Body Contoring

• Body Contouring

  Non-surgical or surgical procedure that aims to reshape an area of the body to get rid of extra skin, eliminate excess fat, and reshape or contour the area
• Body Contouring

  • The right treatment depends on the patient's goal
  • Not intended for weight loss
  • Healthy lifestyle and weight maintenance are essential to maintain results
• Non-surgical Body Contouring

  • Little to no downtime
  • No general anesthesia, incisions or scars
  • Side effects are minimal
  • Gradual onset of results allows patients to be discreet about treatments
  • Results can last as long as a patient maintains his or her weight
  • Fat reduction
  • Smooth cellulite
  • Tighten skin
  • Rejuvenate vaginal tissues
• Non-surgical Body Contouring

  • Less dramatic results
  • Reduces fat only (minimal sculpting ability compared to liposuction)
  • Cannot choose exactly how much fat is lost, only estimate a percentage
  • Multiple treatments may be needed to achieve desired results
  • May not be suitable for patients with significant amounts of fat to lose
• Patient Selection for Non-surgical Body Contouring

  • At or near their ideal body weight who do not need significant reshaping in an area
  • Reduce isolated pockets of diet and exercise resistant fat
• Body Contouring (Pre-Treatment)

  1. Detailed patient medical history including previous treatment methods

  2. Determine if patient suitable for treatments

  3. Discuss options and make recommendations

  4. Inform the patient of typical treatment results and possible adverse effects

  5. Accurate patient expectations

  6. Consent forms

  7. Always record for better continuity of care

  8. Before and after photos
• Non-surgical treatment modalities

  • Cryolipolysis – coolsculpting
  • Radiofrequency
  • HIFEM
  • High-intensity focused ultrasound
  • Laser therapy
  • Injection lipolysis
• Cryolipolysis

  • Use freezing temperatures to crystalize and break down fat cells
  • Temperature just low enough to freeze fat cells
  • Fat cell apoptosis
  • Removed by body through a natural inflammatory clearing process
• Cryolipolysis Devices

  • Zeltiq CoolSculpting
  • Clatuu 360
  • CoolTech
• Comparing Cryolipolysis Brands

  • Safety and risk of side effects
  • Effectiveness
  • Cost
• Contraindications for Cryolipolysis

  • Loose skin
  • Cryoglobulinemia
  • Cold urticaria
  • Paroxysmal cold hemoglobinuria
  • Raynaud's phenomenon
• CoolSculpting

  • FDA-approved
  • Selectively targets and destroys subcutaneous fat cells without damaging surrounding tissue
  • Removed through natural inflammatory clearing process
  • Results are not instant - 20% to 25% reduction of fat after 6 months
  • Results are operator dependent
  • General rule – repeat 2 sessions for same area
  • Treatment interval 1 month apart
  • Expensive treatment
  • Very high consumable cost
  • Cost per cycle from RM2800
• CoolSculpting Applicator Types

  • COOL ADVANTAGE (CoolFit, Coolcurve, CoolCore) - 35 min
  • COOL ADVANTAGE PETITE (Flat, Curve+, Curve) - 35 min
  • COOL ADVANTAGE PLUS (CoolCurve, CoolCore) - 45 min
  • COOL MINI - 45 min
  • COOL SMOOTH PRO - 75 min
• Coolsculpting treatment process

  1. A gel pad applied to targeted treatment area

  2. Applicator (cupped device) placed on top of gel pad

  3. Strong suction power pinching at treatment area followed by cool sensation

  4. Discomfort (pulling, pinching, mild ache, cramping) diminish 3-5 mins after Rx as area become numbed

  5. Treatment time: 35 to 60 min per cycle

  6. Immediately after Rx, area massaged
• Coolsculpting Side Effects

  • Immediately after: Redness, swelling, mild bruising
  • 2 weeks after: Redness, tender, itchy, numbness
  • Serious side effect rare: vasovagal sxs - giddy, nausea, lightheadedness, sweating
• Possible Coolsculpting Complications

  • Excess fat removal - indentation
  • PIH
  • Paradoxical fat hyperplasia
  • Frostbite (local injury due to cold)
  • Hernia or worsening of existing hernia
• Radiofrequency (RF)

  • RF energy is a form of electromagnetic current
  • RF generates heat when passing through tissue
  • Generates temperatures 7x higher in subdermal adipose tissue compared to dermis
  • Fat necrosis
  • RF technology has been used for skin tightening and wrinkle reduction, and localized fat reduction and body sculpting
• Radiofrequency (RF) Technologies

