, they usually have a variety of procedures performed. Therefore, acquiring this cutting-edge technology has been a practice builder for us and has resulted in a good return on our investment.

Dr. Germain wrote about CoolScuplting with Linda Cooke, MD in the April 2011 edition.

Marguerite Germain, MD, FAAD provides medical, surgical, and cosmetic dermatology services at Germain Dermatology in Mt. Pleasant, SC.

vShape: A Next Generation Uniform Bipolar RF System

A Q&A with Michael H. Gold, MD, FAAD

Can you discuss how vShape fits into your practice?

We have been using the vShape™ (Alma) focused radiofrequency workstation for about six months now. It is a next generation of the Accent system that I’ve had in my practice for several years. vShape delivers uniform bipolar radiofrequency energy for skin tightening and body contouring procedures.

What has been your experience thus far?

I have a lot of different devices, including several radiofrequency systems, and each has its benefits. However, I have been extremely pleased with the ease of use and versatility of the vShape. One of the most go-to devices that I’ve had in a long time was the Accent—and now I’m finding the same for the vShape.

What differentiates the device from other RF technologies?

vShape delivers uniform bipolar radiofrequency. One drawback with this technology is that other systems have had to rely on external heat monitoring. vShape has heat sensors integrated into the handpiece, making it a lot more user-friendly.

The vShape is attractive because it combines multiple technologies into one, like the roller and massage handpieces, which assist with contouring and cellulite treatments. Plus, there are no disposables, and that’s an important consideration for me.

How are you using vShape in your practice?

We use vShape for any kind of body contouring or skin tightening procedures, as well as for cellulite control. A lot of other devices do very well, but day in and day out, I turn to the vShape as a reliable, well-built device. I have also found that the system integrated seamlessly into my practice. It is easy to use and program and allows me to delegate the administration of treatment.

Lots of people offer RF. They all have to compete with what I know I can get with the vShape.

Michael H. Gold, MD, FAAD is Founder and Medical Director of Gold Skin Care Center in Nashville, TN. He is President of DASIL: www.thedasil. org.