NON INVASIVE BODY CONTOURING
Dr Leela Velusamy
INTRODUCTION o Over the past 5 to 10 years, there has been considerable growth in body size and patient BMI o Historically, the approach to body contouring has largely involved invasive procedures such as liposuction.
o Liposuction is the amongst the top 5 cosmetic procedures globally. o Non-invasive body contouring technology is the fastest growing segment of the aesthetic capital equipment space.
WHAT IS IT? o Procedures that alters the shape of different areas of the body without surgical intervention. o OR the optimization of the definition and the shape of the human physique o Females often desire to have a body free from cellulite and fat o Males – toned body shape and well shaped abs and muscles
WHY NON INVASIVE? o Surgical procedures may induce complications from anesthesia, infection and even death, caused the influence and development of non - invasive non surgical approaches to body contouring. o Non invasive procedures tend to be more alluring because of it’s quicker recovery, fewer side effects and less discomfort
HOW TO ACHIEVE THIS? o Many technologies are out there – from painless devices to invasive major liposuction
CELLULITE o A common presenting complaint of our body contouring patients o It’s a phenotypic description of lumpy, bumpy, irregular, ‘cottage cheese’ like skin
o Etiology and pathophysiology in the basic science of cellulite is still poorly understood and debated
CELLULITE (CONT’D) o Usually a problem amongst women
o Studies show approximately 90% of women have some amount of cellulite, primarily in the areas of the hips, thighs, buttock and abdomen.
THE BASIC SCIENCE OF NON INVASIVE BODY CONTOURING o It’s really the basic science of the adipocyte.
o An adipocyte is essentially a fat cell. o It’s a very important cell involved in energy storage, hormone regulation and a host of other endocrinological functions.
ADIPOCYTES o They have a large cytoplasm that serves as a storage depot for triglycerides, which are composed of glycerol and free fatty acids o It’s our intermediate and long term energy storage depot. o When calorie intakes exceeds caloric output, adipocytes then swells with triglyceride (Hypertrophy) Large cytoplasm
ADIPOCYTES (CONT’D) o As adipocytes continue to enlarge intralobular and interlobular fascial compartments, they create “bulges “ or convex distention’s of soft tissue that then modify our contours.
CONVEX DISTENSIONS oIn the female topography, common convex distensions include “out pouching,” “bulges,” or convex distensions of the hips, lower abdomen, outer thighs, inner knees, arms and bra line. o Typical android distribution of subcutaneous adiposederived convex distensions commonly include love handles, lower abdomen, “spare tire”, male fatty breast tissue and the submentum.
COMMON TARGETED AREAS o Tummy areas o Love handles o Thighs o Flabby arms o Bra liners
WHEN ARE NON INVASIVE TREATMENTS APPROPRIATE? o They are appropriate for excess fat removal and body contouring with proper patient expectations.
IS IT PAINFUL? o The treatments are well tolerated by most patients.
o On occasion, a burning sensation may be felt.
INDICATIONS OF NON INVASIVE BODY CONTOURING o Realistic expectations of a modest reduction of localized fat
o Modest cellulite improvement o Compliance with multiple visits
o Reasonable lifestyle and BMI
CONTRA INDICATIONS OF NON INVASIVE BODY CONTOURING o If the patient is pregnant, has a pacemaker or is medically unwell
o Unrealistic expectations o Large BMI
PROPER PATIENT PREPARATION o Taking consistent before and after photographs
o Make circumference measurements o Record weight because of a poor diet or lack of exercise
COMPARISON OF TECHNOLOGIES Technology
Mechanism of action
Pain level
Side effects
Treatments needed
High intensity focused ultrasound
Necrosis
High
Massive bruising and tenderness up to 2 weeks
1-2
Unipolar radiofrequency
Apoptosis
Medium
Redness and tenderness for 1-3 days
2-3
Low-level laser therapy
Apoptosis
None
None
6
Acoustic wave therapy
Apoptosis
None
None
8
Cryolipolysis
Apoptosis
None
Numbness and bruising for up to 7 days
1-2
HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) o Has been used for nearly half a century for the non invasive treatment of tumors of various organs o To eliminate unwanted abdominal fat effectively reduces waist circumstance, with minor pain and side effects.
HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) o Ultrasound energy penetrates through the skin layers into the targeted fat without harming skin or surrounding tissue. o High energy ultrasonic waves are focused into the subcutaneous tissue, quickly raising the temperature above 56째C, resulting in coagulative necrosis of the adipocytes and a subsequent reduction of the fat layer. oResults in adipocyte death, rather than just metabolic amplification of the fat cell metabolism thus offering long term non invasive body contouring effect.
HIFU DEVICES
QUIZ 1 Why do adipocytes have a large cytoplasm?
