Improvement in arm and post-partum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device

Variable Energy and Ultrasound-based Liposculpture of the Arms: Multicenter and Multidevice Study

Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.

Loss of subcutaneous fat in 20 patients, both sexes, using a second-generation TECAR device of 1.240 Watts and results analyzed with magnetic resonance

BACKGROUND

Body contouring and abdominal fat loss without surgery are increasingly used technique. In a study in pigs, it is noted that both capacitive and resistive radiofrequency stimulation reduced subcutaneous fat. One human study demonstrated a loss of 2.90 cm in waist diameter. Second-generation TECAR (Acronym for Transfer Electric Capacitive and Resistive) device with 4 channels, 200 cm2 work area per channel, and high power (1240 W), regulates body energy input by measuring absorption in the body and adjusting the power for 80 min at 50°C.

AIMS

To evaluate the loss of subcutaneous fat, this magnitude was measured in grams and centimeters throughout the abdomen by MRI before and after each treatment.

SUBJECT AND METHODS

We have studied 25 patients, 13 women and 12 men with a mean age of 49 years. All patients had their waist diameter measured and an MRI performed before and after 10 continuous sessions except Saturday and Sunday, over 2 weeks. Additionally, a lipid profile was performed on the same day of the study and at the end of it. The study was approved by the Ethics Committee.

RESULTS

Waist diameter decreased by 5.5 cm, these differences being statistically significant (p = 0.000). Subcutaneous fat measured by MRI in cm decreased by 784 cm (p = 0.000). In grams, it decreased 808.7 g (p = 0.000). In the lipid profile, all the values decreased, but they were not statistically significant.

CONCLUSIONS

The use of this second generation of TECAR equipment at 1 MHz decreases the waist diameter by more than 5 cm and leads to the loss of more than 800 grams of subcutaneous fat in 12 days. It is a method without risks or side effects, well tolerated, and an alternative for those patients who do not want to go to the operating room.

Simulation-guided development of advanced PID control algorithm for skin cooling in radiofrequency lipolysis

BACKGROUND

The clinical outcomes of bipolar radiofrequency (RF) lipolysis, a prevalent non-invasive fat reduction procedure, hinge on the delicate balance between effective lipolysis and patient safety, with skin overheating and subsequent tissue damage as primary concerns.

OBJECTIVE

This study aimed to investigate a novel bipolar radiofrequency lipolysis technique, safeguarding the skin through an innovative PID temperature control algorithm.

METHODS

Utilizing COMSOL Multiphysics simulation software, a two-dimensional fat and skin tissue model was established, simulating various PID temperature control schemes. The crux of the simulation involved a comparative analysis of different PID temperatures at 45 °C, 50 °C, and 55 °C and constant power strategies, assessing their implications on skin temperature. Concurrently, a custom bipolar radiofrequency lipolysis device was developed, with ex vivo experiments conducted using porcine tissue for empirical validation.

RESULTS

The findings indicated that with PID settings of Kp = 7, Ki = 2, and Kd = 0, and skin temperature control at 45 °C or 50 °C, the innovative PID-based epidermal temperature control strategy successfully maintained the epidermal temperature within a safe range. This maintenance was achieved without compromising the effectiveness of RF lipolysis, significantly reducing the risk of thermal damage to the skin layers.

CONCLUSION

Our research confirms the substantial practical utility of this advanced PID-based bipolar RF lipolysis technique in clinical aesthetic procedures, enhancing patient safety during adipose tissue ablation therapies.

Metabolic changes after nonsurgical fat removal: A dose response meta-analysis

BACKGROUND

Obesity-induced insulin resistance leads to the metabolic syndrome. Both bariatric surgery and surgical fat removal have been shown to improve metabolic health, but the metabolic benefits of nonsurgical fat removal remain uncertain. The aim of this paper is to establish whether nonsurgical fat removal exerts measurable, lasting metabolic benefits by way of changes to serum lipid profiles.

METHODS

PubMed, Cochrane CENTRAL, Embase, and clinical trials registers were searched using the Polyglot Search Translator to find studies examining quantitative changes in metabolic markers after nonsurgical body contouring procedures. The MethodologicAl STandard for Epidemiological Research (MASTER) scale was adopted for the quality assessment of the included studies. The robust-error meta-regression (REMR) model was employed.

RESULTS

Twenty-two studies and 676 participants were included. Peak body compositions measures manifest as a reduction of 2 units in body mass index (BMI), 1 kg of body weight (BW), 5 cm in waist circumference (WC) and 1.5 cm in abdominal fat thickness (FT), sustained up to 60 days postprocedure. Transient increases of 15 mg/dL in low-density lipoprotein (LDL), 10 mg/dl in triglycerides (TG), and 15 mg/dl in total cholesterol (TC) were observed at 2 weeks postprocedure.

