Three-dimensional volumetric quantification of fat loss following cryolipolysis

Clinical Efficacy Analysis of Circumferential Upper Arm Liposuction with Double Incision: A Study of 496 Cases

BACKGROUND

In cases where the upper arm exhibits an irregular cylindrical appearance with subcutaneous fat concentrated primarily in the posterior lateral aspect, traditional localized fat suction techniques may lead to uneven or disharmonious results when addressing this concern. Many practitioners have turned to circumferential fat suction methods using multi-incision approaches to ensure effective results and fat removal. However, these methods often involve numerous incisions and complex procedures, necessitating the development of new, more efficient surgical techniques.

METHODS

We collected and screened patients who underwent upper arm circumferential liposuction with a double incision technique at our hospital from October 2020 to February 2023. A total of 496 cases were included in our retrospective analysis, in which we examined factors such as the length of surgery, arm circumference before and after surgery, subcutaneous tissue thickness before and after surgery, fat suction volume, postoperative satisfaction, and postoperative complications of the patients.

RESULTS

The average length of surgery was 71.7 min. 458 cases (92.3%) showed significant improvement, 23 cases (4.6%) reported satisfaction, and 10 cases (2.0%) were essentially satisfied. Additionally, 339 cases (68.3%) experienced an improvement in skin laxity. Four cases (0.8%) developed localized hard nodules with slight tenderness in the early postoperative period, which resolved without special treatment after observation and follow-up for 1-3 months. Three cases (0.6%) reported localized pain or numbness, and they were given oral medication. Their symptoms disappeared after 1-3 months of observation and follow-up. Three cases (0.6%) had localized pain or numbness, and their symptoms disappeared. All of these cases improved and resolved after one month of taking mecobalamin tablets. There were also three cases (0.6%) with mild pigmentation of the incision and two cases (0.4%) with mild limitation of unilateral upper arm abduction movement. However, upper arm activities were not affected after three months to one year of follow-up. No serious complications were reported, resulting in an overall satisfaction rate of 99.0%.

CONCLUSION

The double incision upper arm liposuction is safe, effective, time-saving, with high satisfaction and fewer complications, and is worthy of clinical popularization and application.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .

Cryolipolysis: The future of cryolipolysis

BACKGROUND

Cryolipolysis has revolutionized the field of cosmetic dermatology as a nonsurgical procedure, utilizing controlled cooling to selectively destroy fat cells.

AIMS AND METHODS

This review article will focus on the future prospects of cryolipolysis, considering advancements in current technology as well as innovations that hold promise for the future. We will explore emerging trends in cryolipolysis, considering novel applicator designs, combination therapies, an innovative injectable treatment approach, and the evolving role of this technology in the field of cosmetic dermatology.

CONCLUSION

The future holds promise for advances in cryolipolysis using both the noninvasive topical cooling approach and the novel injectable ice-slurry technology.

Cryolipolysis in the United States-Review of the clinical data

BACKGROUND

Noninvasive body contouring is becoming more popular in the United States as an alternative to liposuction. The most popular of these methods, cryolipolysis, uses precisely controlled cooling to reduce focal adiposities. The number of cryolipolysis procedures performed annually has experienced rampant growth in United States markets, and the indications have likewise diversified. In light of this change, it is imperative to perform an updated review of available US safety and efficacy data on cryolipolysis.

AIMS

To examine the safety and efficacy of cryolipolysis treatments in the United States using data extracted from research performed exclusively at US-based sites.

METHODS

In order to identify relevant studies, a literature search was conducted on PubMed using the terms "CoolSculpting" OR "cryolipolysis" OR "lipocryolysis." Articles were manually reviewed to exclude literature reviews, research not performed on humans, studies on experimental combinations of techniques, and any studies not performed in the United States.

RESULTS

The initial literature search returned 246 results. Following manual review, a total of 18 studies were selected for data extraction. Mean reduction in fat thickness by ultrasound was 2.0-5.1 mm or 19.6%-32.3%; mean reduction by body caliper was 2.3-7 mm or 14.9%-21.5%. Side effects were mild and transient. Four instances of PAH were documented in 3453 treatment cycles.

CONCLUSIONS

Cryolipolysis is a safe, modestly effective method for reducing focal adiposity. Complications are rare and treatable. However, US-based studies are few in number and often of low power and/or quality. More high-quality research is needed for all aspects of cryolipolysis.

Noninvasive lipolysis modalities in aesthetic medicine

BACKGROUND

Adipose tissue is a vital metabolic organ that takes part in body homeostasis. However, an increase in fat tissue can be detrimental for one's health and lead to undesirable changes in body shape. Noninvasive lipolysis is becoming an increasingly popular method to destroy and remove excess body fat and improve one's satisfaction with their body appearance.

AIM

The aim of this study was to perform an evidence-based review of the clinical efficacy and safety of noninvasive lipolysis modalities in fat reduction.

MATERIALS AND METHODS

An evidence-based review was performed to evaluate the scientific evidence available on the subject. Three electronic databases (PubMed, Scopus, and Embase) were searched between February and May 2022 for randomized controlled trials and observational studies performed on adult population in the last 20 years investigating the clinical outcomes of noninvasive lipolysis modalities. The selected studies were divided by modality type (cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy), and the data on the efficacy and safety were extracted.

RESULTS

In total, the search identified 55 papers which met the inclusion criteria. All four energy-based modalities, including cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy, were shown to be clinically effective in terms of both objective body measurements, such as fat layer thickness or circumference reduction, and subjective patient satisfaction. Furthermore, the abovementioned methods were proven to have a low side effect profile.

CONCLUSION

In conclusion, although evidence supports safety and efficacy, further well-designed trials are needed to strengthen confidence in long-term effectiveness and safety of noninvasive lipolysis.

Use of a microwave device for the treatment of cellulite and localized fat adiposity: a 1-year follow-up study

BACKGROUND

The body contour market has grown steadily over the last years, due to the persistent demand for non-invasive treatments for localized fat adiposities, cellulite, and skin laxity.

MATERIALS AND METHODS

The purpose of this observational study was to evaluate the efficacy and safety of a new device delivering microwaves (MWs) energy for unwanted fat and cellulite reduction after a full cycle of treatments and 1 year later. A total of 45 patients with localized adiposity and/or cellulite in different body areas (inner thigh, upper arm, abdomen, culotte de cheval, buttocks), received four treatment sessions, 4 weeks apart. Photographic records and global aesthetic improvement scale (GAIS) score were performed.

RESULTS

For the treatment of cellulite the average GAIS score passed from 3.65 ± 0.49 at 1-month follow-up (1MFU) to 2.7 ± 0.66 at 1-year follow-up (1YFU). For the treatment of localized adiposity, the average GAIS score passed from 3.52 ± 0.51 at 1MFU to 2.82 ± 0.88 at 1YFU. No particular red area was detected either during or after the treatment. There was no mention of assessment of pain or side effects.

CONCLUSIONS

The study findings showed that MWs allow for the treatment of cellulite and localized fat adiposity in a safe and effective way, with results lasting over time up to 1 year after the end of the treatment.

Objective Assessment of the Long-Term Volumizing Action of a Polycaprolactone-Based Filler

Background

The polycaprolactone-based filler, (PCL-1, Ellansé-S), forms part of the recently growing portfolio of biodegradable collagen-stimulating fillers. It is comprised of a suspension of 25-50 micron diameter microspheres of polycaprolactone (PCL) (30%) in a carboxymethyl cellulose (CMC) gel carrier (70%) and has gained popularity due to its long-term volumizing action.

Objective

This study outlines a retrospective case series of nine patients injected with the PCL-1, for volume augmentation in the mid-face. Objective volume calculations were performed with the Canfield Vectra 3D Imaging System at two time points post-implantation, with the objective of determining the longevity of the volumizing effect of the bio-stimulating substance.