To serve as a storage depot for triglycerides
SUMMARY: HIFU o Uses high intensity, focused sound waves to disrupt fat cells
o Causes them to dissolve gradually over time o Approved by the FDA
RADIOFREQUENCY (RF) o RF devices currently dominate the worldwide non invasive body sculpting device market o Delivers controlled energy to excess fat areas, creating heat deep within fat cells and subsequently destroying them.
o RF energy penetrates the skin layers to selectively heat the skin tissue where the collagen fibers are embedded o The local heating causes the an immediate contraction of the collagen fibers, and fat cells drain then shrink.
RADIOFREQUENCY (RF) o The local heating causes the an immediate contraction of the collagen fibers, and fat cells drain then shrink. o Those all important fibroblast cells (part of our connective tissue) are stimulated to produce new collagen and elastic fibres,
o Effect of this is tighter, smoother, younger looking skin with a visible lift o Fats cells are reduced and stubborn cellulite looks less noticeable
RF DEVICES
LOW LEVEL LASER THERAPY (LLLT) o Originally was a non – invasive, non – thermal approach to disorders requiring reduction to pain and inflammation and stimulation of healing and tissue regeneration. o Over the last decade, LLLT started to be explored as an adjuvant to liposuction for non-invasive body contouring, reduction of cellulite, and improvement of blood lipid profile.
o It’s defined as treatment with a dose rate that causes no immediate detectable temperature rise of the treated tissue and no macroscopically visible changes in tissue structure.
LOW LEVEL LASER THERAPY (LLLT) o Laser dosage is a magnitude used to define the energy applied to the tissue
laser beam
o Units are in joules per centimeter squared o Dosage is calculated as the laser power measured in milliwatts, multiplied by treatment time in seconds, and divided by the area of the laser spot directed towards the tissue.
LLLT DEVICES
SUMMARY: LLLT o Most advanced method
o Specially target to melt cells o Once the fat cells are melted, it will result in toned skin and defined abs
o Cleared by the FDA in 2010
ACOUSTIC WAVE THERAPY (AWT) o New approach to cellulite treatment
o Uses pressure waves that impact both of the major causes of cellulite; fibrous septae and protrusion of fat into the lower dermis o It produces a pressure wave that passes through the skin and fat to impact the fibrous septae o The pressure breaks up the collagen of the septae and releases the skin, allowing a smoother surface.
QUIZ 2 What does HIFU stand for?
a. b. c. d.
High Intensity Focused Ultrasound High Infrared Frequency Ultrasound High Intensity Frequency Ultrasound High Infrared Focused Ultrasound
CRYOLIPOLYSIS o Novel non invasive technology of using cold exposure to selectively and gradually lead to the reduction of subcutaneous fat o There is evidence to suggest the onset of an inflammatory reaction with the adipose tissue in response to cold exposure
o This phenomenon is a cold induced apoptotic adipocyte cell death for those fat cells that have been exposed to a cold stimulus that is above freezing but below body temperatures for a defined duration.
CRYOLIPOLYSIS o Causes a percentage of the fat cells to self destruct over several months
o Research suggests that fat cells are more sensitive to cold compared to other tissues (Manstein and colleagues)
MANSTEIN AND COLLEAGUES o Performed porcine experiments to evaluate the effect of controlled application of cold to skin and subcutaneous fat o Three complementary pig studies were completed; an initial exploratory study, a dosimetry study and a follow – up safety study to assess the impact of such selective lipolysis on lipid levels. o They used a copper plate that was cooled and regulated to -7 °C by an attached heat exchanger chamber and applied the plate to multiple sites on the animals
MANSTEIN AND COLLEAGUES (CONT’D) o Exposures varied between 5 to 21 minutes and the pigs were observed for 3.5 months o No significant skin changes manifested during the observation period, but selective fat absorption had occurred at treatment sites, as evidenced by contour indentations o On gross tissue observation, a 40% reduction in fat thickness had occurred, which was confirmed by histology to demonstrate reduction in distance between fat septae
CRYOLIPOLYSIS DEVICES
POTENTIAL COMPLICATIONS o Thermal injuries from RF devices can occur but they are very rare with instances far less than 1% o With the Cryopolysis technology, a reported temporary, but annoying, dysesthesia can happen in up to 20% of patients, but there are no reports of permanent sensory loss o The most common complication is patient dissatisfaction.
SEVERAL CAVEATS TO THESE NEW TECHNOLOGIES OF WHICH CLINICIANS SHOULD BE AWARE o Do not serve as a significant method for weight loss, realistic expectations should be set with patients o Patient often think they will receive liposuction like results and it’s crucial to educate patient in the modest significance of 2 to 4cm of circumferential improvement in body contour o Limited benefit for patients with large BMIs or large focal fatty deposits
SEVERAL CAVEATS TO THESE NEW TECHNOLOGIES OF WHICH CLINICIANS SHOULD BE AWARE oThey do not target visceral fat which is implicated by cardiovascular diseases; therefore, health benefits are largely cosmetic o None of these modalities are alternatives to a healthy diet and lifestyle
QUIZ 3 What are the contraindications of non invasive procedures?
If the patient is pregnant, has a pacemaker or is medically unwell, having unrealistic expectations or a large BMI
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