CONCLUSION

While nonsurgical fat removal exerts sustained effects on body anthropometrics, changes to serum lipid profiles were transient. There is no compelling evidence at present to support the conclusion that nonsurgical fat removal is metabolically beneficial.

Experimental evaluation of high intensity focused ultrasound for fat reduction of ex vivo porcine adipose tissue

PURPOSE

The present study was stimulated by the continuous growth of commercially available high intensity focused ultrasound (HIFU) systems for fat reduction. Herein, HIFU was utilised for fat ablation using a single-element ultrasonic transducer operating in thermal mode.

METHODS

The custom-made concave transducer that operates at 1.1 MHz was assessed on excised porcine adipose tissue for its ability to reduce fat. Ultrasonic sonications were executed on the adipose tissue utilising acoustical power between 14 and 75 W and sonication time in the range of 1-10 min. The mass of the adipose tissue sample was weighed afore and after ultrasonic sonications and the effect of the sonication on the mass change was recorded.

RESULTS

Mass change was linearly dependent with either increasing acoustical power or sonication time and was in the range of 0.46-1.9 g. High acoustical power of 62.5 W for a sonication time of 1 min and a power of 75 W for a sonication time of 5 min, respectively resulted in the formation of a lesion or possible cavitation on the piece of excised adipose tissue.

CONCLUSION

The study demonstrated the efficacy of the proposed transducer in achieving a reduction of excised fat tissue. The present findings indicate the potential use of the transducer in a HIFU system indicated for the reduction of subcutaneous adipose tissue where increased values of acoustical power can result in increased amounts of fat reduction.

Abdominal massage: A review of clinical and experimental studies from 1990 to 2021

OBJECTIVE

To systematically review the current state and holistic application of abdominal massage (AM).

DESIGN

A systematic review of qualitative evidence was conducted. All English articles exploring the topic of AM that had been published until the end of June 2021 were retrieved.

DATA SOURCES

The PubMed, Cochrane library, and Embase databases were accessed. Some original texts were obtained from Google Scholar.

DATA EXTRACTION AND SYNTHESIS

Two authors independently evaluated all search data to identify relevant studies. Disagreements were settled by discussion with a third author. Results were independently extracted into standardized sheets and checked for accuracy.

MAIN RESULTS

A total of 107 full-text reports were eligible for inclusion. Adult digestive disorders, pediatric disorders, gynecological disorders, obstetric disorders, metabolic disorders, psychological disorders, the side effects of AM, and animal experiments accounted for 49.53%, 14.02%, 7.48%, 7.48%, 4.67%, 4.67%, 5.61%, and 6.54% of all these papers, respectively, with most reports focusing on clinical studies.

CONCLUSION

The variety of diseases treated with AM is gradually increasing, and the treatment programs of AM for many diseases are being gradually optimized. Different forms of AM, especially mechanical AM, have been widely studied; the side effects of AM have also been considered; and the possible mechanisms of AM therapy continue to be discovered. In general, AM is an effective and safe therapy and can be widely used in various diseases, but further studies are necessary to clarify the mechanism of AM for different diseases. In the future, AM could become an even safer, more popular, and more modern therapy.

Complications With Noninvasive Fat and Cellulite Reduction Devices: A Cross-sectional Analysis of the US Food and Drug Administration Manufacturer and User Facility Device Experience Database

BACKGROUND AND OBJECTIVE

The US FDA mandates that manufacturers and device operators disclose medical device reports (MDRs) to monitor suspected injuries and device malfunctions by submitting information to the Manufacturer and User Facility Device Experience (MAUDE) database. Given the rapid growth in the noninvasive fat and cellulite reduction market, it is essential that physicians be aware of associated adverse events.

STUDY DESIGN/MATERIALS AND METHODS

Using the MAUDE electronic database on the FDA website, the authors performed a comprehensive search of reported complications of noninvasive fat reduction and cellulite reduction devices from January 1, 2014 to January 1, 2020 at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm. Medical device reports that likely represented medical adverse events from device use were included.

