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What’s Important?

  1. Patient selection is critical.

  2. All modalities work best in someone who is exercising and dieting and is only about 10–15 pounds overweight.

  3. Results are not immediate.

What’s New?

  1. Heat, cold, and ultrasound devices are used to remove body fat.

  2. Injectable deoxycholic acid can be used to diminish body fat.

What’s Coming?

  1. Studies are evaluating if removing body fat has any effect on the fat-burning hormone adiponectin or insulin sensitivity.

  2. Doctors are beginning to combine injectable deoxycholic acid with body contouring devices to enhance results.

The popularity of non-invasive body contouring has risen in recent years. Increasing numbers of patients are seeking a non-invasive way to sculpt their bodies because of the greater risk of complications, prolonged downtime, as well as the cost of liposuction and surgical body contouring.1 According to the American Society of Plastic Surgeons, a total of 427,965 non-surgical body contouring procedures were performed in 2017 compared to 388,742 in 2016.2 The American Society of Aesthetic Plastic Surgery reported a 217% increase in non-invasive body contouring procedures from 2012 to 2017.3

There are numerous modalities for non-invasive body contouring, including several injectable and device-oriented options. The choice of technique depends on various factors: anatomical location of the treatment area, cost, number of treatments needed, and amount of skin laxity in the treatment area. The most commonly treated areas are the abdomen, lumbar rolls, hip rolls/flanks, inner thighs, submental area, and bra fat area.4

Proper selection of patients is imperative. Patients who are poor candidates for any type of body contouring are those with excessive skin laxity, and those with unrealistic expectations. While these treatments are effective, combining them with lifestyle changes such as exercise and improved diet will greatly improve the results.5,6 Some physicians suggest using supplements to speed the liver’s breakdown of fat, but this approach has not been conclusively proven to be effective.7

Regardless of the modality used, it is crucial to accurately and precisely measure the changes throughout the treatment process using standardized and reproducible methods. Standardized pre-procedure photos with consistent positioning and lighting are essential. Using a tape measure, while effective, can be affected by positioning, posture, lighting, weight changes, as well as respiration. Repeated measurements, taking measurements at the same time of the day, or using an apparatus that standardizes tension may be necessary. Ultrasound has also been used as a method for quantifying changes in fat reduction. It is widely accessible and can visualize the fat layer. Designation of landmarks is critical for reproducibility and may be user dependent. It is also unclear how much of a change in fat layer thickness can induce a detectable change in the ultrasound. In addition, magnetic resonance imaging has been used to measure reduction in fat but is very costly and not readily accessible. Measurements in this case should be limited to extremities. Subjective ...

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