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Surgical and Non-Invasive Treatments for Body Contouring Surgical and Non-invasive Treatments for Body Contouring Jayne Joo, MD Director of Cosmetic Dermatology, Department of Dermatology, University of California, Davis Director of Mohs micrographic surgery, Sacramento VA Medical Center Disclosure I have no relevant relationship with industry. Fat is big business § United states is the most obese country in the world (35.3% of the population age 15+) ú Source: OECD Health Statistics 2015, http://dx.doi.org/10.1787/health-data-en. § According to the American Society of Dermatologic Surgery 88% of Americans report feeling bothered by excess weight on their bodies § Improvement in psychosocial function, self-esteem, body image and quality of life after aesthetic surgery § Demand for noninvasive forms of body contouring is increasing ú Minimally invasive procedures increased by 137% from 2000 to 2012 in US ú Liposuction has declined from 350,000 (2000) to 198,000 (2009) § In 2015, the global market for body shaping platforms and disposables reached over $1 billion (Medical Insight Inc. “Energy Based Body Shaping/Skin Tightening.” Medical Insight, Inc. 2016.) Body contouring after massive weight loss Maia M, Costa Santos D. Body Contouring After Massive Weight Loss: A Personal Integrated Approach. Aesthetic Plast Surg. 2017 May 31. Non-invasive: the future of fat removal? § Surgical body-shaping procedures down by 14% in 2012 § Advantages: ú Lower risk ú Fewer complications ú Less aftercare ú Faster treatment/healing time ú Less pain ú No need for anesthesia § Disadvantage: ú Tend to require multiple sessions ú Subtler results Ideal treatment § Safe § Painless § No downtime § Fast § Effective in 1 or few treatments § One size fits all Non-invasive technologies § Cryolipolysis § Radiofrequency § Laser-based § Light-based § Ultrasound § Injection lipolysis Cryolipolysis § “Freeze fat” § Based upon concept of popsicle panniculitis § Controlled cooling of adipose tissue to induce adipocyte apoptosis § Reduces fat content by ~20-26% at treatment site § No downtime Coolsculpting (Zeltiq) § FDA approved § Suction draws in target tissue into cup-shaped applicators CoolAdvantage™ with interchangeable contours § Tissue is drawn into handpiece under vacuum § Treatment duration: 45 to 60 mins § # treatment cycles depends on area § 1 to 3 treatments spaced 8 weeks apart Adverse effects § Pain § Bruising § Erythema § Numbness § Dysesthesia Coolsculpting Before After Coolsculpting Before After Long Lasting Results Baseline 2 months 2 years 6 years Baseline 3 months 5 years 9 years Bernstein EF. Long-term efficacy follow-up on two cryolipolysis case studies: 6 and 9 years post-treatment. J Cosmet Dermatol. 2016 Dec;15(4): 561-564. Submental Contouring Kilmer SL, Burns AJ, Zelickson BD.. Safety and Efficacy of Cryolipolysis for Non-Invasive Reduction of Submental Fat. Lasers Surg Med. 2016 Jan; 48(1):3-13. Submental Contouring with Cryolipolysis Before 12 Week Follow-up 2 CoolSculpting Treatments Procedure by Brian Zelickson, MD (-4.5 lbs) Weight change, 0.05 kg (0.1 lb) (0.05%) from baseline. 2 treatment cycles per visit to the lateral and central submental areas, 2 treatments spaced 6 weeks apart Bernstein EF, Bloom JD. Safety and Efficacy of Bilateral Submental Cryolipolysis With Quantified 3-Dimensional Imaging of Fat Reduction and Skin Tightening. JAMA Facial Plast Surg. 2017 Apr 20. Paradoxical adipose hypertrophy § Rare, 1:20,000 § Incidence 0.0051% § More common in males § Pathogenesis unknown § No single, common characteristic has been identified among affected individuals § Onset 2 to 3 months after treatment § Does not spontaneously resolve Jalian HR, Avram MM, Garibyan L, Mihm MC, Anderson RR. Paradoxical Adipose Hyperplasia After Cryolipolysis. JAMA Dermatol. 2014 March ; 150(3): 317–319 High intensity focused ultrasound (HIFU) § Generates high-energy acoustic waves (100 to 10,000 W/cm2) that converge at a specific focal point in adipose tissue § Rapidly raises the temperature (to >65°C) around adipose tissue and causes coagulative necrosis § Focal point depth of 1.3 cm § Allows localized destruction of adipose tissue at precise tissue depths without damage to skin surface or surrounding tissue Liposonix (Solta) § “1 hour, 1 treatment, 1 inch” § Contraindicated in patients with < 1 cm of adipose tissue beyond the focal treatment depth § Liposonix creates a temperature rise above 56°C effectively destroying the targeted adipose tissue without damaging tissue outside of the intended focal zone. § Macrophages are attracted to treated adipose tissue, engulfing free lipids and cellular debris. § Destroyed cells are naturally processed by the body and excreted gradually over 8-12 weeks. Transducer focuses ultrasonic waves that converge at a specific depth Jewell ML, Solish NJ, Desilets CS. Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound. Aesthetic Plast Surg. 2011 Oct;35(5):901-12. Gross pathology demonstrating coagulative necrosis and eventual resorption of treatment zone Jewell ML, Solish NJ, Desilets CS. Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound. Aesthetic Plast Surg. 2011 Oct;35(5):901-12. Histology showing adipocyte disruption Jewell ML, Solish NJ, Desilets CS. Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound. Aesthetic Plast Surg. 2011 Oct;35(5):901-12. Safety, Tolerability, and Efficacy of HIFU § Sham-controlled trial, randomized trial § 168 patients, ages 18 to 65 years, BMI ≤ 30 kg/m2 § Baseline waist circumference change at 12 weeks post-tx: -2.52 cm (higher energy) vs -2.10 cm (lower energy) vs -1.21 cm (sham) § 47.5% “satisfied” to “very satisfied” with treatment results § 51.7 to 53.4% “likely” or “very likely” to pursue additional treatment § Adverse effects: mild to moderate discomfort, bruising and edema § Less discomfort at lower energy levels Jewell ML, Baxter RA, Cox SE, Donofrio LM, Dover JS, Glogau RG, Kane MA, Weiss RA, Martin P, Schlessinger J. Randomized sham-controlled trial to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg. 2011 Jul;128(1):253-62. Baseline Post treatment Baseline Post treatment Decrease of 2.55 cm from baseline wait circumference Jewell ML, Baxter RA, Cox SE, Donofrio LM, Dover JS, Glogau RG, Kane MA, Weiss RA, Martin P, Schlessinger J. Randomized sham-controlled trial to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg. 2011 Jul;128(1):253-62. VASER Liposuction § Vibration Amplification of Sound Energy at Resonance § Targets unwanted fat using ultrasonic technology whilst preserving important tissues such as nerves, blood vessels and collagen and helps with particularly stubborn areas that will not shift through diet or exercise and can improve overall shape. § Small probe inserted which is used to transmit sound energy and liquefy fat cells prior to removal through a suction process § Single treatment § Improves overall shape and body contour § Manual lymphatic drainage (massage to stimulate lymphatic system) is recommended to encourage of lymph fluid which helps with recovery and results Velashape § Syneron-Candela § Realself worth it rating 57% § For treating cellulite and reducing body circumference § Typically requires 3 treatment session § Combines infrared light, bipolar radiofrequency energy, vacuum and massage, which cause heating of fat cells and surrounding connective tissue/dermal collagen. Ultrashape (Syneron-Candela) § The UltraShape Power system works by emitting acoustic waves of focused ultrasonic energy (200 ± 30 KHz frequency) that converge into a confined focal volume underneath the skin, thereby, targeting only subcutaneous fat at a controlled depth. Unlike traditional ultrasound technology, UltraShape Power’s energy transmits pulsed ultrasound, allowing control over temperature elevation. § 3 treatments, 2 weeks apart Ultrashape Photos: Ruthie Amir, MD Photos: Eun Hee Kang, MD Radiofrequency (RF) § Used for skin tightening >> fat/cellulite reduction § Causes thermal injury using electrical energy § Passing of energy creates heating § Monopolar vs multipolar § Monopolar RF: ú Energy is passed from single electrode into the tissues and directed to a return pad § Multipolar RF: ú Two or more electrodes within the same handpiece are positioned at different points on the skin so that the waves pass between them to create a heating effect. Radiofrequency § . EndyMed 3Deep § For body contouring and cellulite reduction § Multisource RF technology that delivers controlled, focused RF energy deep into the skin § Uses an array of several electrodes and a sophisticated algorithm that manipulates the phase of current flowing between each pair of electrodes. The multiple electrical fields created repel each other, leading to the ideal combination of energy directed to a deeper skin layer. The repelling forces between adjacent electromagnetic fields drive energy vertically into the target tissue, reducing the amount of energy flowing through skin surface and alleviating the need for cooling. Venus Freeze § Venus Freeze is an FDA-approved, non-invasive treatment for cellulite and loose skin on the face, neck, and body. § Uses radio frequency and magnetic pulses to stimulate the generation of new collagen and elastin fibers over time. There is a recommended six sessions for the face/neck and eight to 10 for the body). Inmode BodyFX § Radio-Frequency provides
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