  • Monopolar
  • Bipolar
  • Multipolar
• Radiofrequency (RF) Machines

  • Thermage (Monopolar)
  • Vanquish (Multipolar)
  • Exilis Ultra (Monopolar + Ultrasound)
• Thermage Radiofrequency (RF)

  • Patient selection: Age 30 to 60s with moderate skin laxity, not much benefit for obese patient or extreme skin redundancy
  • Treatment areas: Flanks, upper/lower abdomen
  • Safe for all skin types
  • Dissolves fat cells
  • Tightening effects continue for months following treatment
  • Side effects: erythema, burns, blistering, edema, transient hyperpigmentation
• Thermage treatment

  1. Treatment time: 55 to 70 mins

  2. Monitor for excessive pain/heat

  3. Signs of erythema or oedema

  4. Expected outcomes: mild erythema or oedema

  5. Single session
• Vanquish Radiofrequency

  • Uses radio frequency to heat the fat
  • Contactless, hands-free
  • The applicator heats from a distance of one cm from the skin
  • Treats a larger area
  • Abdomen, love handles
  • Done without anaesthesia
  • Treatment time: 30 m
  • Repeated once a week, 4-6 sessions
• HIFEM (High-intensity focused electromagnetic technology)

  • Uses a powerful but harmless form of electromagnetic stimulation
  • These magnetic fields create electrical currents
  • Induces muscle contractions not achievable voluntarily
  • Result in growth and multiplication of muscle fibres
  • When muscles contract enough times, begin to build muscles and burn fat
• HIFEM Devices

  • EmSculpt
  • EmSculpt Neo
• EmSculpt Neo and EmSculpt

  • Can treat patients up to BMI 35
  • Treatment areas: Abdomen, buttocks, thighs, arms, calves
  • EmSculpt Neo: Four 30-min session scheduled 5-10 days, 30% reduction in subcutaneous fat, 25% increase in muscle mass
  • EmSculpt: Four 30-min session every 2-3 days, less fat reduction
• HIFEM Contraindications

  • Pacemakers
  • Implants
  • Hemorrhagic conditions
  • Heart disorders
  • Pregnancy
  • Following recent surgery
  • Epilepsy
• Best time to see optimum HIFEM results is 2-6 weeks after the last treatment
• Advice to maintain healthy lifestyle and diet post HIFEM treatment
• HIFEM treatments are recommended to repeat every 6 months
• High-intensity focused ultrasound (HIFU)

  • Focusing high frequency and high intensity ultrasound energy on a targeted area of the body
  • External transducer, target adipose tissue
  • High convergence of ultrasound energy
  • Molecular vibrations
  • Temperature increase
  • No effects on surrounding tissues
  • Coagulative necrosis of fat cells
• High-intensity focused ultrasound (HIFU)

  • Localized fat reduction and body sculpting
  • Also help skin tightening
  • Treatment areas: Abdomen, Flanks
  • Requires 1 to 3 treatments, 2 weeks apart
  • Results appear gradually, final results 6 to 12 weeks
  • Destroyed fat cells do not grow back
  • Results can last with weight maintenance
• High-intensity focused ultrasound (HIFU)

  • Localized fat reduction and body sculpting
  • Also help skin tightening
• HIFU devices

  • LipoSonix
• HIFU treatment

  1. 1 to 3 treatments, 2 weeks apart

  2. Results appear gradually

  3. Final results 6 to 12 weeks

  4. Destroyed fat cells do not grow back

  5. Results can last with weight maintenance
• Factors which can affect the results of HIFU and RF:
• Low-level Laser body contouring

  • SculpSure laser used to achieve hyperthermic temperatures
  • Fat cells are preferentially heated and disrupted
  • Damaged fat cells eliminated by lymphatic system
  • No impact on other types of cells in the skin or other structures
  • Emerald laser uses cold (non-thermal) low-level laser – meaning NO heat
  • Create tiny temporary openings
  • The light encourages fat cells to release lipids, or fatty acids, through these openings
  • Fat cells becomes smaller
• SculpSure

  • Uses laser energy (1060nm) delivered through an applicator
  • Can treat up to 4 different areas at one time
  • 25-minute treatments ("lunchtime lipo")
  • Minimal S/E
  • No downtime, No pain
• Emerald Laser

  • No downtime, No pain, No bruising, No freezing, No side-effects, No risks or complications
• Injection Lipolysis

  • Multiple fine injections of active ingredients into the treatment area beneath the skin
  • Break down fat cells on contact – isolated reduction of fat pocket
• Phosphatidylcholine (PPC)

  From soybeans and naturally occuring in human body