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Fat removal procedures

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Fat removal procedures are used mostly in cosmetic surgery with the intention of removing unwanted adipose tissue. The procedure may be invasive, as with liposuction,[1] or noninvasive using laser therapy, radiofrequency, ultrasound or cold (cryoablation or cryolipolysis) to reduce fat, sometimes in combination with injections.[2][3]

Fat is sometimes removed from one location to another on a person in an autograft, such as in some breast reconstruction and breast augmentation procedures.[4] These techniques are distinct from bariatric surgery, which aims to treat obesity by minimizing food consumption or by interfering with the absorption of food during digestion, and from injection lipolysis, which relies solely on injections marketed as causing lipolysis.[2]

Invasive

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Liposuction

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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]

Serious complications include deep vein thrombosis, organ perforation, bleeding, and infection.[10] Death occurs in about one per ten thousand cases.[11]

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

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Ultrasound

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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

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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

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Patient with cryolipolysis applicator

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 and in India, the Coolsculpting cost typically ranges from ₹60,000 to ₹115,000.[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]

Injection lipolysis

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Main article: Injection lipolysis

Injection lipolysis is a procedure that reduces localized subcutaneous fat deposits, most commonly submental fat (double chin). This technique involves the injection of lipolytic substances, such as deoxycholic acid (branded as Kybella in the United States), directly into the targeted fat tissue. Deoxycholic acid is a naturally occurring bile acid that aids in the breakdown and absorption of dietary fat. When injected into subcutaneous fat, it causes the dissolution of the fat cell membranes, causing them to die. The destroyed fat cells are then gradually eliminated by the body's natural metabolic processes over the following weeks.[33][34] While the procedure is generally considered safe when performed by a qualified healthcare professional, potential side effects may include swelling, bruising, numbness, and rarely, nerve injury in the treated area.[33][34][35]

Regulatory status

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In 2010, Zerona, another low-level laser treatment, was cleared for marketing by the FDA as an infrared lamp.[36] 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.[37]

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.[38][39]

