For many people, getting rid of excess fat can be a lifelong battle. Whether it is undesirable love handles, excess fat around the knees or flabby upper arms, pockets of fat can be difficult to reduce and sometimes diet and exercise are not enough to make a noticeable difference. Now, dermatologists are finding that the introduction of non-invasive fat removal technologies is opening the door for more people who are not candidates for liposuction to remove stubborn fat, safely and effectively.
"Fat cells are by nature very different than other cells, particularly in how they respond to stimuli such as temperature," said dermatologist Lisa M. Donofrio, MD, FAAD, associate clinical professor, department of dermatology, Yale University School of Medicine, New Haven, Conn. "Most of the new technologies recently introduced for fat removal were developed based on this knowledge and, as a result, can target specific areas of body fat using energy delivered as either heat or cold."
Radiofrequency: A Hot New Way to Target Fat
One of the newest fat reduction technologies is radiofrequency, which delivers energy to the areas of fat by driving controlled heat deep within the fat cells and subsequently destroys them. While radiofrequency has not yet been approved by the U.S. Food and Drug Administration (FDA) for fat removal, Dr. Donofrio explained that the technology is being widely used by dermatologists with much success for people with pockets of excess fat. Since there is no downtime with this procedure, patients can resume their regular activities immediately.
"Radiofrequency is a very versatile procedure that can be used on any area of the body -- from large areas like the abdomen to very small areas such as the chin -- with the same degree of success," said Dr. Donofrio. "For people who are not considered overweight but have stubborn pockets of unwanted fat that are not responding to diet and exercise, radiofrequency is a good option."
Another benefit of radiofrequency is its ability to both reduce fat and tighten the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Dr. Donofrio might use radiofrequency to tighten the skin first and then remove excess fat. However, if she determines that there is mostly fat in an area, she would remove the fat first and then tighten the skin afterward.
Cryolipolysis: Putting the Freeze on Fat
A new, non-invasive procedure approved by the FDA that is being used to remove localized areas of fat in the lower abdomen or along the sides of the body is cryolipolysis. Since fat cells are more sensitive to cold temperatures than other skin cells, cryolipolysis freezes the lipids in fat cells which then slowly dissolve with no trauma or injury to surrounding tissues. For this reason, results are not immediate and fat layer reduction becomes visible gradually over the course of two to six months.
"While cryolipolysis is a very innovative approach for fat reduction, the machine itself is limiting and not as versatile as radiofrequency -- as it currently only allows for the treatment of larger areas of fat," explained Dr. Donofrio. "However, future developments in cryolipolysis could enable dermatologists to treat the inner thighs, neck and arms for more refined fat reduction."
Ultrasound Starting to Make Waves in Fat Reduction
Ultrasound, using high-intensity, focused ultrasonic waves (sound waves) to cause destruction and leakage of fat cells, is being investigated for fat reduction. Similar to other non-invasive procedures used for fat reduction, the ultrasound energy penetrates through the skin layers into the targeted fat without harming skin or surrounding tissues. Dr. Donofrio explained that the difference with ultrasound is that it involves the mechanical destruction of fat cells that dissolve gradually over time rather than destruction by temperature extremes.
"Although ultrasound is not FDA approved yet for fat removal, it could be another option in the future for people who want to target specific areas of fat without surgery," said Dr. Donofrio. "At this point, more data is needed to determine its effectiveness in fat reduction."
Results Still Require Patience
Dr. Donofrio added that since radiofrequency, cryolipolysis and ultrasound are external devices, they only affect the surface of the fat layer and require multiple treatment sessions (typically four sessions) to produce the best results.
These non-invasive procedures are not meant to replace tumescent liposuction for fat removal. Tumescent liposuction is a controlled, precise procedure, whereas the external devices require a "wait-and-see" approach in which the dermatologist will evaluate how the fat is responding. The candidates for tumescent liposuction often are not the same as candidates for an external fat reduction treatment. For example, patients who are taking blood thinners or have a contraindication for surgical procedures are not good candidates for tumescent liposuction but could be candidates for a non-invasive procedure.
"While these new, non-invasive technologies are good, they are simply not as effective in removing fat as an invasive procedure like liposuction," said Dr. Donofrio. "It's important for patients to remember that invasive treatments for fat removal are medical procedures that should be performed by a board-certified doctor who has education, training and expertise in this procedure, such as a dermatologist."
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