Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring

Non-invasive Body Contouring Technologies: An Updated Narrative Review

INTRODUCTION

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices.

METHODS

We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring.

RESULTS

Totally 193 references were used in 11 main topics.

CONCLUSION

In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section.

LEVEL OF EVIDENCE I

This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Cryolipolysis: A promising nonsurgical technique for localized fat reduction

BACKGROUND

Cryolipolysis, also known as fat freezing, is a nonsurgical technique specialized for localized fat reduction. Utilizing targeted cold exposure to adipose tissue, cryolipolysis devices induce cellular apoptosis in adipocytes while sparing surrounding tissues, resulting in the selective disruption of fat cells and subsequent removal of damaged cells by macrophages. A reduction of the fat layer produces a noninvasive cosmetic benefit that provides an accessible alternative to liposuction. Objective and subjective measurements have demonstrated significant reduction in fat volume and high patient satisfaction rates. Cryolipolysis has been proven to be safe with minimal adverse effects. However, further research is needed to fully understand the mechanism of cryolipolysis and its efficacy in different treatment areas. This paper aims to provide a comprehensive overview of cryolipolysis, including its mechanism of action, indications, contraindications, adverse effects, results and outcomes, safety profile, and areas requiring further research.

METHODS

Our primary phase of literature review consisted of a PubMed search looking for all published literature around cryolipolysis. We employed a review approach that examined over 30 papers with the key search terms of "cryolipolysis," "fat-freezing," "cosmetic dermatology," "body contouring," "adverse effects," "adipocyte apoptosis," "Coolsculpting®," "cold panniculitis," and "localized fat reduction." We then analyzed each paper, extracting relevant information to gain a multidimensional understanding of cryolipolysis to provide a comprehensive review.

CONCLUSION

Cryolipolysis, with its ability to target and reduce localized adipose tissue, has emerged as a promising nonsurgical technique in the field of body contouring. It offers patients a valuable option for achieving their desired fat reduction without the need for a lengthy recovery period or major surgery. Cryolipolysis has shown to reduce the number of adipocytes in the treated area, a phenomenon that can be objectively quantified through various means, including fat caliper measurements, ultrasound assessments, and 3D imaging, or subjectively observed through patient satisfaction rates, clinical observations, and investigator assessments. In addition to its effectiveness in reducing localized adipose tissue, cryolipolysis also holds potential in the area of skin tightening. Preliminary studies suggest that cryolipolysis may have a positive impact on skin elasticity and tightening. Further investigation of this mechanism is needed to provide a better understanding of its potential in achieving optimal cosmetic outcomes for patients. By combining the benefits of fat reduction and skin tightening, cryolipolysis has the potential to offer a comprehensive nonsurgical solution for body contouring.

A review of research for a cryolipolysis technology

BACKGROUND

Obesity and excess body fat are known health issues and a major aesthetic concern. Numerous modalities have been developed to address unwanted deposits of adiposity, including the development of various noninvasive methods overcoming the limitations and risks of invasive alternatives. Cryoadipolysis, also known commonly as cryolipolysis, involves the harnessing of selective cryolysis, the selective cold-based damaging of subcutaneous fat cells which die via apoptosis, and are removed naturally by the body over time.

AIMS

To provide a brief but comprehensive summary of the literature supporting two related cryoadipolysis devices that are only available outside of North America, Cooltech and Cooltech Define (Sinclair).

RESULTS/DISCUSSION

Review of 10 available clinical studies evaluating the two devices, specifically, showed both devices to be safe, with side effects profiles comparable to those of similar platforms in the armamentarium. Both operate by non-invasively lowering the temperature of localized subcutaneous fat and maintaining it at or below a threshold that causes disruption of adipocytes via crystallization, inducing apoptosis (programmed cell death). Over time, clinically significant reductions in fat thickness and circumference of the treated area were noted. Patient satisfaction is high. The literature also highlights the necessity of adherence to patient selection and device use guidelines to minimize potential for rare paradoxical adipose hyperplasia and maximize patient satisfaction.

