Liposuction = Weight Loss?

Many people approach liposuction with the hope that this procedure will aid them in controlling their weight. However, ever since the early days of liposuction, and even with some physicians preforming large volume liposuction, it has been clear that people who have liposuction do not end up weighing less. The standard mantra has been that liposuction, and almost certainly Zeltiq as well, are spot reduction measures and not weight reduction measures. However, until now there has not been a good explanation for this. After all, it seems logical that if a pound or two of fat were removed, the patient should end up weighing a pound or two less. A study recently published in the journal "Obesity" provides some explanations.

Zeltiq: A Triple but not a Home Run

The Zeltiq Coolsculpting device has been the most succesful piece of equipment we have ever acquired. It works exactly as advertised. It is useful for belly fat, love handles and back fat. We have also used it on the buttocks and the male breast. These last two applications are off label, and the use on the buttocks was for volume reduction and not shaping.

Everyone sees results, which usually start to become apparent after one month, and can continue to improve for up to three months. Each treatment removes 20-25% of the fat in the roll of tissue thay is grabbed by the machine. Most people end up having two, or occasionally more treatments in the same area. Everyone sees results and we have had no unhappy patients.

Zerona: Do You Believe in Magic?

Zerona is a FDA approved device using "low-level" laser light to "contour" the body. Before getting further into this discussion, to avoid interactions with the company's  lawyers, I should make two things clear. First, what I am writing represents my own personal opinion about this device, based on what I've learned in discussions with representatives of the company as well as information on their web site and information presented by speakers at medical meetings. Also, I own a competing device, the Zeltiq, which actually does much of what Zerona purports to do.

There is a long history of medical quackery claiming fat reduction without dieting or discomfort. Zerona, in my opinion, is the latest example of this. Zerona plays on the public's fascination with lasers as well as the almost universal desire to be thinner. While getting treated with the Zerona you lie on a table while 4 low-level lasers rotate above your body. There is no discomfort because, I believe, nothing is happening, though the company, Erchonia", would dispute that.

Non-invasive Fat Removal: Why we've acquired a Zeltiq device

Ever since the development of safe and successful liposuction, at the end of the last century, there has been a hunt for a less invasive way to obtain similar results. This has coincided with the desire of the public for less invasive procedures, and the dramatic increase in treatments that catered to this desire. The most obvious examples are the rapid adoption of botulinum toxin and fillers by physicians and the general public.

Despite the ongoing popularity of liposuction, a variety of approaches have been studied as ways to remove fat without entering the skin. One approach has been to use focused ultrasound to disrupt the fat cells. This has become commercially available as the UltraShape device. It is currently available in a number of countries, but not yet for sale in the US. Reports are that the results with this device are variable and unpredictable. The company apparently is experimenting with adding radio-frequency energy to the device, to improve its effectiveness.

Cellulite: The Latest Skinny, I

In the latest issue of the Journal of the American Academy of Dermatology there are two review articles on cellulite. The first discusses the pathophysiology of the condition and the second the treatment. Not a lot of recent work has been done to try to understand cellulite. It is unclear if cellulite is actually a disease, since 85-98% of women past puberty have it.

Laser Fat Destruction & Eyelid Burns

Although many cosmetic surgeons now recognize that lower eyelid bags are more commonly due to tissue loss rather than true fat protrusion, there are many who are still excising lower eyelid fat. Apparently a very small subset of these is attempting to remove this fat by making a small incision in the lateral lower lids, inserting a fiber from the "LaserTight" device and attempting to melt the fat and tighten the skin. This is a procedure that is new to me, and on the surface appears fraught with hazard. There are muscles near the fat that, if injured, could make it difficult for both eyes to move in a coordinated fashion. Furthermore, bleeding from eyelid surgery can rarely result in loss of vision, and this procedure is performed without direct visualization.

Cryolipolysis: Fat Removal Without Surgery?

As cosmetic surgery has become more more sophisticated, there has been a movement toward less invasive procedures. Many of the initial attempts were marginally effective, but with time the effectiveness and specificity of these procedures has improved. Fat removal has so far not been affected by this trend. The supposed, but still unproven, advances of laser assisted liposuction still required surgery. The use of mesotherapy, which involved the injections of solutions of varying composition, proved to be problematical for treating fatty areas of significant volume, and had problems that resulted in a number of lawsuits and the bankruptcy of a chain of facilities that were formed to capitalize on the treatment. Now, an article in the most recent "Dermatologic Surgery" journal reports on the use of external cooling to reduce fat.

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.   

Can Topical Creams Help Fat Reduction?

Obesity is a significant health problem and a significant social problem as well. Overweight and obese people are significantly more likely to have experienced depression than people of normal weight. Weight loss can reduce the amount of depression among those formerly overweight.

Lipodissolve and SmartLipo: Alternatives to Liposuction

LipoDissolve and SmartLipo have been proposed as alternatives to traditional liposuction. How well they work is still open to question.