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INTRODUCTION

Mankind has long been obsessed with achieving the so-called “perfect body”; in differing times and different circumstances, the ideal body has evolved. Currently, in our image-obsessed culture, many people possess a strong desire to lose weight to achieve their perfect body. Unfortunately, obesity is an epidemic in our culture and weight loss is a challenging goal for many. Although traditional dieting and exercise remain the best way to lose weight and maintain the weight loss, this may not work for all patients. Even patients who have achieved weight loss may continue to have small “problem areas.” As a result, patients are increasingly turning to their physicians, desiring new technologies to help achieve body contouring and the ideal physique.

Historically, liposuction was the only means to achieve body contouring – other than diet and exercise. Although liposuction remains the gold standard, it is an invasive procedure with associated pain, bruising, downtime, and rarely, more serious side effects. Modern medicine has witnessed a dramatic movement toward minimal or no downtime procedures, as patients have become increasingly unwilling to tolerate prolonged healing or recovery times. While many topical agents have been reported to improve the appearance of cellulite, the improvements have typically been limited or modest in clinical experience.1–4 The field of body contouring has rapidly evolved in the last several years with the introduction of numerous new technologies including lasers, RF devices, ultrasound devices, and cryolipolysis. Non-invasive fat removal procedures are now far more commonly performed than liposuction procedures. Non-invasive devices have been reported to have multiple beneficial effects including: improving the appearance of excess adipose tissue, reducing the overall volume of fat, reducing waist and thigh circumference, improving the appearance of cellulite, and skin tightening. Although these technologies are relatively new, and their potential utility must ultimately be determined by well-designed randomized scientific studies, the initial results and possibilities of some of these technologies are promising.

DETERMINING THE PATIENT’S STATUS AND TREATMENT GOALS

The first step in determining which therapeutic option is the best is to assess each patient individually and discuss their therapeutic goals. Depending on the patient’s weight and individual body habitus, as well as their “problem areas” and goals, some devices may be a better option than others. As always, it is important to assess whether the patient has realistic goals as to the benefits of a procedure prior to any treatment.

The classic definition for obesity is based on a patient’s body mass index (BMI = person’s weight in kilograms divided by the square of their height in meters). This is a quick and easy calculation for patients and physicians. Obese patients are defined as those patients having a BMI>30. Typically, obese patients (BMI>30) are not good candidates for non-invasive body contouring and likely would benefit more from bariatric or other surgical interventions to help achieve meaningful weight loss. Thus, the simple BMI calculation may ...

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