Choosing the right fat reduction technique

Before and after treatment with UltraShape 

The FDA’s recent clearance of SculpSure (Cynosure) shines a light on the billowing demand for noninvasive lipolysis and the promise that unwanted fat will vanish without a prick or incision. Dermatologists and others faced with the daunting decision of which technologies to purchase or rent should also know there are clear differences between what invasive and noninvasive fat reduction can accomplish, according to William P. Coleman, III, M.D.

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Dr. Coleman, editor in chief of Dermatologic Surgery, clinical professor of dermatology and adjunct professor of surgery (plastic surgery) at Tulane University Health Sciences Center, New Orleans, was a clinical investigator for the FDA trials for UltraShape (Syneron Candela). He presented “The skinny on fat reduction: invasive versus noninvasive” at the October 2015 American Society of Dermatologic Surgery (ASDS) annual meeting in Chicago.

Patient choice critical for success

The most important thing dermatologists can do is to choose the right patients for the right fat reduction options.

“Many who come in asking for non-invasive treatment have to be advised to have liposuction. If you rely on noninvasive devices only, you are not doing a first-class job,” Dr. Coleman says.

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Nine in 10 patients who consult him for fat removal will benefit far more from local anesthesia liposuction than any of the noninvasive devices. Not only that, but liposuction will cost them less, he says.

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The key: minimal fat deposits

Noninvasive fat removal has its place in body sculpting. The key for dermatologists who want happy patients is to know that place, according to Dr. Coleman.

The ideal candidate for noninvasive fat reduction is a person at their ideal body weight, with isolated, small accumulations of fat, he says.

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“I do not perform non-invasive fat removal on patients who have more than minimal fat deposits. This only leads to disappointment,” he says.

Among today’s noninvasive technologies, each has its attributes, but be careful of the trade names the dermatologist says.

“… for instance CoolSculpting (Zeltiq) does not sculpt, but is more of a block treatment. UltraShape truly sculpts, but can only destroy superficial fat,” he says.

Noninvasive approaches can also be used in conjunction with liposuction to tweak areas that have not responded satisfactorily to liposuction or noninvasive lipolysis, Dr. Coleman says.

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Liposuction hard to beat

With as easy as today’s liposuction procedure is on patients, calling it invasive sounds nonsensical to most dermatologists who perform the procedure, according to Dr. Coleman.

Liposuction has advanced considerably with the introduction of local anesthesia liposuction (or the tumescent technique) and the evolution of very small cannulas. Both innovations were by dermatologists, says Dr. Coleman.

And there are perks to liposuction beyond fat removal.

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“All procedures are done under local anesthesia and most report it is easier than a dental procedure. Our typical patient is driving and doing light exercise the next day. We can re-inject some of the fat removed into the face or buttocks, and only one procedure is required compared to multiple non-invasive treatments,” he says.

In fact, Dr. Coleman says, liposuction is a better alternative for addressing all body areas of unwanted fat.

“Only small adipocytes are suitable for noninvasive techniques,” he says.

Disclosure: Dr. Coleman is an investigator for UltraShape’s (Syneron Candela) FDA trials.