03 Sep Noninvasive Body Sculpting
Noninvasive Body Sculpting
There is no free lunch (except at De Luz Medical Aesthetics every second Wednesday of the month) or magic bullet for defying gravity or battling the bulge. However, when someone is on the right track with diet and exercise, maybe even weight loss, body sculpting can help. Body sculpting has two different aspects: skin tightening and fat reduction. This is true for invasive or surgical body sculpting, like liposuction and facelifts, and noninvasive body sculpting. For the remainder of this discussion I will limit myself to just noninvasive body sculpting techniques.
Skin tightening is achieved through stimulating the bodies normal processes to produce more collagen and reorganize existing collagen to better support the skin. Fat reduction can occur by promoting an immunologic or inflammatory response to dispose of injured fat cells.
When the dermis is warmed to at least 390C (102.20F) two things happen: first, existing collagen and elastin tighten or constrict and, second, a mild injury occurs. The tightening of collagen and elastin fibers in the dermis is immediate but unfortunately lasts only a few days. The mild warming sets off a healing cascade. The healing cascade brings in fibroblasts which set about building and reorganizing new collagen. The healing cascade takes several weeks to months and builds with every treatment. When one heats the subcutaneous fat above 420C (107.60F), the fat cells are injured prompting a response from the body’s immune system. The immune system cleans up the injured cells, excreting them naturally. Different means exist to warm the dermis and subcutaneous fat: laser, ultrasound and radiofrequency.
Laser and other light based therapies warm the dermis through the direct absorption of light energy by water and collagen in the dermis. Laser also causes the increase of enzymes and growth factors in the dermis leading to increased collagen production. Many different lasers and intense pulsed light (IPL) devices work in this way, think photofacial. Laser and IPL can warm the dermis but have much less effect on the deeper subcutaneous fat which make them a good option for the face.
Ultrasound or High-Intensity Focused Ultrasound (HIFU) warms directly to a preset depth in the body typically directly into the subcutaneous fat. For Liposonix, the subcutaneous fat between 1 and 2 cm below the skin is heated to 560C (132.80F). HIFU is very effective at warming and destroying fat cells but has less effect at warming the dermis and when poorly aimed it can cause significant side effects, like pancreatitis.
Radiofrequency (RF) provides a combination of dermal and subcutaneous fat heating. RF devices, such as Venus Freeze, use alternating electric current of 1 MHz to generate heat. In the dermis or subcutaneous fat, the electric current meets the innate electrical resistance of the various tissues and the resistance generates heat (think high school physics). The radiofrequency can be delivered over the skin or bypassing the epidermis directly into the dermis.
One type of treatment for subcutaneous fat uses cold, Zeltiq Coolsculpting. This technique takes advantage of the higher freezing points of fat compared to other tissues, like the skin. Much like heating the fat cells, after freezing the injured fat cells are scavenged by the immune system and disposed of naturally. Currently, this technique while effective is best for those who only have isolated problem areas around the midsection but may have other applications soon.
Thank you for time and attention,
Robert Zieber, MD
De Luz Medical Aesthetics
Next week: Noninvasive body sculpting: part 2.