Liposuction is a type of
cosmetic surgery that removes
fat from the human body in an attempt to change its shape.[5] Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect
obesity related problems.[6][7] In the United States it is the most commonly done cosmetic surgery.[8][9]
The procedure may be performed under general, regional, or local
anesthesia and involves using a cannula and negative pressure (suction) to suck out fat.[8] It is believed to work best on individuals of normal or near normal weight and good skin elasticity.[8]
Post operational downtime can last anywhere from 2 – 4 weeks to 3 full months for patients to fully heal and be able to resume normal activities.[12]
Noninvasive
Ultrasound
Focused thermal ultrasound techniques work by raising the tissue temperature up to 48 °C,[13] resulting in coagulative necrosis of adipocytes, with sparing of vessels and nerves. Passive heating of the skin may also induce collagen remodeling.[14][15][16]
Hydrolipoclasy is a technique that is being studied as an alternative to
liposuction.[17] It involves injecting a
hypotonic solution into an area of fat and then subjecting it to
ultrasound waves.[17]
Low level laser light
Low level laser light reduces the stability of
adipocyte cell membranes, allowing cells to release their stores of fat without damaging the cell.[18]
Cryolipolysis
Cryolipolysis, for instance with
CoolSculpting, is a method intended to remove fat by freezing.[19][20][21] It involves controlled application of
cooling within the temperature range of −11 to +5 °C (+12.2 to +41 °F) for the localized reduction of
fat deposits, intended to reshape the contours of the body.[19][20] The degree of exposure to cooling causes
cell death of
subcutaneous fat tissue, without apparent damage to the overlying
skin.[20][22] It appears primarily applicable to limited discrete fat bulges.[19][20][23]
Adverse effects include transient local redness, bruising and
numbness of the skin, and these are expected to subside.[20][23] Typically, sensory deficits (numbness) will subside within a month. The effect on peripheral nerves was investigated and failed to show permanent detrimental results.[22]
Another adverse effect is paradoxical adipose hypertrophy (PAH) which causes fat tissue to grow larger rather than become reduced in size as a consequence of the procedure.[24][25] Supermodel
Linda Evangelista has initiated legal action for damage caused by PAH.[26][27] Some studies indicate that PAH side effects are common on a per-patient basis, since a typical patient receives multiple treatments.[28]
Based on the premise that fat cells are more easily damaged by cooling than skin cells (such as
popsicle panniculitis), cryolipolysis was developed to apply low temperatures to tissue via thermal conduction.[29] In order to avoid
frostbite, a specific temperature level and exposure are determined, such as 45 minutes at −10 °C (14 °F).[20][30] While the process is not fully understood, it appears that fatty tissue that is cooled below body temperature, but above freezing, undergoes localized cell death ("
apoptosis") followed by a local inflammatory response that gradually over the course of several months results in a reduction of the fatty tissue layer.[20][22][30]
Typical cost per treatment area varies depending on location. Price in the US ranges from $750 to $1,500,[31] with UK prices about £750 per area to be treated.[32] In the U.S., the CoolSculpting procedure is FDA-cleared for the treatment of visible fat bulges in the
submental area, thigh, abdomen and flank, along with bra fat, back fat, underneath the
buttocks, and upper arm.[21]
Regulatory status
In 2010, Zerona, another low-level laser treatment, was cleared for marketing by the FDA as an infrared lamp.[33] Zeltiq obtained FDA marketing clearance for
cryolipolysis of the flanks, and in 2012 received marketing clearance for cryolipolysis of the abdomen.[20] This treatment has also been cleared for the treatment of the upper arm, back fat, bra fat, banana roll, submental area, and thighs.[34]
Various lipolysis techniques including
injection lipolysis, RF, laser, ultrasound, and cryolipolysis were forbidden in France by a decree of the French Public Health Authority in 2011. The decree was revised in 2012, distinguishing invasive techniques, which remain forbidden, from permitted non-invasive techniques; laser, RF, ultrasound and cryolipolysis that did not penetrate the skin became legal, and injection lipolysis and
mesotherapy remained illegal. Laser devices that involve inserting the probe through the skin transcutaneously but do not suck out the liquefied material are also prohibited. Surgeons are permitted to perform surgical liposuction techniques using laser-assisted lipolysis so long as suction is performed.[35][36]
^
abMulholland, RS; Paul, MD; Chalfoun, C (July 2011). "Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level laser therapy". Clinics in Plastic Surgery. 38 (3): 503–20, vii–iii.
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^Ortiz, AE; Avram, MM (September 2015). "Noninvasive body contouring: cryolipolysis and ultrasound". Seminars in Cutaneous Medicine and Surgery. 34 (3): 129–33.
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10.12788/j.sder.2015.0171.
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^Seretis, Konstantinos; Goulis, Dimitrios G; Koliakos, Georgios; Demiri, Efterpi (2015). "Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: A Systematic Review". Obesity Surgery. 25 (10): 1950–8.
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^Seretis, K; Goulis, DG; Koliakos, G; Demiri, E (December 2015). "The effects of abdominal lipectomy in metabolic syndrome components and insulin sensitivity in females: A systematic review and meta-analysis". Metabolism: Clinical and Experimental. 64 (12): 1640–9.
doi:
10.1016/j.metabol.2015.09.015.
PMID26475176.
^Jewell, Mark L.; Solish, Nowell J.; Desilets, Charles S. (October 2011). "Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound". Aesthetic Plastic Surgery. 35 (5): 901–912.
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^Sklar, Lindsay R.; El Tal, Abdel Kader; Kerwin, Leonard Y. (Apr 2014). "Use of transcutaneous ultrasound for lipolysis and skin tightening: a review". Aesthetic Plast. Surg. 38 (2): 429–41.
doi:
10.1007/s00266-014-0286-6.
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^Nestor, Mark S.; Newburger, Jessica; Zarraga, Matthew B. (March 2013). "Body contouring using 635-nm low level laser therapy". Seminars in Cutaneous Medicine and Surgery. 32 (1): 35–40.
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^
abcColeman, SR; Sachdeva, K; Egbert, BM; Preciado, J; et al. (2009). "Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves". Aesthetic Plastic Surgery. 33 (4): 482–8.
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^
abNelson, AA; Wasserman, D; Avram, MM (2009). "Cryolipolysis for reduction of excess adipose tissue". Seminars in Cutaneous Medicine and Surgery. 28 (4): 244–9.
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