Body Contouring What is Body Contouring?
There is an almost universal social pressure to lose weight, to reduce fat, and to rejuvenate the skin, which is a result not only of media representations of ideal bodies but also of our growing knowledge of the detrimental effects of obesity. It is becoming increasingly popular to use noninvasive devices to achieve these goals, such as by improving the definition, smoothness, and shape of the human body. It is said that body contouring is the fastest-growing area of dermatology.
Body contouring usually involves an invasive procedure (e.g., liposuction) that has numerous negative effects, financial costs, and a large downtime. Recent demand for more effective and safer procedures for reducing fat and skin tightening has led to the development of several novel noninvasive modalities for body contouring. Although results from using noninvasive body contouring techniques may be less dramatic and may not be achieved immediately, they do not carry the risks and adverse effects that are associated with surgical procedures and are therefore increasingly requested by patients who want to improve their appearance. New noninvasive techniques target the physical properties of fat to cause a diffusion of triglycerides from the cells of the body and to lead to reduced size, necrosis, or apoptosis of adipocytes. Among the modalities, cold-induced adipocyte apoptosis has been available for the longest time and has been the most extensively researched.
There are 4 main techniques that are commonly used for achieving noninvasive body contouring: cryolipolysis, radiofrequency, high-intensity focused ultrasound (HIFU), and laser therapy. Although no single procedure has been established as being the gold standard, investigators are constantly trying to determine which noninvasive procedures are most effective. We review each of these modalities to help dermatologists choose the most effective treatment for their patients.
Cryolipolysis
Cryolipolysis works by freezing adipocytes that have lipid content that are more susceptible to freezing than surrounding water-rich cells, allowing them to undergo selective apoptosis and the surrounding tissues to be preserved. If adipocytes are frozen and killed, the macrophages that are able to digest the apoptotic cells produce a decrease in the amount of fat in the subcutaneous layer of the skin over the next 2 to 3 months. Cryolipolysis is an FDA-approved treatment for reducing fat in the abdomen and thighs in 2010 and again in 2015 and 2016.
People apply a small, flexible suction tube to the area they are treating and then vacuum the treated area between 2 cooling panels for 30 to 60 minutes. Patients who have undergone cryolipolysis are very satisfied with the results of the procedure, and there have been no reported adverse effects. Common complications of cryolipolysis include redness, swelling, and a feeling that someone is touching the treatment site; less frequent complications include pain, tingling, and bruising; however, these conditions generally resolve within a few weeks of treatment. There are some concerns about lipid levels and liver enzymes increasing after adipose tissue is removed. These values have been reported to be within normal limits during and after cryolipolysis. Patients should be warned about the risks of paradoxical adipose hyperplasia, a rare side effect of cryolipolysis in which a large, hard, tender mass of fat is observed at the treatment site 2 to 3 months after treatment. This condition is estimated to occur in 1 in 20,000 patients. The incidence of paradoxical adipose hyperplasia, a rare side effect of cryolipolysis, may be underestimated, because one practice reported a risk of 0.47% in 422 treatments. This has not been reported in patients who have undergone other fat reduction modalities such as fatty liver transplantation or liver transplantation. It is safe for patients of all skin types to undergo cryolipolysis; there have been no reports of skin pigmentation changes following treatment. It should not be performed in patients who are suffering from severe cold-induced conditions (eg, cryoglobulinemia, cold urticaria), or in patients who have severely varicose veins or atopic dermatitis. Patients who undergo this procedure benefit most from removing small or moderate amounts of adipose tissue and removing fat cells (Figure 2).12,17 Cryolipolysis can be used to treat menopausal symptoms.