Chapter 6: Devices for the Improvement of Body Contour

INTRODUCTION

With an increase in both sedentary activities and cosmetic consciousness, demand for treatments that improve body contour continues to grow.¹ Several invasive and noninvasive options for body contouring exist. While liposuction and other surgical corrections remain the gold standard for invasive body contouring, patient demand for noninvasive methods of contouring has grown significantly. American Society for Plastic Surgery 2011 survey data found noninvasive treatments for cellulite have grown by 21% from 2010 to 2011 and 58% from 2000 to 2011, while liposuction has decreased by 42% from 2000 to 2011, and invasive surgical body contouring procedures after massive weight loss decreased by 8% from 2010 to 2011.² Risks and undesirable side effects of invasive treatments, including significant pain, swelling, recovery time, infection, and surgical scars, may be avoided with many noninvasive treatment options. The field has expanded tremendously in recent years, growing to include treatments that have been reported to reduce fat and promote adjuvant skin tightening, with subsequent reduction in circumference. Devices currently producing these effects use technology that targets fat through infrared heat, radio frequency (RF), ultrasound, and/or cryolipolysis.

PATIENT SELECTION

Current noninvasive body contouring options most often have the potential to provide mild-to-moderate reductions in fat and/or mild improvements in skin laxity, with resultant reduction in circumference (Table 6-1). Typically these changes occur over a period of weeks to months and for many devices may require multiple treatments. Therefore, the ideal candidates are patients with normal to slightly increased, stable body weight with mild-to-moderate excess fat who will demonstrate improvement in contour with proportionate mild-to-moderate fat reduction.³ Good general health, exercise, and nutrition are important factors that likely influence results and particularly maintenance of results. Proper candidate selection, patient education, and management of expectations are important to achieving the goal of patient satisfaction. Patients demonstrating unrealistic expectations, or signs of body dysmorphic disorder, are unlikely to achieve optimal satisfaction. Patient preference for surgical or noninvasive options is an important factor in treatment choice. Individual patient factors including the location of excess fat, depth of fat, presence and severity of cellulite, size of the affected area, overlying skin elasticity, proximity to bone or underlying structures, history of previous surgeries, and desired speed, recovery time, and cost of treatment each influences treatment choice (Table 6-2).