Non-surgical liposuction

Non-surgical liposuction techniques use laser energy, radiofrequency, ultrasound or cold (cryolipolysis) to reduce fat.[1] Devices are applied directly to the skin of the treatment area and do not employ injections (as in injection lipolysis) or incisions (as in laser assisted liposuction). Although fat loss is more subtle with non-surgical lipolysis techniques compared to surgical liposuction, non-surgical lipolysis techniques have several advantages including reduced risk, reduced cost, and reduced healing time.[2] Laser,[3] radiofrequency,[4] and ultrasound[5] techniques provide additional advantages of tissue tightening.[6] Because there is no suction involved, terms such as laser lipolysis, cryolipolysis or body contouring are preferred to non-surgical liposuction.

History and Development

In 2010, Zerona became the first non-invasive lipolysis device approved by the FDA following a randomized controlled trial demonstrating circumference reduction of the waist, hip, and thighs.[7] Zeltiq obtained FDA approval in 2010 for cryolipolysis of the flanks and additional approval in 2012 for cryolipolysis of the abdomen.[8] Strawberry was approved by the FDA in 2013.[9]

Techniques

Low level laser light

Low level laser light reduces the stability of adipocyte cell membranes, allowing cells to release their stores of fat without damaging the cell.[10][11] Because the fat is released into the extracellular space, cardio based exercise is usually promoted after the procedure. Exercise increases lymph flow and is thought to also promote the use of the lipids as an energy source. This is also why adequate hydration is encouraged. The laser technologies are differentiated mainly by the wavelength of light used.

Ultrasound

Focused thermal ultrasound techniques work by raising the tissue temperature above 56° C, resulting in coagulative necrosis of adipocytes, with sparing of vessels and nerves. Passive heating of the skin may also induce collagen remodeling.[12][13][14][15]

Cryolipolysis

Cryolipolysis is the term for using cryogenics to induce lipolysis. Adipose tissue is cooled above freezing causing localized cell death and inflammation.[16]

Devices

There are several devices on the market.

Device Manufacturer Mechanism Wavelength
Zerona Erchonia Corp Low level laser 635 nm divergent beams
Strawberry Laser Lipo Ltd Low level laser 660 nm
I-Lipo Chromogenex Low level laser 650-660 nm
Smoothshapes Cynosure Low level laser 650 nm and 915 nm
Lumislim Titan Medisico Plc Low level laser 650 nm and 940 nm
Exilis BTL Radiofrequency
Thermage Solta Medical Radiofrequency
Endymed Caesarea Radiofrequency
Liposonix Solta Medical Thermal Focused Ultrasound
UltraShape Syneron/Candela Inc Nonthermal Focused Ultrasound
CoolSculpting Zeltiq Aesthetics Cryolipolysis

Comparison to surgery

Costs may vary depending on treatment area and clinic prices. While it may cost less than invasive liposuction, the cost of multiple treatments do add up. Since it is non-invasive and non-surgical, there is no recovery time. Patients can immediately resume their daily activities. One to two days of discomfort is possible.

Risks

Numerous risks have been noted with this procedure.[17] The cited study notes 'Safety of Ultrasound Assisted Lipoplasty (UAL) is controversial. One study of 250 consecutive UAL patients concluded that internal UAL is "both safe and effective" despite three cases of dermal necrosis (1.2 percent), 28 postoperative seromas (11.2 percent), and 35 patients with Reston foam blisters.[18] Based on this report, most experienced liposuction surgeons have concluded that UAL is less safe than Tumescent Liposuction with microcannulas.'

Legal Status

Various lipolysis techniques ("actes de lyse adipocytaire à visée esthétique") including injection lipolysis, RF, laser, ultrasound, and cryolipolysis were forbidden briefly in France by a decree made by the French Public Health Authority on 11 April 2011. This decision was later revised on 17 February 2012, in which the law distinguished invasive techniques from non invasive techniques, and only the invasive techniques remained illegal. As a result, laser, RF, ultrasound and cryolipolysis that did not penetrate the skin became legal, and injection lipolysis or mesotherapy remained illegal. Additionally, any laser devices that involve inserting the probe through the skin transcutaneously but do not suction out the liquefied material are also prohibited. Surgeons are permitted to perform surgical liposuction techniques using laser assisted lipolysis as long as suction is performed.[19] [20]

