Non-invasive liposuction alternatives (part 2 of 2)

The holy grail in liposuction and fat removal is a non-operative procedure that safely, effectively and permanently removes only the undesired fat cells.  Without pain,  side effects, down-time, or risks.  This would result in an ideally “sculpted” 3 dimensional contour.

We are not there yet but there are a couple of exciting, new, non-invasive techniques that are currently being utilized to remove fat.  There are certainly many more on the horizon.

CoolSculpting™ by Zeltiq™ – The idea is that fat cells are more sensitive to freezing than the skin.  Very cold panels are placed on the treatment area for 1-3 hours.  This is uncomfortably cold but not unbearable.  The treatment area is limited by the size of the panel and only one anatomic area can be treated at a time.  The body reabsorbs the injured fat over the next 3 weeks to 3 months.

According to the company’s website, there is about a 20% reduction in fat in the treatment area although the results are quite variable.   CoolSculpting recently got FDA approval.

This is an exciting new procedure, especially for the patient with a single, small, perfectly smooth treatment area.

The biggest problem I can see with the procedure is the inability to “sculpt” the area (despite the name CoolSculpting™) and the inconsistent amount of fat reduction.  With current liposuction techniques, the surgeon has the ability to measure the fat that has been removed, there is no guessing.  The fat can be removed by sculpting to achieve the desired contour.   Liposuction done properly is a very artistic procedure.

I am just not sure a cold rectangular treatment area is sophisticated enough to achieve individualized results.  I can see CoolSculpting and other fat freezing modalities becoming more sophisticated as they become better understood.  Custom cooling pads designed by the surgeon with deeper treatment in the areas requiring more fat removal would be quite interesting.

Zerona™ – FDA approved external low level laser device penetrates the skin and targets fat cells.  The procedure is painless, there are no needles or injections.  A single Zerona treatment session is 4o minutes long (20 minutes per side) this is repeated every other day for 2 weeks (6 sessions).

The mechanism of action of Zerona laser is a cellular activation of the fat cells from low level laser.  These cells communicate with surrounding fat cells telling them to dump their fat stores.   After Zerona, the body reportedly excretes the contents of the injured fat cells, literally in the “poop”.

The results published demonstrate a definite reduction in circumference in the  areas treated with Zerona.  The results achieved are usually reported in the number of inches lost.  This is misleading.  A 4 inch reduction means that in the areas treated (waist + hip + right thigh +left thigh), there was a total of 4 inches.  The average result was actually a bit little less than that.   The average waist size lost was a little over 1?.

Regarding the safety of Zerona, these lipids are reportedly excreted from the body.   According to their website, bad cholesterol and total cholesterol in the blood did not increase after treatment, and may have actually decreased.  That doesn’t necessarily mean that they did not deposit in the coronary arteries but it is at least calming.   Further research is underway.

The reviews of Zerona are not overwhelmingly positive.  In fact the Realself “worth it” index is a pitiful 31%.   Likely this has to do with the fact that most of these procedures are being done in medical spas, focused on money more than results.  The overweight patient that would really require a more significant procedure such as liposuction is unlikely being turned away.

A good friend of mine is a plastic surgeon (not in Utah) who using Zerona.  He expressed that he has been satisfied with the outcomes of the procedure.   He cannot get close to the same outcomes he can achieve with liposuction; but for a noninvasive procedure, it actually does something.

My biggest concern with Zerona is that, like CoolSculpting, it cannot be sculpted or measured.

I guess I am a control freak but I want to see what is being removed, how much, and from where.  Accuracy matters!

This doesn’t mean that I will never do these procedures.  I just need more data and more Guinea Pigs (other surgeons patients) demonstrating safety and effectiveness before I hop on board…

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Dr. York Yates
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