RESULTS

The search yielded 165 MDRs, a majority submitted by patients. There were 68 MDRs reported on cryolipolysis (41.2%), 34 MDRs reported on 1,060-nm laser lipolysis (20.6%), 19 MDRs reported on high-intensity focused ultrasound (11.5%), 17 MDRs reported on vacuum-assisted subcision (10.3%), 10 MDRs reported on 1,440-nm laser-assisted subcision (6.1%), 8 MDRs reported on monopolar radiofrequency (4.8%), 6 MDRs reported on focused ultrasound (3.6%), and 4 MDRs reported for a combination infrared light, bipolar radiofrequency energy, massage, and gentle suction treatment (2.4%).

CONCLUSION

It can be safely presumed that most physicians do not regularly report adverse events to the FDA; however, the MAUDE database remains the largest global repository of adverse events reported for noninvasive body contouring devices, an area that has grown tremendously over the last few years. Some MDRs may be unrelated and/or unsubstantiated, and MDRs for any given device must be correlated to the total number of procedures performed. Nevertheless, the MAUDE database allows a glimpse into potential adverse events that can occur. The authors hope that physician awareness of this database and the adverse events it reports will help improve patient safety.

Community intervention study of viscera massage in overweight/obese type 2 diabetes high-risk population

BACKGROUND

Prediabetes is an intermediate metabolic state between normoglycemia and diabetes. Without intervention, prediabetes often progresses to diabetes and prediabetes is associated with increased risk of cardiovascular disease, cancer, renal disease, and dementia. Lifestyle modification play a major role in controlling prediabetes. But lifestyle interventions are often with poor compliance and side effects of drugs are often be dislike by people. As a non-invasive therapy with no side effects, abdominal massage (AM), also called viscera massage in China, has been used to treat prediabetes and obesity-associated diseases. The gut microbiota has been recognized as an important factor in the development of metabolic diseases. Individuals with prediabetes have aberrant intestinal microbiota character. Colonic transport time and stool consistency are strongly associated with gut microbiota. Viscera massage can ease constipation by reducing colonic transport time and promoting intestinal motility. We can infer that viscera massage can modulate composition of gut microbiota affects human metabolism. So, in this trial, we will explore the mechanism of viscera massage on prediabetes from the perspective of intestinal microbiota.

METHODS AND DESIGN

Eighty prediabetes individuals will be recruited for this study. Eighty prediabetes individuals will be divided into lifestyle intervention group and viscera massage + lifestyle intervention group by a simple random method. Each group will have 40 individuals. The manipulation of the viscera massage + lifestyle intervention group will be mainly carried out through rubbing the abdomen, kneading abdomen, vibrating abdomen, and pressing the abdomen, 30 minutes per time, once a day, with 2 days off every 5 days. Lifestyle interventions will be performed by combining pushing healthy lifestyle guidance information through Wechat application and giving face-to-face advice together daily. The lifestyle intervention group will receive healthy lifestyle intervention only. All the intervention will be conducted for 4 weeks. Weight, body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio will be measured at the last day of every week. Triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood-glucose, 2-hour post-meal blood glucose (2hPG) and glycosylated hemoglobin, fasting insulin and insulin resistance index will be tested at the first day and last day of the intervention course. The fecal samples of subjects will be gathered at the first day and last day of the intervention course and will be performed 16S rRNA gene sequencing and metagenomic detection. Finally, the effect and potential mechanism of viscera massage on prediabetes will be discussed in combination with all the results.

DISCUSSION

The results of this study will be used to verify the effect of AM on prediabetes and explore the mechanism of AM on prediabetes from the perspective of gut microbiota.

Bipolar Fractional Radiofrequency Treatment of Suprapatellar Skin Assessment Using Noninvasive Devices and Microbiopsy

BACKGROUND

Noninvasive treatments for skin tightening are gaining popularity. However, no studies have assessed bipolar fractional radiofrequency treatment on suprapatellar skin.

OBJECTIVES

The purpose of this study was to evaluate the efficacy of bipolar fractional radiofrequency treatment on suprapatellar skin.

METHODS

Twenty patients received 1 bilateral suprapatellar bipolar fractional radiofrequency treatment. They returned 7 days, 3 weeks, 3 months, and 6 months posttreatment. Noninvasive measurements were obtained at each visit, including high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and skin elasticity. Microbiopsies were collected in the treatment area for histologic and gene expression analyses. Three clinicians completed photographic evaluations comparing texture and laxity at baseline vs 6 months posttreatment.

RESULTS

Fifteen subjects completed all 6 visits. Both transepidermal water loss and dermal-epidermal junction roughness were increased at 3 weeks and 3 months posttreatment. Both attenuation coefficient and stiffness were increased significantly at 3 and 6 months posttreatment. Blood flow 0.5 mm below the surface and expression of epidermal hyaluronic acid and inflammatory genes IL-1b and IL-6 were significantly higher at 7 days posttreatment compared with pretreatment and 3 months posttreatment. There were no statistically significant changes in collagen- or elastin-related genes and proteins at 7 days or 3 months posttreatment. An improvement in texture and laxity was observed at 6 months posttreatment in 17.7% and 24.4% of photographs, respectively.

