Choose the right noninvasive fat reduction device for your practice

Las Vegas - Choosing between noninvasive fat treatments often requires a point-by-point comparison, keeping in mind the physical and other constraints of one’s practice, says an expert who spoke at the Cosmetic Surgery Forum.

“Here’s my conundrum: We know liposuction works, but I don’t want to add liposuction to my practice,” says Heidi A. Waldorf, M.D., director of laser and cosmetic dermatology, Mount Sinai School of Medicine, New York.

Although trained in liposuction during her fellowship, she says, she delayed incorporating it into her practice because of ulnar neuritis from lifting weights at the gym.

“Once my elbow was back to normal, I found I was so busy there wasn’t time for liposuction,” she says. The only way her practice will offer liposuction is if she adds a colleague who performs it.

Meanwhile, “Patients want a noninvasive way to reduce fat. And there are finally noninvasive devices that work.” Because she already has a Thermage CPT radiofrequency device (Solta), her analysis excluded the Exilis device (BLT) and other similar tissue-tightening devices. Ultimately, she narrowed her search to two devices that she says are effective and backed by solid manufacturers.

In the latter area, Dr. Waldorf says, “When you decide to buy a device, ask your investment advisers to check out the company.” Since all devices now have disposable elements, “Make sure you choose a company that can support your device long-term.” In this regard, she says the CoolSculpting (Zeltiq) and Liposonix (Solta) devices passed muster.

She assessed the pros and cons of each device for her practice as follows:

• Pain - CoolSculpting can cause pain after treatment; with Liposonix, patients feel pain during treatment, Dr. Waldorf says.

• Areas that can be treated - CoolSculpting freezes fat that can be suctioned into the applicator cup; Liposonix has a handpiece that can be applied in a customizable pattern to heat fat with high-intensity focused ultrasound (HIFU).

• Treatment time required - “CoolSculpting takes one hour per ‘cup’ of fat, meaning the upper and lower abdomen and flanks takes four hours. The same area can be treated with Liposonix in about an hour.”

• Staff time required for treatment - CoolSculpting requires minimal staff involvement - patients only need to be attached and then removed from the device; the full Liposonix procedure is performed by a staff person, Dr. Waldorf says.

Because her practice is heavier on staff than space, Dr. Waldorf says, having a treatment room occupied for four hours would prove problematic. This was a major factor in her choosing Liposonix. Moreover, “The CoolSculpting is a big, bulky device; Liposonix is a slimline device.”

Because she has other Solta devices, Dr. Waldorf says, “From a financial point of view, I already have a program where I get my tips and other disposables at a discounted price. Finances are always a consideration when you’re evaluating a machine.”

Clinical considerations

The Liposonix device’s HIFU penetrates deeply, she says.

“As opposed to my Thermage machine, which heats the skin’s surface, Liposonix reaches the subcutaneous adipose tissue. It produces a dual tissue response - initially, it produces thermal cellular disruption and fat cell necrosis, followed by contraction and thickening of collagen in the subcutaneous layer,” Dr. Waldorf says. “So for me, an additional benefit was that many of the women who come for treatment have skin laxity as well.”

Within eight to 12 weeks, she adds, the body’s inflammatory response clears fat cells destroyed by the device, and the collagen contraction improves overall contours.

Therefore, “I tell people not to come back until three months post-treatment. Some of them can even get more improvement a few months later.” At three months, one patient she treated had lost 8 cm from her waist and 9.5 cm from her hips, despite her weight remaining constant. The patient had already been working out before she started treatment, Dr. Waldorf explains.

“And she told me post-treatment that when she is exercising, she is more aware of her muscles rather than feeling the extra layer of fat - which she feels very good about.” This patient also liked the way the treatment smoothed the contour in the area under her C-section scar, Dr. Waldorf adds. Additionally, “She no longer has hooding and a little indentation by her belly button, and her skin is less crêpey in treated areas.”

Other patients’ results may be less dramatic, Dr. Waldorf says. For example, another patient lost 3 cm around her waist and 1 cm from her hip. “Our waist and hip measurements are very specific,” requiring staff members to take circumferential measurements the same distance from the floor each time.

This patient’s weight actually decreased, Dr. Waldorf adds, but her most noticeable result was a straighter, more snug profile around the abdomen. “From her perspective, when she put her pants on, she had less of an overhang, and she felt less wiggly.”

Regarding patient selection for Liposonix treatment, Dr. Waldorf says, “If you can’t pinch an inch, it’s not going to work. Also, you must make sure that the fat is external.”

When she began using the device, she explains, she treated patients who had external fat plus intra-abdominal fat. “And they didn’t see much of a difference, because they’re just going to keep gaining the weight around their organs.” Somewhat similarly, Dr. Waldorf notes that when patients gain fat after liposuction treatment, it may concentrate in the intra-abdominal cavity because that’s where fat cells remain.

Overall, she adds, noninvasive fat treatments work better for patients who are already dieting and exercising and just need a little bulge treated. In this regard, she says, “Focus on the bulges. Don’t try to treat everywhere. I also stress to patients that one of the positives here is that since we’re only taking 10 to 20 percent of the fat, if they gain weight, they can still gain weight in that area,” not in the arms or back, as can happen after liposuction.

Equally, if not more, important is that 10 to 20 percent fat reduction will not be noticeable for someone who is significantly overweight, so such patients are not candidates, Dr. Waldorf says.

For pain control, “I give people 800 mg of ibuprofen when they arrive, because it takes them time to get photographed and measured. But we also have massage unit (Tapping Massager, Fujiiryoki) that’s used over the shoulders to distract them. And we have a Compact Personal Massager (Brookstone) that patients can hold in appropriate locations” to introduce a vibration sensation that masks some of the discomfort from the treatment. Pretreatment ice packs are also helpful. DT

Disclosures: Dr. Waldorf is a speaker and trainer for Solta and an investigator for Kythera.