References

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  1. ^ Shridharani, SM; Broyles, JM; Matarasso, A (2014). "Liposuction devices: technology update". Medical Devices: Evidence and Research. 7: 241–51. doi:10.2147/MDER.S47322. PMC 4114741. PMID 25093000.
  2. ^ a b Mulholland, 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. doi:10.1016/j.cps.2011.05.002. PMID 21824546.
  3. ^ Ortiz, AE; Avram, MM (September 2015). "Noninvasive body contouring: cryolipolysis and ultrasound". Seminars in Cutaneous Medicine and Surgery. 34 (3): 129–33. doi:10.12788/j.sder.2015.0171. PMID 26566568.
  4. ^ De Souza, MM; Jewell, AD; Grief, SN; Vail, BA (December 2018). "Plastic Surgery for Women". Primary Care. 45 (4): 705–717. doi:10.1016/j.pop.2018.07.008. PMID 30401351. S2CID 53225345.
  5. ^ Dixit, VV; Wagh, MS (May 2013). "Unfavourable outcomes of liposuction and their management". Indian Journal of Plastic Surgery. 46 (2): 377–92. doi:10.4103/0970-0358.118617. PMC 3901919. PMID 24501474.
  6. ^ 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. doi:10.1007/s11695-015-1797-1. PMID 26210190. S2CID 37230028.
  7. ^ 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. PMID 26475176.
  8. ^ a b c Norton, Jeffrey A. (2012). Surgery Basic Science and Clinical Evidence. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 2014. ISBN 9783642572821.
  9. ^ Khan, MH (November 2012). "Update on liposuction: clinical pearls". Cutis. 90 (5): 259–65. PMID 23270199.
  10. ^ Tierney, Emily P.; Kouba, David J.; Hanke, C. William (December 2011). "Safety of tumescent and laser-assisted liposuction: review of the literature". Journal of Drugs in Dermatology. 10 (12): 1363–9. PMID 22134559.
  11. ^ Draelos, Zoe (2011). Cosmetic Dermatology: Products and Procedures. John Wiley & Sons. p. Chapter 56. ISBN 9781444359510.
  12. ^ Dixit, Varun V.; Wagh, Milind S. (2013). "Unfavourable outcomes of liposuction and their management". Indian Journal of Plastic Surgery. 46 (2): 377–392. doi:10.4103/0970-0358.118617. ISSN 0970-0358. PMC 3901919. PMID 24501474.
  13. ^ Otto, Morkel J. (October 2016). "The safety and efficacy of thermal lipolysis of adipose tissue via ultrasound for circumference reduction: An open label, single-arm exploratory study". Lasers in Surgery and Medicine. 48 (8): 734–741. doi:10.1002/lsm.22544. ISSN 1096-9101. PMID 27320384. S2CID 46804557.
  14. ^ Fabi, Sabrina Guillen (2015). "Noninvasive skin tightening: focus on new ultrasound techniques". Clinical, Cosmetic and Investigational Dermatology. 8: 47–52. doi:10.2147/CCID.S69118. ISSN 1178-7015. PMC 4327394. PMID 25709486.
  15. ^ 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. doi:10.1007/s00266-011-9700-5. ISSN 1432-5241. PMID 21461627. S2CID 32498269.
  16. ^ 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. PMID 24567045. S2CID 26579022.
  17. ^ a b Fonseca, BelchiolinaB; Godoy, FúlvioB; Levenhagen, MarceloA; Melo, RobertaT; Franco, MarianeA; Beletti, MarceloE (2011). "Structural changes of fat tissue after nonaspirative ultrasonic hydrolipoclasy". Journal of Cutaneous and Aesthetic Surgery. 4 (2): 105–10. doi:10.4103/0974-2077.85025. PMC 3183714. PMID 21976901.
  18. ^ 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. ISSN 1085-5629. PMID 24049928.
  19. ^ a b c Ingargiola, M. J; Motakef, S; Chung, M. T; Vasconez, H. C; Sasaki, G. H (2015). "Cryolipolysis for Fat Reduction and Body Contouring: Safety and Efficacy of Current Treatment Paradigms". Plastic and Reconstructive Surgery. 135 (6): 1581–1590. doi:10.1097/PRS.0000000000001236. PMC 4444424. PMID 26017594.
  20. ^ a b c d e f g h Derrick, C. D; Shridharani, S. M; Broyles, J. M (2015). "The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature". Aesthetic Surgery Journal. 35 (7): 830–6. doi:10.1093/asj/sjv039. PMID 26038367.
  21. ^ a b Krueger, N; Mai, S. V; Luebberding, S; Sadick, N. S (2014). "Cryolipolysis for noninvasive body contouring: Clinical efficacy and patient satisfaction". Clinical, Cosmetic and Investigational Dermatology. 7: 201–205. doi:10.2147/CCID.S44371. PMC 4079633. PMID 25061326.
  22. ^ a b c Coleman, 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. doi:10.1007/s00266-008-9286-8. PMID 19296153. S2CID 23744367.
  23. ^ a b Nelson, AA; Wasserman, D; Avram, MM (2009). "Cryolipolysis for reduction of excess adipose tissue". Seminars in Cutaneous Medicine and Surgery. 28 (4): 244–9. doi:10.1016/j.sder.2009.11.004. PMID 20123423.
  24. ^ Stroumza, N.; Gauthier, N.; Senet, P.; Moguelet, P.; Nagel, R.; Barthelemy; Atlan, M. (2017-11-14). "Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis". Aesthetic Surgery Journal. 38 (4): 411–417. doi:10.1093/asj/sjx159. ISSN 1527-330X. PMID 29145587.
  25. ^ Nikolis, Andreas (2021). "A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryolipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients". Aesthet Surg J. 41 (8): 932–941. doi:10.1093/asj/sjaa310. PMC 8279305. PMID 33216910.
  26. ^ "News: Linda Evangelista says she was 'brutally disfigured' by cosmetic procedure, will sue company". CBC. Retrieved 23 September 2021.
  27. ^ Tobin, Sam. Linda Evangelista: Cosmetic blunder left me brutally disfigured. The Times, September 23, 2021.
  28. ^ "A Beauty Treatment Promised to Zap Fat. For Some, It Brought Disfigurement". New York Times. April 16, 2023.
  29. ^ Avram, MM; Harry, RS (2009). "Cryolipolysis for subcutaneous fat layer reduction". Lasers in Surgery and Medicine. 41 (10): 703–8. doi:10.1002/lsm.20864. PMID 20014262. S2CID 20850126.
  30. ^ a b Meyer, Patricia; Silva, Julio; Vasconcellos, Liliane; Carreiro, Eneida; Valentim da Silva, Rodrigo Marcel (16 October 2018). "Cryolipolysis: patient selection and special considerations". Clinical, Cosmetic and Investigational Dermatology. 11: 499–503. doi:10.2147/ccid.s146258. ISSN 1178-7015. PMC 6199209. PMID 30410379.
  31. ^ "Can you freeze your fat away?". 24 December 2015. Retrieved 25 August 2016.
  32. ^ "CoolSculpting is only cold-based treatment cleared by US FDA for fat loss". 21 March 2016. Retrieved 25 August 2016.
  33. ^ a b Liu M, Chesnut C, Lask G (June 2019). "Overview of Kybella (Deoxycholic Acid Injection) as a Fat Resorption Product for Submental Fat". Facial Plastic Surgery. 35 (3): 274–277. doi:10.1055/s-0039-1688943. PMID 31189201.
  34. ^ a b Farina GA, Cherubini K, de Figueiredo MA, Salum FG (October 2020). "Deoxycholic acid in the submental fat reduction: A review of properties, adverse effects, and complications". Journal of Cosmetic Dermatology. 19 (10): 2497–2504. doi:10.1111/jocd.13619. hdl:10923/18644. PMID 32654409.
  35. ^ Murdock, Joshua (3 May 2022). "The 10 Kybella Side Effects: What to Expect". GoodRx. Retrieved 1 June 2024.
  36. ^ Louis, Catherine Saint (February 3, 2010). "Zap or Chill? Targeting Fat Without Surgery". The New York Times.
  37. ^ Department of Health & Human Services (November 21, 2016). "Indications for Use" (PDF).
  38. ^ "Décret n° 2011-382 du 11 avril 2011 relatif à l'interdiction de la pratique d'actes de lyse adipocytaire à visée esthétique", legifrance.gouv.fr, 2011, retrieved 2015-01-08
  39. ^ Touraine, Marisol (2012), "Questions / answers on the prohibition order of lipolyses", sante.gouv.fr
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