Results

A clear increase in volume, between 50-150%, was found in all of the patients at two years, over and above the volume initially injected. All the patients were satisfied with the longevity of the results.

Discussion

The PCL-based filler is believed to afford immediate volume restoration due to the CMC gel component and a long-term action due to neo-collagenesis, induced by the PCL microspheres. The CMC gel is known to dissipate within 6-8 weeks, only to be replaced by new collagen induced by the PCL particles. Thus soft-tissue formation induced by the PCL particles, ultimately leads to a sustained volumizing effect.

Conclusion

The PCL-based filler is shown to have a sustained volumizing effects of at least 2 years duration with clear evidence of increase in volume over and above the volume injected, in all of the cases studied. This is indicative of significant neo-collagenesis induced by the PCL microspheres.

Efficacy and Safety of Cold-Induced Noninvasive Targeted Fat Reduction in Pseudogynecomastia

BACKGROUND

Treatment options for pseudogynecomastia are limited, and the demand for noninvasive breast fat reduction is increasing.

OBJECTIVE

We evaluated the efficacy and safety of a cold-induced lipolysis device for treating pseudogynecomastia.

METHODS

In this 16-week prospective trial, a total of 15 male patients with pseudogynecomastia were treated twice with cryolipolysis. The primary endpoint was a change in the chest circumference from baseline at posttreatment week 8. Secondary endpoints were changes in body weight, fat thickness assessed using ultrasonography, independent evaluator- and patient-rated improvement, and Simon's gynecomastia class (SGC) grading.

RESULTS

The primary assessment, a reduction of 3.05 cm in the mean chest circumference at 8 weeks post-treatment compared to baseline, was statistically significant. The treatment effect was cumulative, with a steady decrease in chest circumference and fat thickness over the 16-week study period. The mean pain score immediately after the first session of treatment was 2.0±1.36, based on a scale of 0~10, with a score of 10 being the worst pain ever experienced. The pain decreased substantially after the end of the procedure.

CONCLUSION

Cryolipolysis was demonstrated to be an effective and safe option for reducing breast fat in pseudogynecomastia. Male with mild to moderate breast enlargement without skin excess can be ideal candidates.

Cryolipolysis on More than One Body Area Increases Lipid Peroxidation without Changing Lipid Profile and Inflammatory Markers

In the present study, the effects of cryolipolysis on one and multiple body areas, assessing body composition, lipid profile and peroxidation and inflammatory markers were investigated. Twenty-four women aged between 20 and 59 years were randomly assigned to three groups: (1) control, (2) cryolipolysis on the abdomen and (3) cryolipolysis on the abdomen + flanks. Anthropometric measurements, bioimpedance and ultrasound were performed, as well serum lipid profile, lipid peroxidation markers (malondialdehyde and myeloperoxidase) and inflammatory markers (C-reactive protein and Interleukin-1β) were determined. In addition, food consumption and physical activity level were evaluated. Data were obtained at 0, 10 and 30 days (t0, t10 and t30) after cryolipolysis. Cryolipolysis did not change anthropometric measurements, body composition or lipid profile. Interestingly, the abdomen + flanks group had significantly increased plasma myeloperoxidase activity at t0, t10 and t30, and increased malondialdehyde levels at t0 and t10 when compared to the other groups. Furthermore, there were no differences between macronutrient intake and total energy value, physical activity level, malondialdehyde and interleukin-1β at t30. Cryolipolysis did not change body composition, lipid profile or inflammatory markers investigated. On the other hand, when used on the abdomen and flanks, it produced an increase in lipid peroxidation markers, malondialdehyde and myeloperoxidase.

Cryolipolysis for abdominal subcutaneous fat reduction: a prospective, multicenter, single arm, clinical study

BACKGROUND

Various treatment methods are used for noninvasive body contouring.

OBJECTIVE

To evaluate the efficacy and safety of a newly designed cryolipolysis device using a three-dimensional cooling method for abdominal fat reduction.

METHODS

Twenty-five participants with clinically apparent abdominal fat tissue participated in the study. The thickness of fat tissue below the umbilicus level was measured using a caliper at baseline and 12 weeks after the first treatment. The height of abdominal subcutaneous fat tissue on ultrasonography and participant satisfaction were assessed at every visit for 16 weeks. All adverse events (AEs) during the study period were recorded. P values <0.05 were considered statistically significant.

RESULTS

Twenty-four participants completed this study; the mean BMI of participants was 29.34±2.36 kg/m² . The mean thickness of abdominal subcutaneous fat was significantly lower at 12 weeks (40.4±6.8 mm, p<0.001) than at baseline (49.3±8.5 mm). Differences in the height of abdominal subcutaneous fat compared to that at baseline were 1.02±0.41 cm (12 weeks, p<0.001) and 1.13±0.44 cm (16 weeks, p<0.001). Rates of abdominal subcutaneous fat reduction at 12 and 16 weeks compared to that at baseline were 28.45% and 31.13%, respectively. The ratio of abdominal circumference to hip circumference at 12 and 16 weeks was significantly decreased compared to that at baseline. Most participants (95.8%) reported improvement in satisfaction scores at 16 weeks. There were no serious AEs during the entire study period.

CONCLUSION

The study demonstrated the efficacy of a noninvasive cryolipolysis device using a three-dimensional cooling method for reducing abdominal subcutaneous fat. This article is protected by copyright. All rights reserved.

High Participant Satisfaction Achieved Using Cryolipolysis for Fat Reduction of the Abdomen and Flanks

BACKGROUND

Patient-reported outcome (PRO) data evaluating the physical and psychosocial impact of cryolipolysis (CoolSculpting) treatment are limited.

OBJECTIVES

The aim of this study was to assess, by means of PRO instruments, multidimensional aspects of satisfaction following cryolipolysis treatment of the flanks and abdomen.

METHODS

This was a multinational, prospective, single-cohort, interventional study. The primary endpoint was the proportion of participants stating they were "satisfied" or "very satisfied" with treatment at 12 weeks post final treatment. Secondary endpoints included satisfaction categorized by treatment area, total number of treatment cycles, baseline BMI, and fat volume reduction measured by 3-dimensional photography at 12 weeks post final treatment. Exploratory endpoints assessed the physical and psychosocial impacts of treatment. Safety was monitored throughout the study.

RESULTS

Of 112 participants who were treated, 74.1% were female. The mean age and BMI were 42.5 years and 24.9 kg/mg2, respectively. Of the 106 evaluable participants, 89.6% were "satisfied" or "very satisfied" with treatment results. Satisfaction was high regardless of body area(s), total number of treatment cycles, or baseline BMI. Mean [standard deviation] fat volume reduction was 264.8 [411.4] mL. Overall, 90.6% reported "noticeable" or "very noticeable" fat reduction, 89.6% were "likely" or "very likely" to treat additional areas, and 93.4% would recommend cryolipolysis to a friend. Twenty-four (21.4%) participants reported treatment-emergent adverse events; 23 (20.5%) reported these as adverse device effects. No serious device-related or unanticipated adverse effects occurred.

CONCLUSIONS

Cryolipolysis (CoolSculpting) for fat reduction of the flanks and/or abdomen was well-tolerated and associated with high levels of satisfaction across multidimensional PROs.

LEVEL OF EVIDENCE: 4

Efficacy of a Novel Injection Lipolysis to Induce Targeted Adipocyte Apoptosis: A Randomized, Phase IIa Study of CBL-514 Injection on Abdominal Subcutaneous Fat Reduction

BACKGROUND

CBL-514 is a novel injectable drug that may be safe and efficacious for localized abdominal subcutaneous fat reduction.

OBJECTIVES

The aim of this study was to assess the safety and efficacy of CBL-514 in reducing abdominal subcutaneous fat volume and thickness.

