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LIPOSUCTION AND BODY CONTOURING

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SUMMARY

  • Liposuction is now the second most frequently performed cosmetic procedure in the United States.

  • Approaches to noninvasive body contouring include cryolipolysis, high-intensity focused ultrasound (HIFU), low-level laser therapy (LLLT), hyperthermic lasers, radiofrequency, and infrared lasers.

  • These approaches to noninvasive fat removal all selectively target components of adipose tissue.

  • All minimally invasive body-contouring technologies fall far short of liposuction in terms of clinical efficacy and rapidity of response.

image Beginner Tips

  • No head-to-head studies have been performed comparing various technologies for body contouring.

  • Be sure to closely investigate the various options before purchasing a device, as some systems require a significant ongoing expenditure on consumables, while others do not.

image Expert Tips

  • Patient selection is critical, as the degree of response seen with body contouring may be relatively modest.

  • Most body-contouring approaches should only be used for patients with a BMI in the normal range.

  • Combination therapies are a reasonable option for many patients.

image Don’t Forget!

  • Some treatments, such as cryolipolysis, take several months to demonstrate complete benefit. Therefore, appropriate planning is important for patients aiming to improve their body profile before a major event.

  • While all treatments are minimally invasive, some lead to more significant postoperative edema and ecchymosis.

image Pitfalls and Cautions

  • Paradoxical adipose hyperplasia may be rarely seen after cryolipolysis.

  • If it occurs, spontaneous resolution is not expected; therefore patients should always be warned of this rare possibility.

  • While there is a theoretical risk of LFT and lipid changes during the fat resorption phase, this has not been reported clinically.

image Patient Education Points

  • Multiple treatments may be required.

  • No minimally invasive treatment can match liposuction in terms of efficacy, flexibility, and rapidity of response.

  • Realistic expectations are critical, and patients who expect a dramatic response should probably be warned against this approach.

INTRODUCTION

The number of cosmetic procedures has soared over the past decades, with liposuction the second most popular cosmetic surgical procedure performed in the United States.1 Despite its popularity and overall safety, liposuction is an invasive surgical procedure with risks including infection, complications from anesthesia, and even death. Therefore there is demand for noninvasive approaches that may lead toward the ideal physique with less risk and downtime. Multiple body-contouring devices have been created over recent years to meet these demands such as cryolipolysis, low-level laser therapy (LLLT), high-intensity focused ultrasound (HIFU), radiofrequency (RF), and infrared lasers.2,3 These new approaches to noninvasive fat removal all selectively target components of adipose tissue that differentiate it from the overlying epidermis and dermis.4

CRYOLIPOLYSIS

Cryolipolysis dates back to the 1970s, when Epstein and Oren observed a red indurated nodule followed by transient fat necrosis on the cheek of an infant who had been sucking on a popsicle. They termed this phenomenon “popsicle ...

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