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March 10, 2008

Fat removal without liposuction?

As there is increasing movement of cosmetic procedures toward less invasive alternatives, one of the areas ripe for improvement is fat removal. Modern liposuction has been around since the early 1980s, and with the exception of the development of tumescent liposuction, developed by Dr. Jeff Klein, a dermatologist, there has not been significant advance toward a less invasive approach. One exception may be the "Lipodissolve" injections to remove fat, but the safety of these is very controversial and they are not practical for larger body areas. Now there are several technologies on the horizon that may prove to offer advances in this direction.   

The first of these is to use a laser positioned on the surface of the skin to destroy the underlying fat. Dr. R. Rox Anderson of Massachusetts General Hospital in Boston has done some preliminary work suggesting that this may be possible. He has done some studies that suggest that certain wavelengths of infrared light are better absorbed by fat than by water, the major component of most tissue. Ideally the fat would absorb the energy much more rapidly than water, but the difference between the two is small. For this to be effective the skin, which contains water, must be protected by cooling, while the fat must be heated uniformly to produce an even result. Since fat holds heat better than water, about twice the energy can be dumped into the fat as is transmitted to the water.
Radiofrequency devices can heat tissue of various types, including fat. Radiofrequency treatment produces heat when an electric current is converted to heat by the electrical resistence of the tissue. Fat should be an appropriate target for radiofrequency current. However, there are currently radiofrequency devices on the market, for skin tightening, and their results vary from person to person, and are not predictable.
Finally there are ultrasound devices that are under development for fat removal. The sound energy can be focused much more deeply than the other devices but the heating that results is not selective and any tissue in its path will be heated.
Noninvasive fat destruction is still on the horizon, but there is reasonable hope that one of these approaches will become practical in the next few years.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA

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