Shape Shifting

Physicians share their experiences with the growing range of noninvasive fat reduction technologies.
Image: a sculpture of a woman's torso

In the five years since Zeltiq’s CoolSculpting device first received U.S. Food and Drug Administration (FDA) approval for the noninvasive destruction of fat in the abdomen, the medical aesthetics industry has seen an array of FDA-cleared fat reduction technologies enter the market. Each is designed to permanently thin down thighs, blast away back flab, whittle middles or slim chin chub with minimal or no downtime.

“Through social media and the internet, consumers are seeing that these nonsurgical treatments actually deliver,” says Jonathan Kaplan, MD, a San Francisco-based plastic surgeon. The benefit to practices, he says, is that these procedures are appealing to consumers who would never undergo surgery, yet are greatly bothered by unwanted areas of fat.

To help you determine whether these technologies—and which ones—are a good fit for your patient base, we spoke with plastic surgeons and dermatologists who are using the latest fat-reduction modalities in their own practices and asked them to share their experiences.

Submental Fat: The New Frontier

Prior to the 2015 FDA approval of Allergan’s injectable Kybella (deoxycholic acid) for the treatment of submental fat, fat reduction and body contouring treatments typically focused on the abdomen, trunks, thighs and arms. Patients who wanted to rid themselves of their double chins had only the option of surgery, liposuction or radiofrequency (RF)-based skin tightening, which could only firm the area for minimal results.

“Kybella is based on mesotherapy,” explains Denver-based plastic surgeon Manish H. Shah, MD. “Its advantages are that it is easy to perform, patient discomfort is minimal and results are permanent.”

But there are downsides: “Many patients need several treatments. (Practitioners can perform up to six treatments spaced one month apart, according to Allergan.) The treatment zone is mostly located in the central neck, leaving lateral neck fat untreated. Results take up to eight weeks to manifest in most patients, and the social downtime is extensive,” says Dr. Shah, who recently underwent the procedure himself so he could offer patients a firsthand account of what to expect.

“I had noticeable swelling in my neck for a good two weeks—I looked like a little frog—as well as numbness in the area that disappeared by 10 weeks post-treatment,” he says.
Jennifer Herrmann, MD, participated in the Kybella clinical trials and continues to offer the procedure in her Beverly Hills, California-based dermatology practice. She finds that most patients require two or three treatments, and she charges $600 per vial, with one to two vials required per session.

“Downtime depends on patient factors and how much product is injected,” she says. “Patients on blood thinners may experience more bruising, and those who have higher volumes injected may have swelling that lasts up to a few weeks. I typically space injections every four to six weeks.”

Image: Getty Images.