Lasers in Practice: Devices for Non-Invasive Fat Reduction
Traditional liposuction remains the gold standard for fat removal. Laser liposuction has recently been developed but still remains an invasive procedure, and it is unclear if laser lipolysis offers any significant advantage over traditional liposuction. The demand for alternatives to invasive lipolysis is great, and a variety of approaches have been developed for non-invasive lipolysis (Table I). In the United States, the majority of these devices are investigational or being used off-label for non-invasive fat reduction.
Radiofrequency
Radiofrequency devices are primarily used for noninvasive
skin tightening. Early observations of subcutaneous
atrophy have led the development of these
devices for body contouring with the potential of subtle
changes in the subcutaneous tissue.
Radiofrequency produces a thermal effect in the tissue
by creating volumetric heating. Coincidental improvement
in cellulite may be noticed due to the lipolysis in
the superficial subcutaneous fat. The gold standard of
radiofrequency devices is unipolar radiofrequency
(Thermage) with the longest clinical experience and
largest peer reviewed studies. The introduction of a
large body tip with Thermage has allowed for the
more efficient treatment of large body areas, such as
the abdomen. Other approaches use unipolar and
bipolar radiofrequency (Alma), bipolar radiofrequency
(Velasmooth), and bipolar radiofrequency with vacuum
(Aluma)
Non-Invasive Lasers
Selective photothermal excitation of fat has been noted
at 1210nm and 1720nm. Low level energy at 635nm
has been reported to cause radiolysis. Commercial
examples of lasers include the 650 and 915nm laser
(Smooth Shapes) in combination with massage, 635nm
diode laser (Echoing Medical) and a 630-680nm laser (Lipolaser). The true clinical effects of some of these
low energy lasers for fat reduction as a standalone
device are unclear, as some require diet and exercise
along with low level laser therapy.
Cryolipolysis
Non-invasive controlled cooling of fat cells can produce
lipolysis. The proposed mechanism is the creation
of fat cell apoptosis by exposure to precise controlled
cooling. Inflammatory cells gradually eliminate
the affected fat cells, producing a reduction in the
thickness of the fat layer. Selective cryoliploysis is the
first commercial device (Zeltiq) with clinical trials
showing fat layer reduction up to 1cm after a single
treatment. The device is being used off-label in the US
and is approved in Europe, Canada and several Asian
countries for non-invasive lipolysis. We have used the
device for approximately four months. Patient selection
is key, and the device is best suited for those who
have isolated areas of fat but are generally in good
shape. Results are most evident following two months
after the initial treatment. The role of multiple treatments
is currently being evaluated. The main advantage
of this treatment is the lack of discomfort and
return to normal activity after treatment with no
downtime. Patients have reported numbness in the
area treated up to one month and areas of ecchymoses
which resolve within a few days.
Ultrasound
Thermal coagulation producing adipocyte apoptosis is
the mechanism by which ultrasound creates lipolysis.
Commercial devices include Ultrashape and
Liposonix. The Ultrashape device requires multiple
treatments and can show reduction of 2 to 6cm after a
series of treatments without reported discomfort. The
Liposonix device utilizes high intensity focused ultrasound
and after a single treatment may show up to a
2.8cm reduction in circumference. Pain control is an
issue with this device. Both devices are investigational
in the US but approved in Canada, Europe and certain
Asian countries for lipolysis.
Conclusions
A variety of devices are being evaluated for non-invasive fat reduction. The majority of these devices are
being used off label in the US for non-invasive fat
reduction. Large and long-term clinical studies are still
in their infancy. Our experience has been limited with
the use of a device that employs cryolipolysis but
early results are quite promising. Over the next few
years, as these devices become utilized more widely,
we will truly understand their role in lipolysis. Until
then, traditional liposuction still remains the gold standard
for fat reduction.
Dr. Narurkar has no relevant disclosures.
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!
Recommended
- General Topics
More than Skin Deep: Sharing Stories for Mental Health
Emily Woolhiser
Alexandra Lawlor