Selective reduction of visceral adipose tissue with injectable ice slurry

Reduction in visceral adipose tissue (VAT) mass reduces body weight and metabolic disease risk in obese patients. However surgical removal of VAT is highly invasive and thus not clinically feasible. We developed an injectable ice slurry for selective reduction of adipose tissue through cryolipolysis. The aim of this study was to investigate safety, feasibility and mechanism of ice slurry-induced cryolipolysis of VAT. Perigonadal VAT in diet-induced obese mice and rats was subjected to slurry or sham treatment. Body weight and blood chemistry were monitored for 56 days post-treatment. Histological analysis and molecular studies were performed to elucidate mechanisms of fat reduction. Treatment of VAT was well tolerated in all animals. Slurry induced adipocyte cell death via selective cryolipolysis; significant weight loss was noted at day 21 post-treatment. RNA sequencing from treated VAT samples showed increased expression of genes involved in inflammation, immune response, collagen biosynthesis and wound healing, and decreased expression of adipokines. This study demonstrates that slurry treatment is safe and effective in inducing cryolipolysis of VAT and subsequent weight loss in mice. Ice slurry is promising as a minimally-invasive treatment to reduce visceral adipose tissue.

Shock Wave Therapy in Plastic Surgery: A Review of the Current Indications

BACKGROUND

Extracorporeal shock wave therapy (ESWT) represents a promising, non-invasive management strategy supporting the treatment of a variety of conditions related to plastic surgery.

OBJECTIVES

This literature review aimed to give a systematic overview of current applications, its mechanism of action, and its potential to provide tangible therapies in plastic surgery.

METHODS

The databases PubMed (National Institute of Health, Bethesda, MD), Embase (via Ovid [Elsevier, Amsterdam, the Netherlands]), and the Cochrane Library (Cochrane, London, UK) were searched for articles published up to June 1, 2021. Clinical studies of any design including ESWT in the context of plastic surgery were included. Two reviewers extracted data, and 46 articles were analyzed after application of the inclusion and exclusion criteria.

RESULTS

Forty-six included studies (n = 1496) were categorized into the following broad themes: cellulite/body contouring/skin rejuvenation, burns/scar treatment, diabetic foot ulcers/chronic wound, and future perspectives of ESWT. Overall, applications of ESWT were heterogenous, and the majority of studies reported effectiveness of ESWT as an alternative treatment technique. Flawed methodology and differences in technical standards limit the outcome and conclusion of this review.

CONCLUSIONS

There is yet insufficient evidence to support the effectiveness of any specific intervention included in this review; however, all included studies reported improvements in key outcomes. Where reported, ESWT displayed a good safety profile with no serious adverse events. Further research is needed to provide more evidence to delineate the indications of ESWT in plastic surgery.

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.

Cryolipolysis on More than One Body Area Increases Lipid Peroxidation without Changing Lipid Profile and Inflammatory Markers

In the present study, the effects of cryolipolysis on one and multiple body areas, assessing body composition, lipid profile and peroxidation and inflammatory markers were investigated. Twenty-four women aged between 20 and 59 years were randomly assigned to three groups: (1) control, (2) cryolipolysis on the abdomen and (3) cryolipolysis on the abdomen + flanks. Anthropometric measurements, bioimpedance and ultrasound were performed, as well serum lipid profile, lipid peroxidation markers (malondialdehyde and myeloperoxidase) and inflammatory markers (C-reactive protein and Interleukin-1β) were determined. In addition, food consumption and physical activity level were evaluated. Data were obtained at 0, 10 and 30 days (t0, t10 and t30) after cryolipolysis. Cryolipolysis did not change anthropometric measurements, body composition or lipid profile. Interestingly, the abdomen + flanks group had significantly increased plasma myeloperoxidase activity at t0, t10 and t30, and increased malondialdehyde levels at t0 and t10 when compared to the other groups. Furthermore, there were no differences between macronutrient intake and total energy value, physical activity level, malondialdehyde and interleukin-1β at t30. Cryolipolysis did not change body composition, lipid profile or inflammatory markers investigated. On the other hand, when used on the abdomen and flanks, it produced an increase in lipid peroxidation markers, malondialdehyde and myeloperoxidase.

