BODY CONTOURING – WHAT REALLY WORKS?

Body Contouring is popular – next to Breast Augmentation it is the second most common procedure.  As body contouring climbs in popularity so do non-invasive forms of body contouring.  But in the end what really works?  Good question.  I read a really good article by Dr. Reza Nassak who did an online review using Medline.  He searched all the popular terms of non-invasive contouring, endermologie, ultrasound, Cool Sculpt – and the list goes on and on.

ENGERMOLOGIE:

This is a mechanical suction device developed in France in the 70’s.  The most recent study of 118 patients showed 99% had reduction in body circumference with mean reduction of 2.9 cm.  Big question is this permanent or do you have to go back all the time for more treatments?

TRACTIVE:

This device uses a low energy diode laser with suction cooling and massage.  The main indication is for the treatment of cellulite – everyone’s dreaded nemesis.  This is similar to Vela Smooth.  The treatment protocol is treatments twice weekly for six weeks.  Results – 30% of patients saw improvement in upper thigh circumference and 37% improvement in their lower thighs.  Their appearance was improved by only 20%.

SMOOTH SHAPES:

This is a laser-suction and massage device.  In this study there were 20 patients who had 2 sessions per week for four weeks on lateral thighs.  Patients were evaluated at 1,3 and 6 months post treatment.  76% saw improvement in cellulite and 84 cc. loss of volume.

RADIOFREQUENCY:

These are probably the most popular non-invasive technologies.  This device delivers heat to the epidermis/dermis with the hopes of skin tightening down the road.

VELASMOOTH/VELASHAPE:

These are combination devices using infra-red radiofrequency and mechanical suction.  The results are mixed – one study showed a reduction in thigh circumference in 71.9% of patients at 4 weeks with VelaSmooth however follow up at 8 weeks showed NO improvement.  Other studies showed better results.

THERMAGE:

For a while this was the hot ticket item.  This is a monopolar radiofrequency device.  This is used more for face and areas around the eye.  Patient selection is key here – but I think it is true for all procedures.  In a 12 patient blinded study for abdominal laxity they found decrease laxity of 1.4, 1.7, 0.2 and 0.9 cm. at 1,2,4, and 6 months.  Note the farther out you go, the less effect there is.  The message – come back for more treatments.

In general radiofrequency shows mixed results.  Bipolar devices like VelaSmooth/VelaShape require more sessions and results show modest short term improvement in cellulite and fat reduction.  Monopolar devices like Thermage show fat reduction in 60-80% of patients.

EXTERNAL ULTRASOUND

There are 2 types - low intensity/low frequency and high intensity focused ultrasound.  Low frequency have not been shown to be effective.  Hi frequency devices are Ultrashape and Liposonix.

ULTRASHAPE:

Ultrashape produces ultrasonic waves at a controlled depth.  A study of 25 patients showed 63% of patients showed improvement in body shape.  In a study of 53 Asian patients results showed a slight decrease in abdominal circumference after one treatment but an INCREASE  after subsequent treatments.

LIPOSONIX:

Liposonix is a another high frequency ultrasound.  In a study of 85 patients, there was a reduction of 4.6 cm. after one treatment at 3 months.  After 3 months, 70% were satisfied.  Although these devices are well used and marketed there is little evidence to support their effectiveness.

CRYOLIPOLYSIS:

These devices depend on freezing the fat.  The largest study involved 518 patients.  Caliper measurement showed 94% had SOME reduction in fat thickness but the average was about 23%.  These devices are good for patients who have small deposits of fat on their flanks or abdomen.  The average reduction of fat ranges from 14% to 25.5%.

LLLT:

This stands for low level laser therapy.  This therapy causes no increase in the temperature of the tissues being treated.  The machine is Zerona.  There have been multiple studies done to show significant circumferential reduction in fat following LLLT.  Some studies also showed a reduction in cholesterol and triglyceriedes.