METHODS

This Phase IIa, open-label, random allocation study consisted of a 6-week treatment period and follow-up at 4 and 8 weeks following the last treatment. Participants were randomly allocated to receive 1.2 mg/cm2 (180 mg), 1.6 mg/cm2 (240 mg), or 2.0 mg/cm2 (300 mg) of CBL-514 with up to 4 treatments, each comprising 60 injections into the abdominal adipose layer. Changes in abdominal subcutaneous fat were assessed by ultrasound at follow-up visits. Treatment-emergent adverse events were recorded.

RESULTS

Higher doses of CBL-514 (unit dose, 2.0 and 1.6 mg/cm2) significantly improved the absolute and percentage reduction in abdominal fat volume (P < 0.00001) and thickness (P < 0.0001) compared with baseline. Although the COVID-19 pandemic halted some participant recruitment and follow-ups, analysis was unaffected, even after sample size limitations.

CONCLUSIONS

CBL-514 injection at multiple doses up to 300 mg with a unit dose of 2.0 mg/cm2 is safe, well-tolerated, and reduced abdominal fat volume and thickness by inducing adipocyte apoptosis. Although other procedures exist to treat abdominal fat, they have limitations and may cause complications. At a dose of 2.0 mg/cm2, CBL-514 safely and significantly reduced abdominal fat volume by 24.96%, making it a promising new treatment for routine, nonsurgical abdominal fat reduction in dermatologic clinics.

LEVEL OF EVIDENCE: 4

Safety, Efficacy, and Tolerability of Simultaneous Bilateral Cryolipolysis Using a Rapid Cycling Contoured Cup Applicator for Noninvasive Fat Reduction in the Enlarged Male Breast: A Pilot Study

BACKGROUND

A previous study using a parallel cooling plate cryolipolysis applicator demonstrated the efficacy of cryolipolysis for pseudogynecomastia. Although the procedure was safe and effective, treatment times were prolonged and anesthetic was needed to reduce treatment discomfort.

OBJECTIVE

To evaluate the safety, efficacy, and tolerability of a short cycle, reduced vacuum contoured cup cryolipolysis applicator for the treatment of pseudogynecomastia.

MATERIALS AND METHODS

Twelve male subjects received simultaneous bilateral treatment consisting of a 35-minute cryolipolysis cycle, followed by a short manual massage, and a second 35-minute cycle with 50% treatment area overlap in a single treatment visit. At the 6-week follow-up, a second treatment was performed with up to 2 overlapping cycles per side. Efficacy was assessed after the second treatment using transcutaneous ultrasound, standardized clinical photography, and subject surveys.

RESULTS

Ultrasound analysis showed a mean fat layer reduction of 5.1 ± 2.3 mm (p < .001). Blinded, independent reviewers correctly identified 97% of baseline/treatment photography results. Surveys revealed 100% subject satisfaction with 91% reporting visible fat reduction and 100% stating they would recommend treatment. Transient side effects included mild intratreatment discomfort, paresthesia, and tenderness.

CONCLUSION

A rapid cycling, reduced vacuum cryolipolysis applicator provides rapid, safe, effective, and tolerable treatment of pseudogynecomastia.

Global Expert Opinion on Cryolipolysis Treatment Recommendations and Considerations: A Modified Delphi Study

Background

Cryolipolysis is an increasingly popular nonsurgical fat-reduction procedure. Published treatment guidance and adverse event (AE) management protocols are limited.

Objective

A modified Delphi study aimed to establish global expert consensus on the use of CoolSculpting (Allergan Aesthetics, an AbbVie Company, Irvine, CA), a noninvasive cryolipolysis treatment system.

Methods

A literature search informed survey topics for an 11-expert Delphi panel. Panelists completed an online 39-question survey. An interim panel discussion, with open-ended questions and yes/no voting, informed a second survey containing 61 statements, for which panelists rated agreement using a 5-point Likert scale. Topics included treatment outcome and responder definitions, patient evaluation and selection, treatment protocols, patient satisfaction, and AEs.

Results

Panelists achieved consensus on 38 final guidelines and recommendations. They reached moderate to complete consensus on 4 statements on defining responders (ie, patients with a range of visible improvement) and 6 statements on patient factors contributing to treatment outcomes (eg, how well the applicator conforms to patient body region). Panelists defined minimum numbers of treatment cycles to achieve visible clinical outcomes for 12 body regions, with moderate to complete consensus on 31 statements. They achieved a strong to complete consensus on 7 statements about patient satisfaction (eg, importance of patient expectations, visible improvement, and before-and-after photographs). Panelists defined management strategies for AEs, with moderate to complete consensus on 15 statements.

Conclusions

A modified Delphi process yielded multiple guideline recommendations for cryolipolysis, providing a needed resource for the broad range of clinicians who perform this noninvasive fat-reduction procedure.

Level of Evidence 5

Application of a Proposed Multi-Positional Circumferential Arm Liposuction Method and Quantification of its Clinical Efficacy Evaluation

BACKGROUND

Upper arm liposuction mainly focuses on the posterolateral region, which may lead to a lack of harmony between the aspirated and unaspirated areas. In addition, the treatment effect of arm liposuction is often evaluated only by preoperative and postoperative photograph comparison and simple measurement; quantitative research on this topic is still lacking.

METHODS

The multi-positional circumferential arm liposuction (MCAL) technique was proposed and applied to a total of 34 females in our hospital from 2017 to 2019. Three-dimensional data of 12 patients before the operation and after 2-3 months were collected and processed by 3D imaging, and the volume reduction rate was evaluated quantitatively.

RESULTS

The MCAL method was successfully applied in the clinic, and its surgical effect was quantitatively studied. The mean follow-up time of 12 patients was (75.2 ±13.1) days, and the postoperative volume was significantly reduced. The postoperative volume of patients with type I, type II and type III decreased by (10.79 ±2.55)%, (17.25 ±3.02)% and (22.76 ±3.51)%, respectively.

CONCLUSION

Our new MCAL technique was successful, maximizing the esthetic results in upper limb contour refinements in the superficial fascial layer. The clinical efficacy of this proposed MCAL method was evaluated by CT and 3D digital technology, which provided further accuracy in demonstrating its effect on the shape of the arm.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com .

The role and clinical benefits of high-intensity focused electromagnetic devices for non-invasive lipolysis and beyond: A narrative review and position paper

BACKGROUND

In 2018, the first device to use high-intensity focused electromagnetic (HIFEM) technology to non-invasively build muscle was brought to market. Even more recently, the first HIFEM and radiofrequency combination device designed to both build muscle and eliminate fat cells came into use (HIFEM+). In view of the increase in recently published original data pertaining to HIFEM, an advisory board recently convened to discuss the group's clinical experiences with this technology.

AIM

Communicate an advisory group's recommendations for the current use of HIFEM+ technology for aesthetic indications.

METHODS

An advisory board meeting to discuss challenges and opportunities for HIFEM devices in aesthetic medicine took place in November 2020, via remote conference. The expert advisory board consisted of a group of senior aesthetic physicians regularly treating patients with non-invasive body contouring devices. A narrative review of the literature and key recommendations from the meeting are presented herein.

RESULTS

To date, the combined results of several clinical studies (including over 500 patients and 30 investigators) support that patients treated with HIFEM+ experience on average, 30% less fat, 25% more muscle, 19% reduction in abdominal separation and up to 5.9 cm reduction in waist circumference. Moreover, HIFEM+ induces a 30% increase in satellite cell content, which is similar to the 36% increase observed following twelve weeks of exercise.

CONCLUSIONS

The advisory board unanimously agreed on several messages related to HIFEM technology, including that the pairing of HIFEM and radiofrequency (HIFEM+) enables a higher intensity of muscle stimulation and lipolysis, compared to HIFEM alone.

National market analysis for body contouring providers: Medical spas and physician practices

BACKGROUND

Non-invasive body contouring has experienced recent growth. To meet demand, medical spas and non-physician operators have grown. Insights into their practice can provide information on their impact.

OBJECTIVE

Our study investigated the current market distribution of body contouring providers in the aesthetic field.

