Fat removal procedures
Fat removal procedures are used mostly in cosmetic surgery to remove unwanted adipose tissue. The procedure may be invasive, as with liposuction, or noninvasive, using laser energy, radiofrequency, ultrasound or cold (cryoablation) to reduce fat, sometimes in combination with injections.
These techniques are distinct from bariatric surgery, which aims to treat obesity by preventing people from eating too much or by interfering with the absorption of food during digestion, and are also distinct from injection lipolysis, in that these procedures are device-based, while injection lipolysis relies solely on injections that are marketed as causing lipolysis.
Liposuction is a type of cosmetic surgery that removes fat from the human body in an attempt to change its shape. Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect obesity related problems. In the United States it is the most commonly done cosmetic surgery.
The procedure may be performed under general, regional, or local anesthesia. It then involves using a cannula and negative pressure to suck out fat. It is believed to work best on people with a normal weight and good skin elasticity.
Focused thermal ultrasound techniques work by raising the tissue temperature above 56 °C, resulting in coagulative necrosis of adipocytes, with sparing of vessels and nerves. Passive heating of the skin may also induce collagen remodeling.
Hydrolipoclasy is a technique that is being studied as an alternative to liposuction. It involves injecting a hypotonic solution into an area of fat and than subjecting it to ultrasound waves.
Low level laser light
Radiofrequency devices work by producing an alternating flow, which creates an electric field over the skin. The electric field shifts polarity millions of times per second, that causes a change in orientation of charged particles.
The method involves controlled application of cooling within the temperature range of -11 to +5 °C for the non-invasive, localized reduction of fat deposits, intending to reshape the contours of the body. The degree of exposure to cooling causes cell death of subcutaneous fat tissue, without apparent damage to the overlying skin. It appears primarily applicable to limited discrete fat bulges.  Adverse effects include transient local redness, bruising and numbness of the skin are common side effects of the treatment and are expected to subside. Typically sensory deficits will subside within a month. The effect on peripheral nerves was investigated and failed to show permanent detrimental results.
Based on the premise that fat cells are more easily damaged by cooling than skin cells. for example in popsicle panniculitis, cryolipolysis was developed to apply low temperatures to tissue via thermal conduction. In order to avoid frostbite, a specific temperature level and exposure are determined, such as 60 minutes at −5 °C (23 °F). 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 followed by a local inflammatory response that gradually over the course of several months results in a reduction of the fatty tissue layer.
Typical cost per treatment area varies depending on location. Price in the US ranges from $750 to $1,500, with UK prices about £750 per area to be treated. Treatment time for general use/application is 35–60 minutes per site, depending on the applicator used.
In September 2000, Zeltiq received EU CE Mark approval for their cryolipolysis device. 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 (also known as banana roll), and upper arm. It is also FDA-cleared to affect the appearance of lax tissue with submental area treatments.
In 2005, Meridian Co., a Korean company, and its North American licensee, Meridian Medical, a British Columbia company, received FDA marketing clearance for a laser device for fat reduction, the Lapex 2000; it was cleared by the FDA as an infrared lamp. and in 2008, a variant, the Lapex BCS, was cleared. Meridian Medical had been founded in 2004 by a Korean company called Meridian and had received an exclusive North American license for intellectual property of the parent company, which had originally developed the devices.
In 2010, Zerona, another low-level laster treatment, was cleared for marketing by the FDA as an infrared lamp and Zeltiq obtained FDA marketing clearance for cryolipolysis of the flanks, and in 2012 received marketingclearance for cryolipolysis of the abdomen.
Starting in 2010, the Korean company Meridian assigned US patents related to their fat reduction devices to a British Columbia company called "YOLO Medical". During this transition, the Lapex line was rebranded as the Yolo Curve. Strawberry, another infrared lamp device, was cleared by the FDA in 2013 SculpSure, another infrared lamp device, was cleared in 2015. Also in 2015, Yolo received marketing clearance for its Lipofina system.
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. 
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