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

Innovation of the protocol for the application of cryolipolysis: Effects and mechanisms of action

BACKGROUND

In recent years, aesthetic procedures aiming at body remodeling and have grown exponentially. Cryolipolysis (CLL) has stood out as a noninvasive resource that acts directly on the subcutaneous adipose tissue promoting a significant reduction of adipose tissue through of cooling that could lead to the crystallization cytoplasmic lipids, loss of cellular integrity, apoptosis/necrosis of adipocytes, and local inflammation, producing selective loss of adipose tissue. Thus, the objective of the present study was to evaluate the effects of a specific technique of CLL application on the inflammatory reactions of the target tissue in different post-application times.

METHODS

This is a randomized, blind clinical study that evaluated the tissue sample of six patients after 45, 60, and 90 days of an innovative protocol for the application of CLL, with samples collected through abdominoplasty surgeries. The samples were evaluated by immunohistochemical analyses of several markers.

RESULTS

A significantly greater increase in fibroblasts was observed at 45 days and greater phagocytic action at 60 days. Regarding the apoptosis process, the expression of caspase 3 and cleaved caspase 3 markers varied at different times, with cleaved caspase 3 being higher at 45 and 90 days after CLL application.

CONCLUSION

The protocol of the CLL presented in this study was able to induce inflammatory responses in addition to confirming the selective apoptotic action at the different times studied.

Non-invasive Body Contouring Technologies: An Updated Narrative Review

INTRODUCTION

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices.

METHODS

We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring.

RESULTS

Totally 193 references were used in 11 main topics.

CONCLUSION

In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section.

LEVEL OF EVIDENCE I

This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Active Heating following Cryolipolysis Reduces Efficacy and Side Effects: A Randomized Split-Body Trial

BACKGROUND

Cryolipolysis-a popular noninvasive technique for body contouring-has fewer side effects compared with liposuction; however, its effectiveness in terms of reducing local adipose tissue is also lower. This study is, to the authors' knowledge, the first prospective, controlled, investigator-blinded split-body trial to evaluate whether postcryolipolytic heating can increase the efficacy.

METHODS

Twenty-five subjects were treated with one session of cryolipolysis on the lower abdomen and a subsequent heating with a mud pack of a randomized side of the treated region (left or right). Epidemiologic, temperature, edema, erythema, hypesthesia, and pain level data were obtained. Photographs, fat layer thickness (on ultrasound, caliper, and abdominal girth), satisfaction, and side effects were documented over a follow-up period of 12 weeks.

RESULTS

The side effects-edema, erythema, and hypesthesia-faded almost completely with heating, whereas they remained on the nonheated site. However, the mean sonographic reduction of local adipose tissue after 12 weeks was significantly lower on the heated sites than on the control sites (9.6% versus 14.1%; P = 0.0003). The overall satisfaction was high (9.2 of 10 points), even though only 44% of participants had a subjective recognition of fat loss without difference between the sites.

CONCLUSIONS

Active heating following cryolipolysis increases bodily well-being by reducing common side effects, but it reduces the effectiveness of cryolipolysis significantly and should therefore be avoided. Further improvements are necessary to enhance the efficacy of cryolipolysis.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, I.

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 (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 .