Los Angeles facial cosmetic surgeon Alexander Rivkin, M.D., says he believes that the field of noninvasive fat reduction or noninvasive body contouring is still in an early stage, where each technology cannot yet achieve the reliable, dramatic results that patients are demanding. A single device has not yet proven to be effective enough to dominate the field, Dr. Rivkin says.
“The two most promising modalities are cryolipolysis (CoolSculpting) and transcutaneous magnetic muscle stimulation (CoolTone). My favorite way to achieve fat reduction is to use a combination of these two devices in a synergistic amplification of effect,” Dr. Rivkin says. “CoolSculpting and CoolTone in combination reduce fat in different ways that seem to be synergistic with one another. I think that this will bring patients the best results.”
Boca Raton dermatologist Jeffrey S. Fromowitz, M.D., says he packages two treatments — CoolSculpting and truSculpt, which some call “fire and ice.”
“This allows us to combine the best of both worlds with fat reduction from [CoolSculpting], then we fine tune the treatments with RF truSculpt. The addition of the RF also adds tissue tightening in areas where we have reduced fat pockets,” Dr. Fromowitz says.
San Antonio, Texas, plastic surgeon Thomas T. Jeneby, M.D., says his number one noninvasive fat reduction technology is CoolSculpting, but he, too, uses a fire and ice approach in some patients with CoolSculpting and Vanquish.
“The Vanquish is a no-touch fat melting system that hovers over the body and spins water molecules causing them to heat up and eventually rupture the fat cells by vibration,” Dr. Jeneby says. “So while CoolSculpting uses cold; Vanquish uses heat. We use both back to back…. This gives synergistic fat reduction to people who do not want surgery.”
In the end, different technologies offer different benefits, according to Beverly Hills plastic surgeon Payman Danielpour, M.D., who says that, in his practice, if fat reduction is the sole objective his favorite device is CoolSculpting.
“It has been clearly proven that cryolipolysis works and can be used in multiple areas of the body, even the hard-to-treat areas,” Dr. Danielpour says. “Radiofrequency can be effectively used for circumferential reduction and skin tightening but the fat reduction is not as pronounced. Lastly, Emsculpt… is revolutionary [on] its own because it’s the first machine to effectively build muscle and lose fat.”
The bottom line: Proper patient selection is key when recommending noninvasive fat reduction or body sculpting technologies, according to Dr. Schlessinger.
“As with any technology there are clearly limitations and benefits and it is incredibly important to pick the right candidate for the right procedures. Without this all is lost,” Dr. Schlessinger says. “For example, about 50% of people that come in for CoolSculpting consultations… simply aren’t candidates. Some, however, are candidates for tumescent liposuction or SmartLipo [Cynosure] that we perform in the office, and when they’re good candidates for that we explain the opportunities and options. For those who are not candidates for either one, we’re just as clear and politely explain the fact that they aren’t a candidate for anything at this time. Many of these are better candidates for bariatric surgery and abdominoplasty.”
Drs. Moore, Jeneby, Engleman, Larrabbee and Rivkin report no relevant disclosures. Dr. Schlessinger has performed clinical trials for Liposonix, Ultrashape and Kybella. Dr. Fromowitz is a speaker for Cutera. Dr. Kilmer has received research support from and has been a medical advisory board member with Cutera (stock options too), Cytrellis (stock options) Alastin, Allergan, Dominion, Pulse Biosciences, Lumenis Lutronic, Merz, Sciton, Sienna Labs, Solta/Valeant (advisory board only) and Syneron/Candela. She has received research support in the past year from Galderma, BTL, R2 Derm and Revance. She has stock in Avava and HintMD.