MATERIALS AND METHODS

For the 30 most populous cities, data were collected for non-invasive body contouring providers in medical spas and physician practices. Descriptive ratios were calculated, and various local factors were examined.

RESULTS

The cities with the greatest number of body contouring providers were New York (138), Los Angeles (106), and Houston (87). Population size had a significant relationship, while median household income did not. For number of body contouring providers per 100 000 persons, the top cities were Austin (4.87), Houston (3.74), and Las Vegas (3.41). The mean ratio of providers in medical spas to physician practices was 1.81. In total, 70.0% of cities had equal or more body contouring providers in medical spas than physician practices.

CONCLUSION

Certain cities have experienced an unequal distribution of body contouring providers, and many cities are skewed in favor of medical spas over physician-based practices.

Fat Grafting in Radiation-Induced Soft-Tissue Injury: A Narrative Review of the Clinical Evidence and Implications for Future Studies

SUMMARY

Radiation-induced changes in skin and soft tissue result in significant cosmetic and functional impairment with subsequent decrease in quality of life. Fat grafting has emerged as a therapy for radiation-induced soft-tissue injury, and this narrative review aims to evaluate the current clinical evidence regarding its efficacy. A review was conducted to examine the current clinical evidence of fat grafting as a therapy for radiation-induced injury to the skin and soft tissue and to outline the clinical outcomes that can be used to more consistently quantify chronic radiation-induced injury in future clinical studies. The current clinical evidence regarding the efficacy of fat grafting to treat radiation-induced injury of the skin and soft tissue suggests that fat grafting increases skin softness and pliability, induces volume restoration, improves hair growth in areas of alopecia, reduces pain, and improves cosmetic and functional outcomes. However, literature in this field is far from robust and mired by the retrospective nature of the studies, lack of adequate controls, and inherent limitations of small case series and cohorts. A series of actions have been identified to strengthen future clinical data, including the need for physical examination using a validated scale, appropriate imaging, skin biomechanics and microcirculation testing, and histologic analysis. In conclusion, radiation-induced soft-tissue injury is a significant health burden that can lead to severe functional and aesthetic sequelae. Although still in a preliminary research phase, there is promising clinical evidence demonstrating the benefits of fat grafting to treat chronic changes after radiation therapy. Future clinical studies will require larger cohorts, adequate controls, and consistent use of objective measurements.

Feasibility Study of Electromagnetic Muscle Stimulation and Cryolipolysis for Abdominal Contouring

BACKGROUND

In addition to reducing subcutaneous fat for body contouring, some patients are interested in toning the underlying muscle layer.

OBJECTIVE

This feasibility study evaluated the safety and efficacy of electromagnetic muscle stimulation (EMMS) alone, cryolipolysis alone, and cryolipolysis with EMMS for noninvasive contouring of abdomen.

METHODS

Abdomens of 50 subjects were treated in a study with 3 cohorts: EMMS alone, Cryolipolysis alone, and Cryolipolysis + EMMS in combination. Electromagnetic muscle stimulation treatments were delivered in 4 sessions over 2 weeks. Cryolipolysis treatments were delivered in one session. Combination treatments consisted of one cryolipolysis and 4 EMMS visits. Efficacy was assessed by independent physician Global Aesthetic Improvement Scale (GAIS), circumferential measurement, Subject GAIS (SGAIS), and Body Satisfaction Questionnaire (BSQ).

RESULTS

Safety was demonstrated for all study cohorts with no device- or procedure-related adverse events. Independent photo review showed greatest mean GAIS score for the Cryolipolysis + EMMS cohort followed by Cryolipolysis only, then EMMS only cohort. BSQ showed greatest average score increase for Cryolipolysis + EMMS cohort followed by Cryolipolysis only cohort, then EMMS only cohort. Mean circumferential reduction measurements were greatest for Cryolipolysis + EMMS cohort followed by Cryolipolysis only, and then EMMS only cohort. The mean SGAIS improvement score was equal for the Cryolipolysis only and Cryolipolysis + EMMS cohorts, followed by the EMMS only cohort.

CONCLUSION

A multimodal approach using cryolipolysis and EMMS was safe and demonstrated enhanced body contouring efficacy for this feasibility study.

A German Prospective Study of the Safety and Efficacy of a Non-Invasive, High-intensity, Electromagnetic Abdomen and Buttock Contouring Device

OBJECTIVE: This study evaluated the efficacy of a novel treatment method utilizing high-intensity focused electromagnetic field (HIFEM) in reducing fat and strengthening the muscles in the abdominal and gluteal areas. METHODS: A total of 14 patients, aged 23 to 49 years (mean: 33.2 years) received four treatments on the abdomen and/or buttocks, each lasting for 30 minutes. Ultrasound imaging was performed at baseline, immediately post-treatment, and eight weeks after the last treatment to examine the changes in thickness of the rectus abdominis and subcutaneous fat. Additionally, waist circumference, digital photographs, and patient satisfaction were collected at the same time points. The improvement in digital images was evaluated by practitioners and the patients themselves. RESULTS: Two months after the treatments, ultrasound measurements showed, on average, a 15.7-percent reduction of subcutaneous adipose tissue and an average increase in the thickness of the rectus abdominis muscle by 26.1 percent. The abdominal circumference of the treated patients showed an average decrease of 2.84 centimeters. Immediately following the final session, the patient's satisfaction was 87.5 percent; eight weeks later, it was 100 percent. During the patient evaluation of photographs, 25 percent of the patients rated their appearance as improved, 66.7 percent as significantly improved, and 8.3 percent as greatly improved. Using the Global Aesthetic Improvement Scale, the medical practitioners rated the patients as 100-percent improved. No relevant side effects of the treatment were documented. CONCLUSION: The data collected on the HIFEM procedure evaluated here are in line with the results from clinical studies and applications of this treatment in the United States. These results support the efficacy and tolerability of the HIFEM procedure. The treatment achieved high doctor and patient satisfaction.

Cryolipolysis (CLL) for Reduction of Localized Subcutaneous Fat: Review of the Literature and an Evidence-Based Analysis

INTRODUCTION

In recent years, cryolipolysis (CLL), a noninvasive approach based upon the inherent sensitivity of adipocytes to cold injury, has emerged. However, it is not clear whether available evidence to date about its efficacy justifies aggressive marketing and extensive widespread application by many practitioners without well-defined indications or objectives of treatment. The current review is intended to evaluate available evidence regarding CLL mechanisms of action and its efficacy not only in fat reducing but also in its ability to result in an aesthetically optimal outcome.

MATERIALS AND METHODS

A systematic search of PubMed and Scopus computerized medical bibliographic database was conducted with the search terms "cryolipolysis," "lipocryolysis," and "cool sculpting." Selection criteria included all matched reports with the search terms in their titles.

RESULTS

Thirty-two reports matched the inclusion criteria of this review. Five experimental studies were identified and included to further supplement the discussion.

CONCLUSION

Most reports about CLL included in this review lacked rigorous scientific methodology in study design or in outcome measurement. Serious concerns about integrity of many of these reports, particularly with respect to validity of photographic outcome documentation in addition to objectivity, conflict of interest issues, and commercial bias, have been expressed. Further research should be encouraged to prove with methodological rigor positive effects of this treatment modality and to determine categories of patients in whom most favorable outcomes might be expected.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Adverse Events Associated With Cryolipolysis: A Systematic Review of the Literature

BACKGROUND

Cryolipolysis is a popular procedure for people seeking noninvasive body contouring. As with any novel therapy, it is critical for providers to familiarize themselves with related adverse events (AEs), to provide appropriate information to patients before treatment.

OBJECTIVE

To describe reported complications and AEs associated with cryolipolysis.

MATERIALS AND METHODS

A systematic review was completed using the PubMed database and following search terms: "cryolipolysis" or "lipocryolysis" or "CoolSculpting." Only randomized clinical trials, prospective cohort studies, retrospective studies, case series, and case reports describing AEs related to cryolipolysis as well as studies written in English were included for review.

