Looking at pros & cons of non-surgical 'fat melting' therapies

As a result, non-surgical procedures have been developed to meet this desire for comparatively quick cosmetic procedures that can help slim and rejuvenate body and facial areas. In his presentation, "Non-Surgical Fat Melting: Myth vs. Reality," at the recent East Coast Dermatology Seminar here, Neil Sadick, M.D., discussed several such procedures and their pros and cons.

Dr. Sadick, who heads a private practice in New York City and is clinical professor of dermatology at Weill Medical College of Cornell University, began with a discussion of old and new treatments for cellulite.

Older treatments, he says, include topical therapy, systemic therapy, massage and endermologie, and liposuction. Among the newer treatments, Dr. Sadick cited mesotherapy, TriActive (Cynosure) and VelaSmooth (Syneron).

"Topical therapy uses methylxanthines, retinoids and lactic acids, while systemic therapy uses herbals and other plant extracts," he says. "Massage and endermologie temporarily improve tissue edema and venous return, but other than that, in these three older therapies, no proven benefits in controlled trials have been observed.

"As for liposuction, it can improve or exacerbate the appearance of cellulite."

NEWER MODALITIES

As for the new treatments, meso-therapy is a technique whereby a mixture of medications is injected directly into the mesoderm of the area to be treated. In use in Europe for decades, mesotherapy was introduced domestically about five years ago. Dr. Sadick says many U.S. dermatologists have found mesotherapy to be a valuable procedure for treating a variety of conditions, including cellulite and fat-deposit reduction.

"In cellulite-reduction treatments, the mesotherapy mixture combines agents for local lipolysis, dissolution of connective tissue, and enhancement of circulation, in a series of injections into the subdermis," he says. "Three to six treatments at four-week intervals usually bring excellent results."

The lipolytic agent used for treating localized fat deposits mesotherapeutically is phosphatidylcholine, or PDC, Dr. Sadick says.

"Protocol is 250 milligrams of PDC injected into the affected area, with the patient either seated or lying down," he says. "Temporary swelling may occur within 48 hours after treatment. I suggest treatment intervals of 15 days with a total of three to six treatments."

UNANSWERED QUESTIONS

Dr. Sadick notes certain questions regarding mesotherapy, such as the lack of standardization of solutions, its unsettled FDA status, unproven histologic effects, and concerns about longevity, efficacy and need for maintenance.

"Once these are resolved, and given that mesotherapy is versatile, requires little downtime and can be applied with minimal pain to the patient, it's my belief that it will be more widely accepted as a viable treatment option," he tells Dermatology Times.

PROMISING TREATMENTS

TriActive is an 808 nanometer semiconductor laser device with energy capacity of up to 6 watts and a repetition rate of between 0.1 Hz and 5 Hz. The device features variable suction and rollers that massage the tissue.

"Two studies show that TriActive can be an effective treatment for reducing fat," Dr. Sadick says. "Dr. Zerbatini and colleagues saw a significant reduction in body-circumference measurement as well as a high level of patient satisfaction after 10 treatments performed twice a week. And Drs. Frew and Katz presented their results of a high level of patient satisfaction at the 13th Congress of the European Academy of Dermatology and Venereology in Florence, Italy, last year."