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The Skinny on fat reduction, cellulite devices


Fresh after her presentations on fat reduction and cellulite treatment devices at ASDS, Sue Ellen Cox, M.D., offers unplugged advice about today’s technologies.

Devices aimed at reducing fat and ridding patients of cellulite’s unsightly bumps look magical in promotional ads, but how do dermatologists look beyond to choose the best technological arsenal for treating their patients? We asked for unplugged advice from Chapel Hill, N.C., dermatologist Sue Ellen Cox, M.D., who presented on fat reduction and cellulite devices in November at the 2016 American Society for Dermatologic Surgery (ASDS) annual meeting in New Orleans.

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The reveal

There are plenty of noninvasive fat reduction devices. Nuances help differentiate them.

Dr. Cox’s noninvasive fat-reduction device of choice and the one that she has been using for about five years is CoolSculpting (Zeltiq).

The ultrasonic destruction of fat cells with UltraShape is another option. Dr. Cox did the clinical trials for UltraShape but doesn’t own the device.

“The company typically recommends three treatments to get the result that is expected or anticipated by the patient,” Dr. Cox says. “What I was seeing during the clinical trials was that it may have not been quite as predictable as what I see with the CoolSculpting, which is typically just one or two treatments for a very defined 20 percent to 25 percent reduction of fat. I can also tell you in terms of studies out there, CoolSculpting for noninvasive fat reduction really does have the most.”

Other options: Vanquish (BTL Aesthetics), a radiofrequency device for fat reduction, and the other ultrasonic device Liposonix (Valeant).

“I had the Liposonix done on my lower abdomen once and didn’t even finish the procedure it was so uncomfortable. And I was not overly impressed with the results that I was seeing in the clinical trials,” Dr. Cox says. “I had the CoolSculpting done on my lower abdomen once and upper abdomen twice with no discomfort.”

The new device on the block is SculpSure (Cynosure), which is a noninvasive laser.

“It’s a 1060 nm wavelength laser that is attracted to fat as its chromophore,” Dr. Cox says.

Dr. Cox says she thinks all these devices are good, but some work better than others.

“Some of them require more sessions, like the UltraShape or Vanquish. Even the SculpSure requires more than one treatment. When CoolSculpting first came out, they talked about it being a one and done thing, but over the years have adjusted expectations by saying there’s a ‘treatment to transformation,’ meaning that you treat an area and you’re going to get 20 to 25 percent reduction in fat. But you may want to treat it again, to get another 20 to 25 percent reduction, or work areas that are adjacent to the areas that you’ve already worked on, so you’re truly sculpting these patients,” Dr. Cox says.

Liposuction still hard to beat (track record-wise)

Though she says these numbers might have since changed, Dr. Cox did a PubMed data search in October 2015 and found there were 50 peer-reviewed articles on CoolSculpting; 37 for Liposonix; 18 for UltraShape; 16 for Vanquish; and eight for Kybella. Cynosure’s website lists three paper presented at American Society for Laser Medicine and Surgery meetings but no published articles in the peer-reviewed literature.

“But if we compare published studies to liposuction, liposuction has over 1,190 peer-reviewed articles. So, liposuction still may be the gold standard, even though that’s not what patients appear to be as interested in because it’s invasive and there’s downtime,” Dr. Cox says.

While liposuction’s appeal might wane in light of new technologies, patients who do opt for the old standby fat removal approach are generally as happy as or happier than those who have noninvasive options.

“If you look at RealSelf, and I pulled the data from 2015 and 2016, it’s across the board in terms of people saying they’re really happy with [liposuction],” Dr. Cox says. “Typically, liposuction has one of the highest ‘Worth It’ ratings and number of reviews,” she says.

For example, at last glance (December 5, 2016), liposuction had 4,561 RealSelf reviews and a 91 percent Worth It rating; UltraShape had 115 reviews and an 87 percent Worth It rating. For CoolSculpting, there were 2,630 reviews and an 83 percent Worth It rating. And Kybella had 279 reviews and 87 percent Worth It rating.

“But I do think that patients are happy with the noninvasive technology. It is pretty easy with the CoolSculpting. The nice thing is they’ve updated the device, so there is a 35-minute cycle time, as opposed to an hour. From the standpoints of patient ease and satisfaction, it’s great,” Dr. Cox says. “In terms of patients being able to return to work with any of these noninvasive devices, it’s pretty immediate. The next day, they can go back to exercising; they can go back to work. There’s really no downtime, with the exception of maybe some temporary numbness or tingling sensation.”

But patients might need multiple sessions with noninvasive devices, whereas, it’s one treatment and done with liposuction, Dr. Cox says.

“You can do several areas at once and have one downtime, one procedure, one expense,” she says.

Dr. Cox says her colleagues that offer fat reduction and removal should keep in mind that the noninvasive are becoming more and more of a commodity offered at salons, medi spas and more.

“There’s a spot near me that was only doing laser hair removal until about six months ago. Now they’re doing CoolSculpting. That’s an issue,” she says.

NEXT: How to choose among devices


Making choices

Dr. Cox says colleagues should learn before they purchase or rent one of these devices.

“Definitely look at the peer-reviewed data,” she says. “That’s why I chose CoolSculpting. There is a lot of data to show it is predictable-that it results in 20 to 25 percent reduction in fat every time you’re hooked up to the device. There was recent information where there was 30 percent reduction with UltraShape, and maybe that’s 30 percent because you have to do it three times. You have to look at all this information critically,” she says.

Dermatologists who don’t hop on the noninvasive fat reduction train might miss opportunities for new patients, Dr. Cox says.

“If you don’t have the noninvasive technology, patients aren’t as likely to be driven to your door. They’re drawn to your office by what they see online or on billboards. If you don’t have the noninvasive technology, they’re less likely to come to your office and they may be a better candidate for liposuction but you might not even get to see them,” she says.

The field for noninvasive fat reduction is burgeoning.

“The demand is so high. Patients calling the office. Who doesn’t have a bulge they’d like to get better?” Dr. Cox says.

Disclosure: Dr. Cox did clinical trials for Liposonix (Valeant Pharmaceuticals), UltraShape (Syneron Candela) and Kybella (deoxycholic acid, Allergan). She is a consultant for Merz.

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