RESULTS

Fifty-three articles were included in this review. The most common AEs associated with cryolipolysis were treatment site erythema, numbness/paresthesia, bruising, and edema. More serious complications of cryolipolysis include severe/persistent pain, dysesthesia, skin hyperpigmentation, motor neuropathy, and paradoxical adipose hyperplasia.

CONCLUSION

Cryolipolysis is a safe option for patients seeking noninvasive body contouring. Most reported AEs are minimal and resolve quickly. It is important that physicians are aware of serious, irreversible AEs and are prepared to counsel patients appropriately before treatment.

Histopathological Features of Tissue Alterations Induced by Cryolipolysis on Human Adipose Tissue

BACKGROUND

Adipose tissue cooling, under controlled conditions, induces physical effects on subcutaneous tissue called cryolipolysis (CLL), which has been proposed as a method to reduce noninvasively the amount of adipose tissue. Although CLL has been widely utilized in clinical practice and many favorable results have been reported in clinical studies, very few published studies have dealt with the effects of such therapies on human adipose tissue.

OBJECTIVES

The aim of this study was to evaluate, through histopathological examination, the in vivo effects of CLL on human adipose tissue.

METHODS

Six patients to be submitted to abdominoplasty were enrolled in the study. Samples were taken from the surgical patch, respectively, 15 days (2 pts), 45 days (2 pts), and 60 days (2 pts) after a single standard session of CLL. Control samples were derived from the nontreated areas of the surgical patch.

RESULTS

Disruption of the adipocytic membranes was evident in all treated areas, with a reduction of cell dissolution in the 60-day samples. Focal dissolution and homogenization of the collagen fibers was evident, resulting in the dissolution of the interlobular fibrous septa. A mild inflammatory response was observed in the 15- and 45-day samples. Neocapillarizzation was observed in the 45- and 60-day samples.

CONCLUSIONS

The lesions demonstrated in adipocytes confirm the theoretical premises of a usefulness of CLL in the treatment of localized adiposis. The alterations in the connective stroma could lead to a structural reorganization and consequently to the in vivo external appearance of the treated areas.

LEVEL OF EVIDENCE: 5

A 3-Dimensional Quantitative Analysis of Volume Loss Following Submental Cryolipolysis

BACKGROUND

Cryolipolysis is a proven and effective means of fat reduction; however, there are no standardized means of measuring volume reduction.

OBJECTIVES

We aim to assess the volume loss using a 3-dimensional (3D) analysis following submental cryolipolysis.

METHODS

A retrospective cohort study between April 2016 and August 2018 was performed. Thirty-five patients underwent a single 45-minute cycle of cryolipolysis to the submental region using the CoolSculpting System. A 3-fold analysis was performed employing an independent observer assessment of 2-dimensional photographs and 3D volumetric analysis utilizing the Vectra XT system, and patient satisfaction was measured with the FACE-Q questionnaire.

RESULTS

Our results suggested the mean (standard deviation) pretreatment volume (n = 35) was 104.12 cm3 (28.78). The 6-week mean posttreatment volume (n = 26) was 81.55 cm3 (21.29). The mean volume reduction found at 6 weeks posttreatment showed a reduction of 22.46 cm3 (19.10) (95% CI 14.74 to 30.17, P < 0.0001). The 12-week mean posttreatment volume (n = 24) was 82.24 cm3 (23.97). The 12-week posttreatment demonstrated a reduction of 22.30 cm3 (14.04) (95% CI 16.37 to 28.23, P < 0.0001). The mean percentage correct for each reviewer correctly identifying the pretreatment and posttreatment photograph was 76.33% (7.14). Patient satisfaction showed a mean FACE-Q score of 54.10 (20.41).

CONCLUSIONS

The study further affirms that submental cryolipolysis is an efficacious and safe, noninvasive method for reducing submental adiposity resulting in notable patient satisfaction rates. Furthermore, results suggest that patients can have a volume loss of about 20% on average, allowing them to be more confident and comfortable with their appearance.

LEVEL OF EVIDENCE: 4

Cryolipolysis for Noninvasive Contouring of the Periumbilical Abdomen With a Nonvacuum Conformable-Surface Applicator

BACKGROUND

Although most cryolipolysis treatments are performed with vacuum applicators, some patients may have areas of fibrous, nonpinchable fat or find vacuum suction to be uncomfortable.

OBJECTIVE

This study evaluates a nonvacuum conformable-surface applicator for cryolipolysis of the periumbilical abdomen.

METHODS/MATERIALS

Twenty subjects with periumbilical subcutaneous fat were treated with a nonvacuum cryolipolysis applicator in this prospective, single-center, open-label clinical trial. Each subject underwent a single treatment cycle with an optional second treatment 10 weeks later. Efficacy was evaluated by blinded review of digital photographs. Subject satisfaction was assessed at 10-week follow-up.

RESULTS

Twenty subjects completed one treatment, of which 6 underwent the optional retreatment. Independent review demonstrated 77% correct identification of baseline photographs after one treatment, which improved to 100% after a second treatment. Patient questionnaires after one treatment revealed 50% satisfaction, with 60% willing to recommend the procedure and 60% reporting visible fat reduction. After second treatment, however, 100% were satisfied, 83% were willing to recommend, and 100% reported visible fat reduction.

CONCLUSION

Cryolipolysis with a nonvacuum conformable-surface applicator is safe, effective, and well tolerated for noninvasive reduction of fibrous periumbilical abdominal fat. Efficacy and subject satisfaction is significantly greater with 2 treatments than with a single session.

Effects of cryolipolysis on lower abdomen fat thickness of healthy women and patient satisfaction: a randomized controlled trial

OBJECTIVE

To analyze the effects of cryolipolysis on the fat thickness of the lower abdomen of healthy women and patient's satisfaction.

METHODS

Design and setting: a randomized controlled trial, with concealed allocation and blinded assessor.

PARTICIPANTS

34 healthy women between 18 and 48 years, skinfold in the lower abdomen ≥3cm, BMI between 18.5 and 27kg/m², low level of physical activity, and no contraindication to cryolipolysis were allocated to intervention group (IG, n=17) or control group (CG, n=17).

INTERVENTIONS

The IG received one session of cryolipolysis with -10°C of temperature for 50min. The CG was not submitted to any kind of intervention. Both groups did the evaluation protocols at baseline, 30, 60 and 90 days after the intervention.

MAIN OUTCOME MEASURES

fat thickness was measured by ultrasonography (US), skinfold (SF) and abdominal circumference (AC1 and AC2).

RESULTS

No significant differences between the IG and CG were demonstrated at any evaluation at any time of follow up for the variables US (30 days: 0.05cm (95%CI: -0.12; 0.22), 60 days: 0.05cm (95%CI: -0.11; 0.20) and 90 days: 0.04cm (95%CI: -0.7; 0.25)), SF (30 days: -0.09cm (95%CI: -0.25; 0.08), 60 days: -0.14cm (95%CI: -0.36; 0.09) and 90 days: -0.001cm (95%CI: -0.237; 0.234)), AC1 (30 days: 0.42cm (95%CI: -1.1; 1.9), 60 days: -0.1cm (95%CI: -1.74; 1.54) and 90 days: -0.007cm (-1.9; 1.9)) and AC2 (30 days: 0.183cm (95%CI: -0.84; 1.20), 60 days: -0.13cm (95%CI: -1.61; 1.35) and 90 days: -0.31cm (95%CI: -1.61; 1.00)).

CONCLUSIONS

The current study showed that a single application of the utilized protocol of cryolipolysis does not produce any significant effect on fat thickness of the lower abdomen of healthy women.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03160976 (https://clinicaltrials.gov/ct2/show/NCT03160976). Contribution of the Paper: the study is one of the first studies in the literature with methodological rigor to report an unfavorable result for localized abdominal fat treatment with a single session of cryolipolysis.