Combination of monopolar 2 MHz radiofrequency and electrical multidirectional stimulation for reducing abdominal circumference and enhancing the muscle definition in subjects with overweight range body mass index

BACKGROUND

The popularity of noninvasive body contouring procedures has been steadily increasing in recent years, however, studies evaluating its effectiveness in individuals with overweight range body mass index (BMI) are limited.

OBJECTIVE

To evaluate the efficacy and safety of combined 2 MHz radiofrequency (RF) and electrical multidirectional stimulation (EMDS) for the improvement of the abdominal contour in subjects with overweight range BMI.

METHODS

Twelve participants with overweight range BMI (23.6-24.9 kg/m² ) underwent a single RF treatment, followed by a series of six EMDS treatments. Follow-up assessments (abdominal circumference [AC] and skinfold thickness measurements) were scheduled 1, 2, and 3 months after the final session.

RESULTS

At 1 month after the final treatment, a 3.1% (2.6 ± 0.47 cm, mean ± SD) significant reduction in mean AC was observed (p ˂ 0.001) and a maximal skinfold thickness reduction of 14% (4.6 ± 1.1 mm) was also noted (p = 0.032). Transient dysesthesia lasting 2-3 hours after EMDS treatment was the most common adverse effect reported by 5 of 12 subjects (41.7%), with no other serious side effects.

CONCLUSIONS

Combined RF and EMDS treatments are safe and effective, yielding significant reductions in both AC and skinfold thickness in patients with overweight range BMI, causing only minimal and transient adverse effects.

Efficacy of a Novel Injection Lipolysis to Induce Targeted Adipocyte Apoptosis: A Randomized, Phase IIa Study of CBL-514 Injection on Abdominal Subcutaneous Fat Reduction

BACKGROUND

CBL-514 is a novel injectable drug that may be safe and efficacious for localized abdominal subcutaneous fat reduction.

OBJECTIVES

The aim of this study was to assess the safety and efficacy of CBL-514 in reducing abdominal subcutaneous fat volume and thickness.

METHODS

This Phase IIa, open-label, random allocation study consisted of a 6-week treatment period and follow-up at 4 and 8 weeks following the last treatment. Participants were randomly allocated to receive 1.2 mg/cm2 (180 mg), 1.6 mg/cm2 (240 mg), or 2.0 mg/cm2 (300 mg) of CBL-514 with up to 4 treatments, each comprising 60 injections into the abdominal adipose layer. Changes in abdominal subcutaneous fat were assessed by ultrasound at follow-up visits. Treatment-emergent adverse events were recorded.

RESULTS

Higher doses of CBL-514 (unit dose, 2.0 and 1.6 mg/cm2) significantly improved the absolute and percentage reduction in abdominal fat volume (P < 0.00001) and thickness (P < 0.0001) compared with baseline. Although the COVID-19 pandemic halted some participant recruitment and follow-ups, analysis was unaffected, even after sample size limitations.

CONCLUSIONS

CBL-514 injection at multiple doses up to 300 mg with a unit dose of 2.0 mg/cm2 is safe, well-tolerated, and reduced abdominal fat volume and thickness by inducing adipocyte apoptosis. Although other procedures exist to treat abdominal fat, they have limitations and may cause complications. At a dose of 2.0 mg/cm2, CBL-514 safely and significantly reduced abdominal fat volume by 24.96%, making it a promising new treatment for routine, nonsurgical abdominal fat reduction in dermatologic clinics.

LEVEL OF EVIDENCE: 4

Comparison of the effects of shock waves versus radiofrequency on abdominal lipolysis: A randomized clinical trial

BACKGROUND

High levels of abdominal adiposity mean higher risk of developing cardiovascular diseases. Aerobic exercise per si reduces the risk of developing this type of diseases. Radiofrequency and shockwave therapy showed to be effective in the reduction of localized abdominal fat.