References

  1. Mulholland, R. Stephen; Malcolm D. Paul; Charbel Chalfoun (2011). "Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level laser therapy". Clinics in Plastic Surgery 38 (3): 503–520, vii–iii. doi:10.1016/j.cps.2011.05.002. ISSN 1558-0504. PMID 21824546.
  2. Fischer, John P.; Ari M. Wes; Joseph M. Serletti; Stephen J. Kovach (2013). "Complications in body contouring procedures: an analysis of 1797 patients from the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program databases". Plastic and Reconstructive Surgery 132 (6): 1411–1420. doi:10.1097/PRS.0b013e3182a806b3. ISSN 1529-4242. PMID 24005367.
  3. Jackson, Robert F.; Gregory C. Roche; Steven C. Shanks (2013). "A double-blind, placebo-controlled randomized trial evaluating the ability of low-level laser therapy to improve the appearance of cellulite". Lasers in Surgery and Medicine 45 (3): 141–147. doi:10.1002/lsm.22119. ISSN 1096-9101. PMID 23508376.
  4. Alster, Tina S.; Jason R. Lupton (2007). "Nonablative cutaneous remodeling using radiofrequency devices". Clinics in Dermatology 25 (5): 487–491. doi:10.1016/j.clindermatol.2007.05.005. ISSN 0738-081X. Retrieved 2014-06-16.
  5. Minkis, Kira; Murad Alam (2014). "Ultrasound skin tightening". Dermatologic Clinics 32 (1): 71–77. doi:10.1016/j.det.2013.09.001. ISSN 1558-0520. PMID 24267423.
  6. Goldman, Mitchel P.; Richard E. Fitzpatrick; E. Victor Ross; Suzanne L. Kilmer; Robert A. Weiss (2013). Lasers and Energy Devices for the Skin. CRC Press. ISBN 9781841849331.
  7. Jackson, Robert F.; Doug D. Dedo; Greg C. Roche; David I. Turok; Ryan J. Maloney (Dec 2009). "Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study". Lasers in Surgery and Medicine 41 (10): 799–809. doi:10.1002/lsm.20855. ISSN 1096-9101. PMID 20014253.
  8. "510(k) filing for Zelitq CoolSculpting". FDA.gov. 2012.
  9. "510(k) filing for Laser Lipo Ltd Strawberry". FDA.gov. 2013.
  10. Nestor, Mark S.; Newburger, Jessica; Zarraga, Matthew B. (2013-03). "Body contouring using 635-nm low level laser therapy". Seminars in Cutaneous Medicine and Surgery 32 (1): 35–40. ISSN 1085-5629. PMID 24049928. Check date values in: |date= (help)
  11. Neira, Rodrigo; Arroyave, José; Ramirez, Hugo; Ortiz, Clara Lucía; Solarte, Efrain; Sequeda, Federico; Gutierrez, Maria Isabel (2002-09-01). "Fat liquefaction: effect of low-level laser energy on adipose tissue". Plastic and Reconstructive Surgery 110 (3): 912–922; discussion 923–925. doi:10.1097/00006534-200209010-00030. ISSN 0032-1052. PMID 12172159.
  12. Fabi, Sabrina Guillen (2015). "Noninvasive skin tightening: focus on new ultrasound techniques". Clinical, Cosmetic and Investigational Dermatology 8: 47–52. doi:10.2147/CCID.S69118. ISSN 1178-7015. PMC 4327394. PMID 25709486.
  13. Jewell, Mark L.; Solish, Nowell J.; Desilets, Charles S. (2011-10). "Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound". Aesthetic Plastic Surgery 35 (5): 901–912. doi:10.1007/s00266-011-9700-5. ISSN 1432-5241. PMID 21461627. Check date values in: |date= (help)
  14. "Effect of low-intensity, low-frequency ultrasound treatment on anthropometry, subcutaneous adipose tissue, and body composition of young normal weight females.". J Cosmet Dermatol. 13: 202–7. Sep 2014. doi:10.1111/jocd.12101. PMID 25196687.
  15. "Use of transcutaneous ultrasound for lipolysis and skin tightening: a review.". Aesthetic Plast Surg. 38: 429–41. Apr 2014. doi:10.1007/s00266-014-0286-6. PMID 24567045.
  16. Zelickson, Brian; Egbert, Barbara M.; Preciado, Jessica; Allison, John; Springer, Kevin; Rhoades, Robert W.; Manstein, Dieter (2009-10). "Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model". Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.] 35 (10): 1462–1470. doi:10.1111/j.1524-4725.2009.01259.x. ISSN 1524-4725. PMID 19614940. Check date values in: |date= (help)
  17. http://www.liposuction.com/ultrasonic-risks.html
  18. Maxwell GP. Ultrasound-assisted lipoplasty: a clinical study of 250 consecutive patients. Plast Reconstr Surg 101:189-202,1998.
  19. "Décret n° 2011-382 du 11 avril 2011 relatif à l'interdiction de la pratique d'actes de lyse adipocytaire à visée esthétique", http://legifrance.gouv.fr'', 2011, retrieved 2015-01-08
  20. Touraine, Marisol (2012), "Questions / answers on the prohibition order of lipolyses", www.sante.gouv.fr