3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia

BACKGROUND

Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume.

OBJECTIVES

To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume.

METHODS

Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System^® before and 6 months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume.

RESULTS

When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4 mL) showed significant differences (p < 0.001) 6 months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5 mL) and after (120 ± 34.6 mL) centrifugation.

CONCLUSION

Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Utilisation of Cryolipolysis among Asians: A Review on Efficacy and Safety

Cryolipolysis is a non-invasive fat reduction method that is capable of reducing subcutaneous fat significantly without damaging surrounding tissues, by applying cold temperature to induce adipocyte apoptosis. Most of the clinical studies in cryolipolysis were conducted in the Caucasian population, and only a few numbers in Asian, who has darker skin with Fitzpatrick skin type III to V. Higher rate of pigmentary changes were reported with the use of cryotherapy in darker skin. Therefore, this report is aimed to provide a comprehensive review regarding utilisation, efficacy and safety profiles of cryolipolysis among Asians. Currently, there are only four clinical trials conducted exclusively in an Asian population. Two studies were conducted in Korea, whereas others in China and Thailand. Cryolipolysis was performed in the abdomen, arm, inner thighs, and submental regions. The reported side effects were mild and transient, including erythema, hematoma, numbness, and pain. There were no pigmentary changes reported. Although only limited data available, those studies have proved that cryolipolysis utilisation among Asians or darker skin types provides the same efficacy and safety profiles as in Caucasians. Therefore, cryolipolysis might be proposed as the first treatment choice for Asian patients who opted to do body contouring.

Precision in 3-Dimensional Surface Imaging of the Face: A Handheld Scanner Comparison Performed in a Cadaveric Model

BACKGROUND

Handheld 3-dimensional surface imaging (3DSI) devices of various precision are becoming more versatile in their applications and more widely accepted by clinicians for documentation.

OBJECTIVES

The authors sought to compare the precision of facial volumetric change measurements of 3 3DSI devices in the cadaveric model: Eva (Artec 3D Inc., Luxembourg), Sense (3D Systems, Rock Hill, SC), and iSense (3D Systems, Rock Hill, SC).

METHODS

A total of 336 scanning and analysis procedures were carried out in 4 cephalic specimens (mean age, 77.25 ± 24.3 years; mean BMI, 21.76 ± 6.6 kg/m2). Two superficial and 2 supraperiosteal regions of interest were injected with 0.5-cc aliquots and subsequently scanned using the 3 different scanners. Correlation coefficients between the injected and measured volume were computed.

RESULTS

The correlation coefficient for the Eva scanner was for subcutaneous regions of interest rp = 0.935 and for the supraperiosteal regions of interest rp = 0.966, compared with rp = 0.760 and rp = 0.364 (superficial vs supraperiosteal) for the Sense and rp = 0.694 and rp = 0.382 (superficial vs supraperiosteal) for the iSense scanner.

CONCLUSIONS

3DSI devices are capable of measuring surface volume changes of the face at a level of 0.5-cc surface volume change and can thus be regarded as useful tools in the preinterventional, intrainterventional, and postinterventional phases of a treatment. One of the 3 evaluated scanners provided very high correlation coefficients between the injected and the measured volume (Eva), whereas the other evaluated 3DSI devices provided moderate (Sense) and low (iSense) coefficients.

Double stacking cryolipolysis treatment of the abdominal fat with use of a novel contoured applicator

Background: Cryolipolysis is a noninvasive method for the selective reduction of subcutaneous fat. The abdomen and flank area are most commonly treated sites and now the treatment efficacy became the important issue. Objectives: To evaluate the effectiveness and safety of double stacking cryolipolysis treatment with the novel contoured applicator for abdominal fat reduction. Materials and methods: 12 healthy Korean were treated using cryolipolysis contact device. The device was applied on participant's left lower abdomen. Performance was held for 35 minutes and immediately repeated the second performance. The right abdomen was left untreated. Participants were examined with high resolution ultrasound and the depth of subcutaneous fat layer was measured initially and 8 weeks after the sessions. Any adverse events were assessed during the entire study period. Results: The subjective reduction of abdominal fat was noted in most participants. No serious adverse events was reported. Reduction of subcutaneous fat layer depth was confirmed in high resolution ultrasound after 8 weeks of treatment. Conclusion: The results of this study indicate that abdominal fat can be reduced effectively by the novel cryolipolysis applicator. With subjective satisfaction of participants our study shows that double stacking treatment appears safe and well tolerated with enhanced treatment outcomes.

Chances and limitations of a low-cost mobile 3D scanner for breast imaging in comparison to an established 3D photogrammetric system

BACKGROUND

In search of new possibilities in 3D surface imaging, several nonmedical scanning systems have been assessed for their implementation in plastic surgery. The aim of this study was to compare a new affordable 3D imaging consumer product with an established medical 3D imaging system for objective 3D breast imaging.

METHOD

We compared a low-cost mobile, handheld scanner against an established medical 3D surface imaging system. Forty-two female patients who underwent different types of breast surgery were captured in a 3D view with both devices. Digital breast measurement, volume measurement, and breast surface-to-surface analysis were done using Mirror software. Repeatability was assessed by repeated 3D scans of the torso and surface-to-surface analysis.

RESULTS

Digital breast measurement showed low differences with good-to-excellent correlation between both devices. Mean breast volume difference was small (-5.11 ± 32.10 mL) within the 95% limits of agreement. Surface-to-surface analysis yielded a higher surface deviation in the lower breast quadrants (1.62 ± 0.80 mm root mean square [RMS] error and 1.81 ± 0.88 mm RMS error) than in the upper breast quadrants. Repeatability was satisfactory with a mean of 0.636 ± 0.279 mm RMS error.

CONCLUSION

Affordable mobile surface scanners may offer new perspectives in the future for 3D breast imaging. Although surface acquisition was sufficient for breast measurements in comparison to an established system, the lack of appropriate medical software for patient consultation next to moderate texture quality needs to be improved for wider acceptance in plastic surgery.

A customized approach for arm fat reduction using cryolipolysis

OBJECTIVES

Cryolipolysis of the arms has been demonstrated to be an effective treatment for non-invasive reduction of subcutaneous fat. This study evaluated the safety and efficacy of the concurrent use of a new commercially-available small applicator in conjunction with an existing medium sized applicator for the customized treatment of arm fat.

METHODS

Bilateral arms of 15 eligible subjects were simultaneously treated using one or two vacuum applicators with flat contours. Either a medium or small cryolipolysis applicator with an oblong cup-shaped cooling surface was selected to treat upper arm fat. The shape of the fat bulge in each subject's arm was assessed and up to two treatment cycles (-11°C for 35 minutes each) were delivered to each arm in one session, based upon investigator discretion. Throughout the procedure and at the completion of each treatment cycle, investigators assessed the subject's level of comfort, as well as sensory and motor nerve effects. Post-treatment manual massage was performed, and clinical assessments of each treatment site were recorded. Adverse events were recorded to monitor procedural safety. Baseline and 12 weeks post-treatment photographs and ultrasound measurements were taken to assess efficacy. Subject questionnaires were administered to evaluate satisfaction.

RESULTS

Fifteen female subjects (mean age of 51.1, mean BMI of 26.8) completed the study. Ultrasound imaging revealed statistically significant fat layer reduction of 2.5 mm (SD ± 2.4 mm, 95%CI 1.6-3.3). Subject surveys administered 12 weeks post-treatment demonstrated 87% satisfaction with the arm cryolipolysis procedure. A panel of blinded, independent physicians correctly identified 83% of the before and after photos. Clinical assessments found adverse events were mild and included erythema and mild swelling that resolved without intervention. Mild treatment area numbness was reported by 73% of subjects at the 4-week interim visit and fully resolved at the 12-week visit.