CONCLUSIONS

Radiofrequency treatment by microneedling of suprapatellar skin shows limited effects in decreasing skin laxity and improving skin appearance. At a molecular level, the treatment resulted in lower elastin and hyaluronic acid levels and increased dermal-epidermal junction roughness based on histology and optical coherence tomography imaging.

LEVEL OF EVIDENCE: 4

Nonsurgical Treatment of Postpartum Lower Abdominal Skin and Soft-Tissue Laxity Using Microfocused Ultrasound With Visualization

BACKGROUND

Microfocused ultrasound with visualization (MFU-V) is a well-established treatment modality for skin tightening. There is a paucity of evidence for its use in body treatments, such as the lower abdomen.

OBJECTIVE

To investigate the effectiveness and safety of MFU-V in treating lower abdominal skin and soft-tissue laxity in postpartum women.

METHODS

The lower abdomen of 20 female patients between 6 and 24 months postpartum are treated with MFU-V using 1.5-, 3.0-, and 4.5-mm transducers. Data are prospectively collected and analyzed at 3 and 6 months using subject-reported and investigator-reported outcome measures. One additional patient underwent planned abdominoplasty 6 weeks after MFU-V treatment with tissue assessed intraoperatively and histologically.

RESULTS

There was a mean improvement of 1.0 and 1.3 grades at 6 months using the investigator-reported and patient-reported skin laxity scale, respectively (p < .001). Patient-reported outcomes and satisfaction survey showed consistent improvement at 6 months. Histological examination of pretreated tissue showed increased total collagen, increased number and thickness of fibrous septae, and no change in fat cells within pretreated tissue compared with the control. No significant adverse events were recorded.

CONCLUSION

MFU-V is an effective and safe treatment modality for lower abdominal skin laxity in postpartum patients.

Single-Plane Versus Dual-Plane Microfocused Ultrasound With Visualization in the Treatment of Upper Arm Skin Laxity: A Randomized, Single-Blinded, Controlled Trial

BACKGROUND AND OBJECTIVES

Non-invasive skin tightening devices have become a safe and non-invasive treatment for patients with skin laxity of the upper arm. The efficacy of microfocused ultrasound with visualization (MFU-V) in skin tightening had been demonstrated in several studies. This study aimed to evaluate the efficacy and safety of MFU-V in treating skin laxity of the upper arm using different treatment protocols.

STUDY DESIGN/MATERIALS AND METHODS

Thirty patients with upper arm laxity were enrolled. Patients were randomly assigned to receive single-plane MFU-V treatment (4 MHz/4.5 mm transducer) on one arm and dual-plane treatment (4 MHz/4.5 mm and 7 MHz/3.0 mm transducer) on the contralateral arm, totaling 200 lines in each arm. Investigator Assessment Skin Laxity Scoring System (IASLSS) and improvement scores were evaluated at 1, 3, and 6 months after the treatment. Adverse events were recorded.

RESULTS

A modest reduction of mean arm circumference was observed on both sides. Mean physician-rated improvement scores,  single-plane treatment received 2.22 (±1.05), 2.70 (±1.32), and 1.61 (±0.79), respectively. Dual-plane treatment received 2.00 (±1.00), 2.56 (±1.05), and 1.39 (±0.54), respectively. Single-plane treatment was superior from physician's ratings (P < 0.05). IASLSS followed the same trend as the improvement scores. Mean patient-rated improvement scores in single-plane treatment were 3.63 (±2.63), 3.69 (±2.83), 1.90(±2.51) for 1, 3, and 6 months, respectively. Dual-plane treatment received 3.5 (±2.57), 3.22 (±2.59), 1.78 (±2.48), respectively. The median pain scores were 2.6 (0-8) for single-plane treatment and 1.9 (0-8) for dual-plane treatment (P = 0.136). No other significant side effects were observed.

CONCLUSION

Both single-plane and dual-plane treatment provide a modest skin tightening effect in the upper arm for at least 3 months. Physicians should assess skin thickness in every patient using the visualization screen to select the appropriate transducer for each individual patient. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Multimodal Radiofrequency Application for Lower Face and Neck Laxity

Nonexcisional facial skin tightening has long been an elusive goal in aesthetic surgery. The "treatment gap" includes cases who are not "severe" enough for excisions surgery but not "mild" enough for most traditional noninvasive aesthetic modalities. In this retrospective review, we present the largest evaluation to date of radiofrequency (RF) skin tightening technology combination including bipolar RF (FaceTite; InMode) and fractional bipolar RF (Fractora modified to Morpheus8; InMode).

