Whether good or bad, it’s a fact that the ever-evasive pursuit to be skinny is embedded in our culture. From celebrity iconization to the media anti-fat bias to mass marketing, thin is in. With that comes constant and, often times, unspoken social pressures to maintain an idealized body.

Enter aesthetic medicine: Cosmetic surgery has been on the rise—in a big way. The American Society of Aesthetic Plastic Surgery, the uncontested authoritative body of aesthetic medicine, estimates that Americans spent more than $13.5 billion on combined surgical and non-surgical procedures in 2015, with liposuction topping the list as the most popular surgical procedure. Notably, non-surgical procedures accounted for 42% of total expenditures in 2015.

The trend for non-invasive procedures continues to rise at a logarithmic rate. Why? Two reasons. First and foremost, there is a significant proportion of the population interested in aesthetic enhancements that are simply unwilling to undergo an invasive surgical procedure. The reasons vary from intrinsic fears of surgery, itself, to prohibitive costs and to the inability to incur significant downtime often required following a formidable surgical procedure. The second—and arguably more compelling reason for the rise in non-invasive treatments—lies in technological breakthroughs and scientific advancements. Advances in science have seen commensurate advances in aesthetic medicine. One of the benefactors of this has been the space of non-invasive energy-based body contouring—the main players being Cynosure’s Sculpsure and Zeltiq’s Coolsculpt.

  • Do these procedures work? Absolutely. These technologies deliver on their promise of reducing subcutaneous fat quickly and painlessly.
  • Are these procedures a replacement for traditional lipoplasty? Not at all, but no one is contesting that. Sculpsure and Coolsculpt offer a viable alternative to liposuction for those patients not interested in more invasive surgery, with a promise of modest results, as compared to traditional lipoplasty.


The science

In 2015, Cynosure’s Sculpsure received FDA clearance for the disruption of fat cells for aesthetic use. The device works by a controlled hyperthermic injury to fat cells by utilizing a 1064-nm diode laser to heat the adipocytes under the skin to temperatures between 42°C and 47°C. Once the temperature window is reached, the fat cells fall into a state of shock and die over the course of several weeks. Once deceased, the fat cells are naturally cleared by the body’s immune system, with the treated area subsequently shrinking. A cooling system on the applicator head keeps the skin chilled during the procedure, thus preventing risk of thermal injury or burns. Because the skin is unaffected, this mechanism allows for the treatment of all skin types, from fair to dark-skinned individuals. No anesthesia is required, and there is no downtime. Pain is minimal.

Studies verified by the FDA concluded an average of 13% of normalized fat reduction based on ultrasound evaluation at the 12-week mark, with a 98% patient satisfaction rate. Independent studies presented at the annual American Society for Laser Medicine and Surgery Conference found up to 24% fat reduction with a single treatment, which was verified by MRI.

The Sculpsure procedure is quick compared to its competitors, taking 25 minutes from initiation of treatment to completion. The device has 4 separate applicators, thus allowing for variability in treatment; larger areas of interest can be treated with all 4 applicators. Conversely, the device allows for the flexibility to treat multiple areas at once should the patient’s particular needs require that.

Zeltiq’s Coolsculpting device represents the other major player in the non-invasive body contouring device space. In 2010, Zeltiq received FDA Clearance for fat reduction of the flank region through the process of cryolipolysis. Unlike Sculpsure, which utilizes thermal energy to disrupt fat cells, Coolsculpting’s mechanism of action is that of controlled cooling, whereby fat cells on the body are targeted and cooled through the strategic placement of an applicator which selectively cools the targeted region. Because fat cells have a greater sensitivity to cold than do other types of surrounding tissue such as skin or muscle, the fat cells become cold shocked and slowly perish through a process called apoptosis. The body then slowly eliminates the fat cells over the course of months. The running time for the procedure takes one hour, with a single treatment producing a 20% to 25% reduction in subcutaneous fat, on average. Much like Sculpsure, no anesthesia is required, and the procedure is relatively pain-free with no recovery time. Rare side-effects include late-onset nerve pain, paroxysmal hyperplasia, and areas of demarcation secondary to treatment.

The interest in aesthetic procedures continues to rise, with liposuction consistently staying at the top of the most popular procedures performed in the United States and worldwide. Technological advancements now allow for the treatment of stubborn areas of love handles and tummy fat without the need for surgery. Sculpsure and Coolsculpting are two such devices which offer a viable alternative to surgery and are able to consistently get rid of unwanted fat in a predictable manner. While these products are, by and large, at their infancy in terms of what they can accomplish as compared to surgery, it is nonetheless exciting to see the introduction of such devices. Over time, we can anticipate a day where this fat reduction technology will evolve to the point of producing true full-body 4-D high-def liposculpture, currently available with more invasive modalities such as the VaserLipo.

The landscape of aesthetic medicine is and will continue to evolve at a dramatic rate with an emphasis on the non-invasives. These procedures promise ever increasingly dramatic results, with little downtime, minimal pain, reduced risk, and most importantly, devoid of the need for the scalpel. Stay tuned: The future of aesthetic medicine is bright.

Glenn Vallecillos, MD, FACS
Glenn Vallecillos, MD, FACS is a Board Certified Plastic Surgeon and a Member of the American Society of Plastic Surgeons. He runs an aesthetic innovation think tank in Beverly Hills, California and has spent the last eight years as a Senior Faculty of Scientiae/Palette’s Alloplastic Injectable Filler and Neuromodulator Training Program, having personally trained over 800 physicians and medical professionals in all levels of surgical and non-surgical aesthetic enhancement. Dr. Vallecillos also holds a consultancy bioengineering position for Hans Biomed, and is a partner in a venture consultancy firm specializing in translational medicine technologies. Dr. Vallecillos has a practice emphasis on revision rhinoplastic and breast surgery, 4D hi-def body contouring, and hyperesthetic facial rejuvenation.


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