AIM (S)

To compare the effects of prescribed moderate aerobic exercise associated with 6 sessions of shockwave therapy or radiofrequency, in the subcutaneous abdominal adipose tissue, in overweight female individuals in fertile age.

METHODS

Randomized clinical trial, with 30 volunteers in fertile age with overweight and/or obese, randomly and equitably allocated in two experimental groups (1-shockwave therapy and 2-radiofrequency) and one control group. Aerobic physical exercise was prescribed to all groups. The values of anthropometric measurements were measured in two moments. The intervention protocol was performed in a clinic for six weeks, with one session per week. The ANOVA test, paired samples t test, Kruskal-Wallis test, and Wilcoxon test were used to compare the results, for a significance level of 0.05.

RESULTS

Of 28 participants completed the study. There were significant differences in waist circumference reduction between the experimental group 1 and 2 when compared to the control group (p = 0.005 and p = 0.014, respectively). There was a statistically significant reduction in navel level circumference in experimental group 1 when compared to experimental group 2 (p = 0.024) and with the control group (p = 0.016).

CONCLUSION

Both resources were effective in reducing abdominal measurements when compared to the control group. However, SWT was superior in reducing the navel level circumference.

Quantitative Assessment of the Cryolipolysis Method for Body Contouring in Asian Patients

Purpose

Cryolipolysis has been demonstrated to be a safe and efficient non-invasive treatment modality for reducing subcutaneous discrete areas of fat; however, only limited studies have focused on body contouring in Asian patients. The present work focuses on the quantitative assessment of the cryolipolysis method for body contouring in Asian patients.

Patients and Methods

The retrospective study evaluated the medical records of 4122 patients with body contouring who underwent cryolipolysis treatment in multiple centers across Japan from January 2019 to June 2019. We evaluated the demographic profiles, treatment areas, and safety assessments among these 4122 patients. The effectiveness of the treatment was assessed in 146 patients at one of the clinics, Shonan Beauty Clinic, out of which 54 and 27 had treatments in the abdomen and upper arm areas, respectively. Clinical outcomes were assessed based on patient surveys, circumference measurements, and assessment of photographs.

Results

Evaluation of choice for treatment area suggested that men generally focused more on the surrounding areas of the abdomen, while women even had options for the abdomen and the upper arm. No long-term side effects were observed during the study period. There was a significant reduction in the circumference of both the abdomen and upper arm areas (P < 0.05). Additionally, 16.7% and 18.5% of patients who had received treatment on their abdomen and upper arm, respectively, returned for the next sessions within six months. Patients who had received treatment on their upper arms were more satisfied in the categories of pain and bruising and treatment effectiveness compared to those who had received treatment on their abdomen.

Conclusion

Based on the results obtained in this retrospective study on Asian patients, it can be stated that cryolipolysis is a safe and well-tolerated nonsurgical fat-reduction procedure. Clinical effectiveness can be consistently achieved with proper patient evaluation and patient satisfaction.

A Prospective Study Determining Patient Satisfaction with Combined Cryolipolysis and Shockwave Therapy Treatment for Noninvasive Body Contouring

BACKGROUND

With an increased interest in nonsurgical and minimally invasive body fat reduction and body contouring procedures with limited side effects and downtime, cryolipolysis has emerged as a compelling and safe alternative to surgical fat removal methods. A massage of the treated areas generally follows cryolipolysis treatment to improve blood circulation and increase apoptotic fat cells' removal. In this study, following cryolipolysis, we used shockwave therapy instead of massage to enhance the results of the body contouring treatment and improve the patient's comfort. We then assessed patients' comfort and satisfaction using the combination of cryolipolysis and shockwave therapy in reducing fat volume.