METHODS

A multicenter retrospective study was conducted between January 2013 and December 2018 using a combination of bipolar RF and fractional bipolar RF for the treatment of facial aging. Data collection included demographic information, Baker Face/Neck Classification, amount of energy used, adverse events, and patient satisfaction. Four cadaver dissections were also conducted to correlate the underlying neuromuscular anatomy with RF treatment of the lower face and neck.

RESULTS

Two hundred forty-seven patients (234 women and 13 men) were included in the study. Average age was 55.1 years (SD, ±8), body mass index was 24.3 (±2.4), and 9% (23/247) of patients were active smokers at the time of treatment. Patients had an average Baker Face/Neck Classification score of 3.1 (SD, ±1.4). The procedure was performed under local anesthesia in 240/247 cases (97.2%). Patients objectively improved their Baker Face/Neck Classification score by 1.4 points (SD, ±1.1). Ninety-three percent of patients indicated that they were pleased with their results and would undergo the procedure again. Complications recorded for our cohort included prolonged swelling >6 weeks (4.8%, 12/247), hardened area >12 weeks (3.2%, 8/247), and marginal mandibular neuropraxia (1.2%, 3/247), which all resolved without further intervention. When considering possible control variables, age seems to be a significant factor. That is, older patients were more likely to benefit from a larger magnitude of the treatment effect (as demonstrated by a decrease in the Baker rating from pre- to posttreatment) when compared with younger patients. However, both groups did demonstrate significant improvements across time.

CONCLUSION

While this combination RF treatment (FaceTite bipolar RF and fractional bipolar RF) does not aim to replace a facelift/necklift in appropriate candidates, it does broaden the plastic surgeons' armamentarium to potentially fill a treatment gap.

Combination treatment with 150 W bipolar radiofrequency, infrared light, and ultrasound-induced lipolysis for thigh circumference reduction

BACKGROUND

A growing patient demand for a favorable body shape has led to the development of many new treatment modalities. Noninvasive devices were developed to improve body contour without physical intervention or scarring and with reduced downtime compared to surgical options such as liposuction.

AIMS

This study examines combining radiofrequency, infrared light, and ultrasound-induced lipolysis for fat reduction and body contouring.

PATIENTS/METHODS

Ten female subjects underwent a combination treatment with 150 W bipolar radiofrequency, infrared light, and ultrasound-induced lipolysis with two devices. A total of three treatments were done every 2 weeks. Data including weight, thigh circumference, patient comfort during the procedure, and fat thickness by skin caliper were collected at each visit. After the series of treatments, subjects and investigators reported satisfaction at 4-, 8-, and 12-week follow-up visits.

RESULTS

At the 12-week follow-up visit, the average change in thigh circumference from baseline was -2.77 cm. The average change in fat thickness at the same time period was -0.14 cm. Self-reported scores of discomfort were low with most subjects reporting no pain to mild discomfort during the study. Treatments were well tolerated with mild erythema reports in 65% of treatments and mild heat in 17% of treatments. 78% of subjects and investigators reported being "very satisfied" at the 12-week follow-up visit, and 100% of participants reported that they would recommend this treatment.

CONCLUSION

Combination treatment with 150 W radiofrequency, infrared light, and ultrasound-induced lipolysis is an effective method for reducing thigh circumference and noninvasive body contouring.

Combined microwaves and fractional microablative CO2 laser treatment for postpartum abdominal laxity

BACKGROUND

Postpartum abdominal changes represent a major esthetic concern affecting women. As the abdomen stretches during pregnancy and some of the muscles lose tone, there is an increased skin laxity and a loss of abdominal elasticity. As a result, the abdomen becomes saggy.

AIMS

To evaluate the performance of a combined microwaves and fractional microablative CO2 laser treatment for reshaping and improvement of abdomen texture/laxity and striae distensae in postpartum women.

PATIENTS/METHODS

Fifteen women (median age 38 years) received three monthly abdomen treatments with a new microwaves platform, the ONDA Coolwaves^® (DEKA) system, followed by a treatment with fractional microablative CO2 laser (SmartXide2; DEKA) a month thereafter. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference and abdominal measurements, digital and 3D photography, the laxity score as well as patient satisfaction index.

