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] SculpSure, the world's first hyperthermic laser for non-invasive fat destruction, obtained FDA approval in 2015^[10]

On January 21, 2005, Meridian Medical received FDA approval for the Lapex 2000.^[11] On December 29, 2008, Meridian received FDA approval for the Lapex BCS.^[12] In 2013, the lipo laser division of Meridian Co. Ltd. separated from the parent company to become YOLO Medical Inc., retaining the patents. During this transition, the Lapex line was rebranded as the YOLO Curve.^[13] On April 24, 2015, YOLO Medical received FDA approval for the successor to the Curve, known as the Lipofina Laser System.^[14]

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.^[15][16] 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.^{[17][18][19][20]}

Radiofrequency

Radiofrequency devices work by producing an alternating flow, which creates an electric field over the skin. The electric field shifts polarity millions of times per second, that causes a change in orientation of charged particles.^[21]

Cryolipolysis

Cryolipolysis is the term for using cryogenics to induce lipolysis. Adipose tissue is cooled above freezing causing localized cell death and inflammation.^[22]

Devices

There are several devices on the market.

Comparison to surgery

Costs vary, depending on treatment area and clinic prices. Total cost, rather than cost per treatment, is the relevant indicator. There may be one or two days of discomfort after each treatment, but no prolonged recovery time and no discontinuation of daily activities.

Legal status

On August 19, 2014, YOLO Medical filed a lawsuit alleging patent infringement against the following: Chromogenex Technologies Ltd., Chromogenex US, Inc., Strawberry – Laser Lipo Ltd., Lilia Enterprises, LLC., Lipolaser Centers of America, One Source Media, Brandon Robinson, Jon Perlman, M.D., David Halpern, M.D., Leonard Grossman, M.D., Stephen Ronan, M.D., F.A.C.S. and VB Laser Trim Clinic.^[23]

Various lipolysis techniques ("actes de lyse adipocytaire à visée esthétique") including injection lipolysis, RF, laser, ultrasound, and cryolipolysis were forbidden in France by a decree of the French Public Health Authority on 11 April 2011. The decree was revised on 17 February 2012, distinguishing invasive techniques, which remain forbidden, from permitted non-invasive techniques; laser, RF, ultrasound and cryolipolysis that did not penetrate the skin became legal, and injection lipolysis and mesotherapy remained illegal. Laser devices that involve inserting the probe through the skin transcutaneously but do not suck out the liquefied material are also prohibited. Surgeons are permitted to perform surgical liposuction techniques using laser-assisted lipolysis so long as suction is performed.^{[24] [25]}

References