CONCLUSION

This study documents the first reported customized approach for assessment and treatment of arm fat using a small or medium cup applicator with varied applicator placement. By incorporating one or two treatment cycles per arm in a single session, the issue of variable fat distribution in people's arms can be addressed. This approach was shown to be a safe and effective way to reduce unwanted arm fat with high patient satisfaction. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Cryolipolysis for the treatment of submental fat: Review of the literature

BACKGROUND

Submental fat accumulation is a common cosmetic concern. Cryolipolysis utilizes noninvasive cooling to lyse adipocytes. A cryolipolysis device was recently approved for treatment of submental fat.

OBJECTIVE

This manuscript provides a review of the preclinical work and clinical trials related to cryolipolysis for the treatment of submental fat. Settings, efficacy, and side effects are also discussed.

MATERIALS AND METHODS

A literature search was performed through Pubmed, EMBASE, Web of Science, and CINAHL, using the search terms "cryolipolysis," "submental," and "paradoxical adipose hyperplasia". Additional sources from the original source bibliographies were used to further supplement this review.

RESULTS

There are 4 clinical trials and one case series (total 101 patients) that evaluated the use of cryolipolysis for treatment of submental fat. In these studies, there was a statistically significant reduction in submental fat and patients expressed high satisfaction with the treatment. Adverse effects were mild and transient.

CONCLUSIONS

Cryolipolysis is a noninvasive cooling technique that is safe and effective for treatment of submental fat. To date, there are no reports of marginal mandibular nerve injury or paradoxical adipose hyperplasia following treatment with this device.

A split-body study evaluating the efficacy of a conformable surface cryolipolysis applicator for the treatment of male pseudogynecomastia

BACKGROUND

Cryolipolysis is a non-invasive method of body shaping that has been used for male pseudogynecomastia. However, traditional vacuum suction cryolipolysis requires a minimum pinchable fat layer which may not always be present in this area.

OBJECTIVE

To evaluate the efficacy and safety of a conformable surface cryolipolysis applicator for the reduction of male pseudogynecomastia.

MATERIALS AND METHODS

Ten male subjects with pseudogynecomastia received two cycles of cryolipolysis to the breast 6 weeks apart. Ultrasound was used to measure the thickness of adipose tissue.

RESULTS

Seven of 10 patients completed the study. Compared to baseline, the mean ± SD change in adipose tissue thickness was 8.12 ± 6.94 mm for the treated versus 1.03 ± 6.03 mm for the control breast at week 6 (p = 0.014), and 8.71 ± 7.04 mm for the treated vs. 2.66 ± 7.04 mm for the control breast at week 12 (P = 0.16). Four (4) of seven (57%) patients were at least slightly satisfied with the treated breast, and although subject satisfaction was higher in the treated breast, this did not reach significance (0.085). Adverse events were mild and transient.

CONCLUSION

A conformable surface cryolipolysis applicator was effective in reducing the mean adipose tissue thickness in subjects with male pseudogynecomastia. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Noninvasive Body Contouring: A Male Perspective

Noninvasive body contouring is an attractive therapeutic modality to enhance the ideal male physique. Men place higher value on enhancing a well-defined, strong, masculine jawline and developing a V-shaped taper through the upper body. An understanding of the body contour men strive for allows the treating physician to focus on areas that are of most concern to men, thus enhancing patient experience and satisfaction. This article discusses noninvasive body contouring techniques, taking into account the unique aesthetic concerns of the male patient by combining an analysis of the existing literature with our own clinical experience.

Evaluation of facial blood flow using three-dimensional scanning

The Vectra X3 3-dimensional face scanner allows us to visualise the erythema of superficial layers of skin in addition to its regular scanning functions. The aim of our study was to find out whether changes we provoked in the circulation of the skin would be registered and displayed by the face scanner. We measured the circulation in the skin of the cheeks of 20 volunteers with a face scanner, a laser Doppler device, and a skin pigmentation analyser before and after the application of a nitric oxide cream. The results were compared in terms of grey tones, local concentrations of haemoglobin, and erythema. All methods showed significant changes (p<0.001) before and after application of the cream. The study proved that the Vectra X3 recognises changes in skin circulation and displays them in a simple and evident way.

Cryolipolysis for Nonsurgical Reduction of Fat in the Lateral Chest Wall Post-Mastectomy

BACKGROUND

Many patients that have undergone mastectomy surgery are left with residual lateral fat under the arm. While the fat may be associated with pain and cause undesirable bulges in clothing and skin irritation, most post-mastectomy patients are not interested in additional surgery.

OBJECTIVES

Cryolipolysis is a nonsurgical procedure for fat reduction. The procedure is typically performed for aesthetic improvement in the abdomen, thighs, and flanks, but cryolipolysis was explored in this study for reconstructive purposes. Efficacy was evaluated for nonsurgical reduction of lateral chest wall thickness post-mastectomy.

METHODS

A contoured cup vacuum applicator was used to treat 31 post-mastectomy patients under the arms. All subjects had undergone mastectomy but had never received cryolipolysis or any surgical procedures to reduce lateral chest wall fat. Treatments were evaluated by independent photo review and patient surveys.

RESULTS

Three blinded, independent physicians correctly identified 84% of the baseline photographs, demonstrating treatment efficacy. The surveys also found that 87% of subjects reported that cryolipolysis met their expectations; 84% noticed reduction in undesirable tissue; 85% reported better bra fit; and 74% noted that clothing fit more comfortably. Patient questionnaires reveal quality of life improvements post-treatment. While 61% of subjects reported pain in the lateral wall prior to the study, when queried post-treatment, only 13% reported pain; the remaining 87% reported no lateral wall pain.

CONCLUSIONS

Results from this study indicate that cryolipolysis nonsurgically reduces unwanted fat and may reduce discomfort from residual lateral chest wall fat in post-mastectomy patients.

LEVEL OF EVIDENCE 4

Multiple same day cryolipolysis treatments for the reduction of subcutaneous fat are safe and do not affect serum lipid levels or liver function tests

Objective

Cryolipolysis is a safe and effective non‐surgical procedure for reducing subcutaneous fat. It spares adjacent structures, is associated with few adverse events, and is well‐tolerated by patients. Previous studies involving one or two simultaneous treatment sites have shown no effect on serum lipid levels or liver tests. The purpose of this study was to determine whether multiple same day treatments (abdomen plus both flanks) result in changes in these blood tests, and is safe.

Study Design

Thirty‐five adult males and females underwent same‐day cryolipolysis (CoolSculpting System, ZELTIQ Aesthetics) of the lower abdomen and flanks for reduction of subcutaneous fat. Serum lipids and liver tests were measured prior to treatment and at 1, 4, and 12 weeks post‐treatment. Expected treatment side‐effects were assessed immediately post‐treatment and at the 12‐week follow‐up visit. Adverse events were also monitored.

Methods

Treatment consisted of one cycle to the lower abdomen using a large vacuum applicator and simultaneous treatment of both flanks, one cycle each, with medium vacuum applicators .Time between the abdomen and flanks procedures was not to exceed 30 minutes.

Results

The procedures were well‐tolerated by patients; expected treatment effects were in general mild or moderate, and resolved without intervention. There were no clinically meaningful changes from baseline to any subsequent time point in any serum lipid test. This was also true for all liver tests. There were no treatment‐related adverse events.

Conclusion

Multiple cycle, same day cryolipolysis treatment of the lower abdomen and both flanks is well‐tolerated and safe. It does not lead to changes in serum lipids or liver tests at any of the measured time points following the procedure. Lasers Surg. Med. 49:640–644, 2017. © 2017 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals Inc.