RESULTS

The overall mean circumferences reduction was 3.6 ± 1.2 cm. Significant improvement in skin laxity and tightening was noted by physicians and patients as well as a reduction of striae distensae. Interestingly, as a result of skin remodeling, repositioning of the umbilicus was also demonstrated. Treatments were well tolerated with no side effects.

CONCLUSIONS

Our data showed a sustainable reduction in circumference and improvement in appearance of abdomen in postpartum women, without compromising patients' safety.

Adjustable Depth Fractional Radiofrequency Combined With Bipolar Radiofrequency: A Minimally Invasive Combination Treatment for Skin Laxity

Increasingly, patients are seeking minimally invasive methods to tighten skin and remodel adipose tissue. A large treatment gap exists among 3 types of patients: (1) the younger demographic, who increasingly desire soft tissue tightening without traditional operations, scars, and downtime; (2) patients with soft tissue laxity who are not “severe enough” to justify an excisional procedure, but not “mild enough” to rely on liposuction with soft tissue contraction alone; and (3) those with recurrent laxity who already underwent traditional excisional procedures. In these populations, plastic surgeons risk under- or overtreating with traditional methods. The purpose of this supplement is to describe the utility of radiofrequency (RF) microneedling (Fractora modified to Morpheus8 InMode Aesthetic Solutions, Lake Forest, CA) in combination with bipolar RF (FaceTite/BodyTite, InMode Aesthetic Solutions). By combining these procedures, the aforementioned treatment gap can be addressed. The RF microneedling allows for subdermal adipose remodeling and skin tightening. Addition of bipolar RF also tightens the skin by contraction of the underlaying fibroseptal network in addition to induction of neocollagenesis, elastogenesis, and angiogenesis at skin surface temperatures of 40° to 50°C. In our experience, these technologies have been effective and safe in these patient populations.

Level of Evidence: 4

A randomized, controlled multicenter study evaluating focused ultrasound treatment for fat reduction in the flanks

INTRODUCTION

Energy-based cosmetic devices offer an in-office treatment option, with minimal downtime, to non-invasively remove unwanted fat. We evaluated focused, pulsed ultrasound treatment to randomized flanks, compared to corresponding non-treated contralateral flanks.

MATERIAL AND METHODS

Subjects were enrolled at three sites for a series of focused ultrasound treatments to a single flank, with the contralateral flank remaining untreated throughout the study. Success criteria included measureable fat thickness reduction on ultrasound imaging in the treated areas at 16 weeks after the final treatment session, and correct identification of the post-treatment photo and treated flank in at least 80% of evaluated images, as assessed by two blinded evaluators.

RESULTS

The post-treatment flank photo and treated flank side were correctly identified in 82% and 93% of cases, respectively. All study subjects demonstrated significant fat reduction in their treated area, as measured by ultrasound and skin caliper. Subjects expressed a high satisfaction from treatment outcomes. There were no complications with treatment.

CONCLUSION

A series of three ultrasound treatments resulted in significant fat reduction in treated flanks. Although treatment results are more modest than with liposuction, non-invasive ultrasound treatment may provide an attractive alternative for patients seeking an in-office, nonsurgical procedure for fat reduction.

Comparison of self-reported signs of facial ageing among Caucasian women in Australia versus those in the USA, the UK and Canada

Background/Objectives

Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self‐reported facial ageing among fair‐skinned Australian women were compared with those living in Canada, the UK and the USA.

Methods

Women voluntarily recruited into a proprietary opt‐in survey panel completed an internet‐based questionnaire about their facial ageing. Participants aged 18–75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I–III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race.

Results

Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume‐related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women.

Conclusions

Australian women reported more severe signs of facial ageing sooner than other women and volume‐related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume‐related ageing. These findings have implications for managing their facial aesthetic concerns.

Low-Level Laser Therapy for Reducing the Hip, Waist, and Upper Abdomen Circumference of Individuals with Obesity

OBJECTIVE

To assess the effectiveness of low-level laser therapy (LLLT) for reducing hip, thigh, and abdomen circumference of individuals with body-mass index (BMI) between 30 and 40 kg/m².

BACKGROUND

Previous studies demonstrated the effectiveness of LLLT for reducing body circumference in the hips, thighs, and abdomen of nonobese individuals with a BMI <30 kg/m².

METHODS

In this randomized, double-blind sham-controlled study, obese, but otherwise healthy, individuals were randomized to undergo 30-min LLLT (n = 28) or sham treatments (n = 25) three times weekly for 4 weeks. Body measurements were obtained after 2 and 4 weeks of treatment and 2 weeks post-treatment ( ClinicalTrials.gov Identifier: NCT01821352).

