Face and Body Contouring

People always want to look their best. Sometimes, localized fat deposits are stubborn and just won’t go away. Patients ask all the time what is best for these areas. The answer is simple, yet complicated. There are now many options to “reduce fat”. Some good, some not so good, some expensive, some inexpensive, many legal, some illegal, some with no downtime, some with downtime and restrictions, and some with complications that can be long-term or permanent.

Liposuction remains the gold standard for fat reduction. Period! Don’t let anyone tell you anything different. Tumescent liposuction removes more fat than any other treatment. Unfortunately, one must wear a garment for weeks, swelling is noticeable, and it takes time to resolve. In short, if you want to lose as much fat as possible, are able to wear a compression garment and avoid physical activity for many weeks, this is a great way to go.

For the rest of us that cannot or do not want downtime or those who do not need a significant amount of reshaping in an area, what is the best option? With all of these different treatment options being thrown at us, it can be confusing. Let’s try to get to the bottom of this.

First, Coolsculpting was all the rave. But, has it lived up to its hype? Yes and no. In short, it works, but….. There is a big but here. One must have enough fat and skin to get sucked into the device. If not, it won’t work or, even worse, one can get skin burns (actually frostbite) or even nerve damage. More and more reports of people being injured with this device are coming out. It is not that the technology is bad or does not work, but some don’t use it properly or use it when it is not appropriate. The results stand for themselves and people can lose 24% fat in a single sessions. Common side effects include swelling, numbness, redness, and tingling, which are all temporary. It cannot be used anywhere on the body, it does not tighten the skin, it often takes hours for treatment, and is very operator dependent. In short, it still is a good treatment option for some, but there are safer options available with no downtime or post-procedure side effects.

What about “fat freezing”? Coolsculpting is the FDA approved fat freezing machine used in the USA. Most spas that advertise “fat freezing” are using machines purchased from China that may or, in most cases, may not even be approved for use in the USA so be very careful! I stress this point to be very careful!

Trusculpt was the next player to try to reduce fat. This technology uses electricity (radiofrequency) to heat the fat. Their Trusculpt 3d machine had mediocre results. Their Trusculpt iD machine, their newer generation technology, lived up to the hype. It tightens skin and reduces fat. Small palm-sized pads are applied to virtually anywhere on the body. The machine has 6 pads that can be used at the same time, so treatments take little time. Studies showed fat reductions that were similar to Coolsculpting, but with several major benefits. It takes 15-20 minutes per treatment session, which is much less than the often hours it takes with Coolsculpting. Patients will require 1-3 treatment sessions for optimal results, which take 3-6 months to fully appreciated. There have been no reports or burns or nerve damage, as has been the case with Coolsculpting. Why is this technology not a household name? Simple. The company foolishly did not invest in marketing, like was done with Coolsculpting. It remains a good option for most, has the versatility of being able to be used on almost any area of the body, is fairly comfortable, and has no downtime. For this reason, it should be a highly considered option.

Emsculpt NEO was the next big player. This uses technology that is similar to Trusculpt to reduce fat, but also incorporates muscle stimulation using electromagnetic energy to help build muscle, similar to the Trusculpt Flex machine. In short, it is two machines in one. This treatment is effective, although may not reduce as much fat at Trusculpt in a single session, but is great for those who are slimmer and one may actually be able to see one’s abdominal muscles. The pads are large and are best for large areas, like the abdomen and buttocks. For the buttocks, one uses the muscle building technology and not the fat burning. Treatments can take 30 minutes or longer, depending upon the number of areas treated. Like most new things, this treatment comes with a higher price tag in many cases, many will not see the benefits of the muscle building, and some will only use the muscle building and not the fat burning. It will be interesting to see how much market share this takes. The manufacturer has spent a lot in marketing this device and hiring celebrities to be spokespersons for the machine. In short, this is a machine to look out for. It cannot be used on as many areas as Trusculpt. Fat reduction is good, but may not be as good as other options, but with the combined muscle building it may be a good option for thinner folks that want to see a six pack. Of course, one must weigh this with the increased cost.

Kybella is not a device, but a medication that can be injected into the fat under the chin (“double chin”) to dissolve the fat. It is very effective. Treatments take about 20 minutes. Most patients only require one or two treatments to achieve optimal results (range 1-4). Most patients return to normal activity within a few days. There is swelling after the procedure that can last one week. This procedure does not tighten skin.

Ultrasound fat reduction is not commonly used, but is available. Ultrashape uses a pulsed ultrasound and Liposonix uses a high intensity focused ultrasound to break down fat cell wells, thus releasing the fat. The abdomen and flanks are most commonly treated. It is non-invasive and has no downtime. Most patients require 1-3 treatment sessions. Results take 6-12 weeks to be appreciated.

Laser treatment, called SculpSure, uses light energy to heat the fat, causing the cells to break down. The skin is cooled, reducing the risk of injury. It is commonly used on the abdomen and flanks, but can be used elsewhere. Treatment is almost painless and takes 25 minutes per area. Most will see results within 6-12 weeks.

Red light therapy, called Ultraslim, is one of the newer devices in the USA. The red light that is delivered through the skin using a special lamp triggers fat cells to create small openings, which releases some of the fat. The abdomen, hips, and thighs can be treated. Treatments take about 30 minutes. Most will require 3 or more treatments to achieve their goals. This treatment is not recommended for those who are pregnant or have liver disease.

When choosing a treatment, one must do their homework. Most providers have one machine and it may not be the best or safest technology. One should do their homework to educate themselves on what is best for them and choose a provider that you trust.

Robert S. Bader, M.D., Dermatologist