Frostbite following cryolipolysis treatment in a beauty salon: a case study

This case study describes frostbite, a previously unreported complication following cryolipolysis, which resulted in substantial necrosis of the flank. Medical attention was not sought until one week after treatment. On examination, two distinct areas of significant frostbite in the left flank with surrounding erythema were revealed. Surgical intervention was avoided, as is recommended in cases of frostbite, and conservative treatment resulted in recovery of the affected area. Here, the authors highlight the adverse effects related to cryolipolysis, analysing the pathogenesis, clinical manifestations and management of this injury. The necessity of regulation within the cosmetic sector and the challenges associated with its implementation are also described. The authors believe emphasis must be placed on increasing patient awareness on the potential hazards of seeking cosmetic treatment from unregulated providers.

Color Doppler Ultrasound Assessment of Activity in Keloids

BACKGROUND

The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated.

OBJECTIVE

To assess the sonographic activity of keloids in comparison with clinical scoring.

MATERIALS AND METHODS

A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement).

RESULTS

Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU.

CONCLUSION

Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.

Prospective Controlled Study of Buttock Fat Transfer Using Ultrasound and Photographic Measurements

Supplemental Digital Content is available in the text.

Background:

Buttock fat transfer is now the preferred method for gluteal augmentation. However, its efficacy has not been well-documented using measurements.

Methods:

Twenty-five consecutive patients underwent buttock fat transfer performed by the author. Twenty-one patients returned for measurements ≥3 months after surgery (inclusion rate, 84%). A separate group of 25 patients undergoing cosmetic surgery without buttock fat transfer served as controls. All patients underwent superwet liposuction using total intravenous anesthesia and no prone positioning. A closed filtration system was used to collect the fat. Subcutaneous fat thickness was assessed using ultrasound imaging. Measurements were made on standardized photographs. The data were controlled for change in body mass index. Clinical data were also evaluated.

Results:

The mean fat volume injected per buttock was 287 mL (range, 70–550 mL). Ultrasound measurements detected a significant increase in the subcutaneous fat thickness (P ≤ 0.001), with mean increments of 0.66 cm for the right buttock and 0.86 cm for the left buttock and no significant change for control patients. The mean calculated fat retention, based on the measured surface area injected, was 66%. Photographic measurements of buttock projection revealed a significant increase in treated patients (P < 0.01) and no significant change in control patients. There were no clinical complications at either recipient or donor sites and no evidence of oily cysts on ultrasound examinations.

Conclusions:

Photographic and ultrasound measurements, and clinical findings, confirm that buttock fat transfer effectively and safely increases buttock projection.

Health technology assessment of non-invasive interventions for weight loss and body shape in Iran

BACKGROUND

The burden of obesity and diet-related chronic diseases is increasing in Iran, and prevention and treatment strategies are needed to address this problem. The aim of this study was to determine the outcome, cost, safety and cost-consequence of non-invasive weight loss interventions in Iran.

METHODS

We performed a systematic review to compare non-invasive interventions (cryolipolysis and radiofrequency/ ultrasonic cavitation) with semi-invasive (lipolysis) and invasive (liposuction). A sensitive electronic searching was done to find available interventional studies. Reduction of abdomen circumference (cm), reduction in fat layer thickness (%) and weight reduction (kg) were outcomes of efficacy. Meta-analysis with random models was used for pooling efficacy estimates among studies with the same follow-up duration. Average cost per intervention was estimated based on the capital, maintenance, staff, consumable and purchase costs.

RESULTS

Of 3,111 studies identified in our reviews, 13 studies assessed lipolysis, 10 cryolipolysis and 8 considered radiofrequency. Nine studies with the same follow-up duration in three different outcome group were included in meta-analysis. Radiofrequency showed an overall pooled estimate of 2.7 cm (95% CI; 2.3-3.1) of mean reduction in circumference of abdomen after intervention. Pooled estimate of reduction in fat layer thickness was 78% (95% CI; 73%-83%) after Lipolysis and a pooled estimate of weight loss was 3.01 kg (95% CI; 2.3-3.6) after lipousuction. The cost analysis revealed no significant differences between the costs of these interventions.

CONCLUSION

The present study showed that non-invasive interventions appear to have better clinical efficacy, specifically in the body shape measurement, and less cost compared to invasive intervention (liposuction).

Quantification of adipose volume reduction with a prospective study analyzing the application of external radiofrequency energy and high voltage ultrashort pulse duration electrical fields

To date, there have been no objective measurements of subcutaneous volume loss following treatments with a noninvasive radiofrequency (RF)-based device. Twenty female patients were treated with a suction-coupled bipolar RF device using external RF energy combined with pulsed electromagnetic RF energy for subcutaneous fat reduction. Parameters followed included weight, Vectra measurements of abdominal circumference and torso volume, and high-definition ultrasound measurements of fat thickness. Measurements were taken before treatment and three times following treatment. Analysis of the measured parameters showed that mean circumference reduction of 2.30 cm was noted at three months post-treatment. Independent volumetric analysis showed a mean subcutaneous volume reduction of 428 cc three months following RF treatment. High-resolution ultrasound fat thickness was reduced by a mean of 39.6% three months following the final BodyFX treatment. Independent and paired-sample t-tests showed a p value of < 0.05. Repeated measures of analysis of covariance (ANCOVA) adjusted for differences in age, as well as height and weight (proxy for body mass index) to minimize individual differences and control for extraneous variables that may affect the pre- and post-treatment results were analyzed. No confounding variables were found. All analyses were conducted using IBM SPSS 21.0.

Objective Assessment of the Precision, Accuracy, and Reliability of a Measurement Method for Keloid Scar Volume (PARKS Study)

BACKGROUND

There is no accepted and validated method for quantitatively measuring keloid scar volume.

OBJECTIVE

The goal of this study was to develop a measurement method for ear keloid scar volume that is economical, practical, safe, reproducible, accurate, and precise.

METHODS

Ten synthetic keloids of various shapes and sizes were temporarily attached to the ears of 5 subjects. Three study raters molded each of the attached synthetic keloids and surrounding tissue of each of the subjects twice using a polyvinyl siloxane dental impression material to form a negative impression of the keloid. Once the impression material cured, the mold was removed from the subjects' ears and randomized for measurement by study raters. Molds were filled with distilled water and weighed to obtain the weight of water required to fill the impression of the keloid.

RESULTS

The test method defined by this study accurately and precisely measures the volume of a focal protrusion extending beyond the normal surface plane of a test subject's ear. The calculated intrarater correlation coefficient values for both the intrarater and interrater reliabilities were >0.75.

CONCLUSION

The techniques and methods used in this study resulted in an accurate and reliable method for measuring ear keloid scar volumes.

Cryolipolysis versus laser lipolysis on adolescent abdominal adiposity

BACKGROUND

Noninvasive body contouring is one of the fastest growing segments of the cosmetic aesthetic industry. There is increased public demand for procedures with fewer side effects and shorter recovery times. Cryolipolysis and Laser lipolysis have been used as treatments for localized body contouring.

OBJECTIVE

To compare the effect of Cryolipolysis versus Laser lipolysis on adolescent's abdominal adiposity.

DESIGN

Randomized, controlled trial.

SUBJECTS

Forty-five obese adolescents of both sexes ranged in age from 13 to 16 years participated in this study were to be categorized into three groups of equal number (each group 15 subjects) randomly selected from population.

METHODS

Participants were randomly assigned to three groups. Group A was received (Cryolipolysis and diet), Group B was received (Laser lipolysis and diet), Group C was received (only diet) all groups were observed for 8 weeks. Weight and height scale for (change in weight), tape measurement for (waist-hip ratio), skinfold caliper, and MRI.

RESULTS

There was no significant difference between three groups post-treatment in BMI and body weight P-value were (0.2, 0.42, 0.67), respectively. There was a significant improvement for Cryolipolysis group in waist-hip ratio, Suprailiac skin fold, and subcutaneous adipose tissue than other groups P-value (0.001).

CONCLUSIONS

Cryolipolysis has a favorable effect than Laser lipolysis in the reduction of waist-hip ratio, skin folds at Suprailiac level and subcutaneous adipose tissue (SAT), there is no significant difference between them in the reduction of BMI and body weight. All groups did not have an effect on VAT.