Cryolipolysis for local fat reduction in adults from Brazil: A single-arm intervention study

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.

The Synthesis of Europium-Doped Calcium Carbonate by an Eco-Method as Free Radical Generator Under Low-Intensity Ultrasonic Irradiation for Body Sculpture

Body sculpture is a common method to remove excessive fat. The diet and exercise are the first suggestion to keep body shape; however, those are difficult to keep adherence. Ultrasound has been developed for fat ablation; however, it could only serve as the side treatment along with liposuction. In the study, a sonosensitizer of europium-doped calcium carbonate (CaCO₃: Eu) would be synthesized by an eco-method and combined with low-intensity ultrasound for lipolysis. The crystal structure of CaCO₃: Eu was identified by x-ray diffractometer (XRD). The morphology of CaCO₃: Eu was analyzed by scanning electron microscope (SEM). The chemical composition of CaCO₃: Eu was evaluated by energy-dispersed spectrophotometer (EDS) and inductively coupled plasma mass spectrometer (ICP-MS). The electronic diffraction pattern was to further check crystal structure of the synthesized individual grain by transmission electron microscope (TEM). The particle size was determined by Zeta-sizer. Water-soluble tetrazolium salt (WST-1) were used to evaluate the cell viability. Chloromethyl-2′,7′-dichlorofluorescein diacetate (CM-H₂DCFDA) and live/dead stain were used to evaluate feasibility in vitro. SD-rat was used to evaluate the safety and efficacy in vivo. The results showed that CaCO₃: Eu had good biocompatibility and could produce reactive oxygen species (ROS) after treated with low-intensity ultrasound. After 4-weeks, the CaCO₃: Eu exposed to ultrasound irradiation on SD rats could significantly decrease body weight, waistline, and subcutaneous adipose tissue. We believe that ROS from sonoluminescence, CO₂-bomb and locally increasing Ca²⁺ level would be three major mechanisms to remove away adipo-tissue and inhibit adipogenesis. We could say that the combination of the CaCO₃: Eu and low-intensity ultrasound would be a non-invasive treatment for the body sculpture.

Ultrasound assessment of abdominal adipose panniculus in patients treated with a single session of cryolipolysis in a clinical setting

Objective

To assess the effectiveness and safety of cryolipolysis treatment (four‐to‐six cycles in one session) for reducing abdominal fat.

Methods

Retrospective study conducted on consecutive healthy women who underwent one session of cryolipolysis for abdominal fat reduction. Ultrasound images (USI) were acquired at baseline and at month 6 after treatment. A patient‐tailored approach based on adipose tissue depth and architecture was selected.

Results

Thirty women were included. The mean age was 51.4 ± 3.4 years, and 27 (90%) were menopausal. At month 6, the mean abdominal fat layer thickness reduction was 46.6% (41.2%–51.9%). The mean contour was significantly reduced from 84.3, 99.2, 90.6, and 97.1 cm to 81.0, 93.6, 85.8, and 92.2 cm in the infracostal, supraumbilical, umbilical, and ischiopubic regions, respectively; p < 0.0001 each. There were no significant changes in weight, body mass index, fat mass, or lean mass throughout the study. After adjusting for smoking, exercise, hypothyroidism, and type of fat, there was a significant reduction in abdominal fat layer thickness (−4.5 ± 0.9 mm, p < 0.0001) and contour measurements in infracostal (−3.3 ± 2.4 mm, p = 0.0317); supraumbilical (−4.8 ± 2.1 mm, p = 0.0254); umbilical (−5.6 ± 2.3, p = 0.0161); and ischiopubic (−4.9 ± 1.8 mm, p = 0.0080). The qualitative analysis of the USI suggested the appearance of numerous bands of ordered and structured collagen fibers.

Conclusions

Four‐to‐six cycles of cryolipolysis, administered in one session, seemed to be a safe and effective procedure for reducing localized fat in the abdominal region in this sample. Additionally, ultrasound images suggested that cryolipolysis was associated with a skin quality improvement and neocollagenesis.

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 .