RESULTS

After 4 weeks, 20 LLLT-treated subjects (71.43%) achieved ≥7.2 cm decrease in combined measurements versus three sham-treated subjects (12%; p < 0.00005). The mean (standard deviation) decrease in combined measurement for LLLT-treated subjects was 10.52 (7.59) cm (p < 0.0001 vs. baseline) versus 1.80 (3.20) cm for sham-treated subjects. Among subjects with a combined ≥7.2 cm decrease, the mean total decrease 2 weeks post-treatment was 15.21 cm. There were no adverse events.

CONCLUSIONS

Based on these results, the device was cleared by the U.S. Food and Drug Administration as a noninvasive esthetic treatment for reduction of circumference of hips, waist, and upper abdomen when applied to individuals with a BMI between 30 and 40 kg/m².

Antiadipogenic effects of subthermal electric stimulation at 448 kHz on differentiating human mesenchymal stem cells

The 448 kHz capacitive‑resistive electric transfer (CRET) is an electrothermal therapy currently applied in anticellulite and antiobesity treatments. The aim of the present study was to determine whether exposure to the CRET electric signal at subthermal doses affected early adipogenic processes in adipose‑derived stem cells (ADSC) from human donors. ADSC were incubated for 2 or 9 days in the presence of adipogenic medium, and exposed or sham‑exposed to 5 min pulses of 448 kHz electric signal at 50 µA/mm2 during the last 48 h of the incubation. Colorimetric, immunofluorescence, western blotting and reverse transcription‑quantitative polymerase chain reaction assays were performed to assess adipogenic differentiation of the ADSC. Electric stimulation significantly decreased cytoplasmic lipid content, after both 2 and 9 days of differentiation. The antiadipogenic response in the 9 day samples was accompanied by activation of mitogen‑activated protein kinase kinase 1/2, decreased expression and partial inactivation of peroxisome proliferator‑activated receptor (PPAR) γ, which was translocated from the nucleus to the cytoplasm, together with a significant decrease in the expression levels of the PPARG1 gene, perilipin, angiopoietin‑like protein 4 and fatty acid synthase. These results demonstrated that subthermal stimulation with CRET interferes with the early adipogenic differentiation in ADSC, indicating that the electric stimulus itself can modulate processes controlling the synthesis and mobilization of fat, even in the absence of the concomitant thermal and mechanical components of the thermoelectric therapy CRET.

Radiesse(®): a novel rejuvenation treatment for the upper arms

Nonsurgical esthetic improvement of the upper arms is a desirable goal for many individuals. Radiesse^® (calcium hydroxylapatite) is an effective dermal filler for a number of indications because of its volumizing effect and the ability to stimulate neocollagenesis. No studies have reported on its safety and effectiveness for the treatment of the upper arm. In a prospective, open-label study, 30 subjects seeking improvement in the esthetic appearance of their upper arms received injections with Radiesse^® (1.5 mL/arm) at two separate visits, 1 month apart. Subjects returned for a follow-up visit 4 months after the second treatment. The primary endpoint was the degree of overall subject and evaluator (investigators and study nurses) satisfaction assessed using the 5-point Global Satisfaction Scale (ranging from “1” very dissatisfied to “5” very satisfied). Secondary endpoints included assessments of skin quality (flaccidity and volume distribution) using a new Visual Analog Scale for upper arms and overall assessment of treatment using the Global Aesthetic Improvement Scale. All (100%) of both subjects and evaluators were “satisfied” or “very satisfied” with treatment. The mean Global Satisfaction Score for investigators and study nurses was 4.60 and for subjects 4.53 (satisfied to very satisfied). Assessments of flaccidity and volume improved significantly compared with baseline at the post-treatment visit and also between visits. Compared with baseline, 77% of subjects were rated as considerably improved (good or great improvement) by the investigator and study nurse; 73% of subjects rated themselves as considerably improved and 43% of these rated a “great improvement.” All stated they would repeat the treatment and recommend it to others. No adverse events were reported. Radiesse^® is an effective minimally invasive treatment option for improving upper arm contours and was associated with a 100% satisfaction rate for both subjects and evaluators.

Complementary and alternative medicine for the treatment of obesity: a critical review

CONTEXT

Obesity and its associated morbidities pose a major health hazard to the public. Despite a multiplex of available diet and exercise programs for losing and maintaining weight, over the past years, interest in the use of complementary and alternative medicine (CAM) for obesity treatment has greatly increased.

EVIDENCE ACQUISITION

We searched PubMed, Google scholar and the Cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to December 2013.

RESULTS

In this review, the efficacy and safety of the more commonly used CAM methods for the treatment of obesity, namely herbal supplements, acupuncture, and non-invasive body-contouring, are briefly discussed. The evidence supporting the effectiveness and safety of these methods is either lacking or point to a negligible clinical benefit, barely surpassing that of the placebo. Furthermore, several limitations are observed in the available scientific literature. These shortcomings include, without being limited to, uncontrolled trial designs, non-random allocation of subjects to treatment arms, small number of patients enrolled, short durations of follow-up, and ambiguous clinical and laboratory endpoints.

CONCLUSIONS

Further investigations are necessary to accurately determine the efficacy, safety, standard dosage/procedure, and potential side effects of the various CAM methods currently in use.

The evidence behind noninvasive body contouring devices

The demand for body contouring is rapidly increasing, and interest in noninvasive approaches has also grown. The author reviewed the evidence base behind the currently available devices and methods for nonsurgical body contouring. There is little high-level evidence in the present literature to support the effectiveness of any of these devices.

Reduction in adipose tissue volume using a new high-power radiofrequency technology combined with infrared light and mechanical manipulation for body contouring

A growing patient demand for a youthful skin appearance with a favorable body shape has led to the recent development of new noninvasive body contouring techniques. We have previously demonstrated that the combination of bipolar radiofrequency (RF) and optical energies with tissue manipulation is an efficient reshaping modality. Here, we investigated the efficacy and safety of a new high-power version of this combined technology, in terms of adipose tissue reduction and skin tightening. Thirty-five patients received one treatment per week over 6 weeks to their abdomen/flank, buttock, or thigh areas and were followed up to 3 months post completion of the treatment protocol. This new device has an increased power in the bipolar RF, as this parameter appears to be the most important energy modality for volume reduction. Patient circumferences were measured and comparisons of baseline and post treatment outcomes were made. Diagnostic ultrasound (US) measurements were performed in 12 patients to evaluate the reduction in adipose tissue volume, and a cutometer device was used to assess improvements in skin tightening. We observed a gradual decline in patient circumferences from baseline to post six treatments. The overall body shaping effect was accompanied with improvement in skin tightening and was clearly noticeable in the comparison of the before and after treatment clinical photographs. These findings correlated with measurements of adipose tissue volume and skin firmness/elasticity using diagnostic US and cutometer, respectively. The thickness of the fat layer showed on average a 29% reduction between baseline and the 1-month follow up. The average reduction in the circumference of the abdomen/flanks, buttocks, and thighs from baseline to the 3-month follow-up was 1.4, 0.5, and 1.2 cm, respectively, and 93% of study participants demonstrated a 1-60% change in fat layer thickness. Patients subjectively described comfort and satisfaction from treatment, and 97% of them were satisfied with the results at the follow-up visit. The application of high-power RF energy combined with infrared (IR), mechanical massage, and vacuum appears to be an effective modality for the reduction in circumferences of the abdomen/flank, buttock and thigh regions, and the improvement of skin appearance. The present study performed with a new device suggests that the underlying mechanism of action is reduction in the subcutaneous adipose tissue volume and intensification of dermal matrix density.

Cellulite - an overview of non-invasive therapy with energy-based systems

Cellulite is one of the most common skin care concerns seen in modern dermatology. The presence of cellulite in the 21(st) century is now considered a major "problem" whose treatment options are varied and numerous, all with hopes of improving the appearance of cellulite and maintaining its response over a period of time. The purpose of this article is to review cellulite, its predisposing factors, its classification, and some of the more common devices now in use to treat the disorder.

Patient Satisfaction after Upper Extremity Laser Lipolysis without Suction

Background and Objective. There has been a heightened interest in laser-assisted fat reduction procedures. We aimed to determine if lipolysis with the 1,320 nm Nd-YAG short-pulsed laser without subsequent suction results in satisfactory contouring of the upper extremity. Materials and Methods. Unilateral laser lipolysis of the upper arm was performed on 5 patients. Subcutaneous, subdermal, and skin surface temperatures were monitored with flexible thermocouples throughout the procedure to aid in the establishment of a treatment endpoint. Photographs and arm circumference measurements were evaluated before and 3 months after laser lipolysis. Patients were given the choice of undergoing the procedure on the contralateral arm at 3 months. Results. All patients achieved no improvement to minimal improvement in upper arm contour. One of five patients was elected to have lipolysis performed on the contralateral arm. Conclusion. Laser lipolysis may be safely performed with the parameters utilized in this pilot study, although minimal improvement was seen in upper extremity contour.