METHODS

We conducted a prospective study of 30 patients who underwent at least one cryolipolysis therapy cycle followed by shockwave treatment. Subjects were given a posttreatment questionnaire to assess the patient's comfort and satisfaction degree with the combination of cryolipolysis and shockwave therapy for fat reduction. Answers were recorded on a five-point Likert-style scale, entered into a database and were analyzed.

RESULTS

We found an overall high satisfaction rate for most patients when treated with shockwave therapy after cryolipolysis treatment. The majority of patients described the discomfort associated with treatment as minimal or tolerable (76.7%) and were prepared to recommend cryolipolysis treatment followed by shockwave therapy to friends (68.9%). Overall, 76.7% of patients found the combination therapy comfortable, 68.3% were satisfied with the results, 57.7% said the results met their expectations.

CONCLUSION

The most important aspects of body contouring methods is a patient's safety, comfort, satisfaction and self-image improvement. In this study, we report a high level of patient satisfaction when using a combination of fat reduction procedures of cryolipolysis followed by shockwave therapy. The majority of cases report being satisfied or extremely satisfied with the treatment and found this body contouring combination method comfortable. Cryolipolysis combined with shockwave treatment appears to be a safe and efficient way of reducing the size of localized and stubborn fat deposits for subjects who desire nonsurgical localized fat reduction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Objective and subjective reduction of cellulite volume using a localized vibrational massage device in a 24-week randomized intra-individual single-blind regression study

Cellulite occurs in females and is a common condition of altered connective tissue matrix and increased adipogenicity with visible dimples and orange‐peel appearance on the skins surface. Whilst advancements in methods continue to help our understanding, attempts to correct the appearance of cellulite topically have yielded limited success. Various kinds of non‐invasive body contouring methods such as whole body vibration have been reported with demonstrable visible improvements in the cellulite condition. The aim of this study was to evaluate volume reduction and improvement of the visible appearance of cellulite as judged both objectively (AEVA‐HE phase‐shift 3‐D fringe projection, macrophotography image grading) and subjectively (questionnaires) after application of a hand‐held localized vibrational device over 24‐weeks. The study was conducted on 40 healthy female volunteers who were instructed how to use the device on defined areas of cellulite of the outside and rear of the thighs (iliotibial band, and over biceps femoris region respectively). The initial 12 weeks of continuous massage application of the study were followed by a 12 week phase in which volunteers were split into 2 subgroups – one for assessment of regression effects and one for continuous application effects. AEVA (skin surface volume) measurements of cellulite‐related dimples correlated with questionnaires and visual image evaluation scoring, in that in the iliotibial region cellulite was significantly reduced at 12 weeks. In the regression subgroup cellulite returned to initial values soon after cessation of treatment, whereas in the continuous application subgroup, cellulite remained diminished. The effect of this device to reduce cellulite as observed in this study proves that continuous use of vibrational massage is beneficial to mitigate visible signs of cellulite.

A. A, Elsayed SH. Effect of focused ultrasound cavitation augmented with aerobic exercise on abdominal and intrahepatic fat in patients with non-alcoholic fatty liver disease: A randomized controlled trial

OBJECTIVES

The study aimed to examine the effect of focused ultrasound cavitation augmented with aerobic exercise on localized abdominal and intrahepatic fat in fatty liver patients.

METHODS

34 fatty liver patients aged 30-45 with a body mass index (BMI) of 30-40 kg/m2 were randomly assigned into two equally numbered groups. Group A received focused ultrasound cavitation and moderate aerobic exercise for three months, while Group B (control group) received moderate aerobic exercise only. Abdominal subcutaneous fat volume, visceral fat volume, liver-to-spleen ratio (L/S ratio), body weight, BMI, and waist circumference were measured both before and after the study period.

RESULTS

Both groups showed significant improvements in subcutaneous fat volume, visceral fat volume, body weight, BMI, and waist circumference relative to baseline where (P < 0.001), with a higher percentage in group A. L/S ratio only showed a significant improvement in group A. Between-group differences were noteworthy regarding L/S ratio and waist circumference where (P < 0.0001).

CONCLUSION

While substantial risky measures in non-alcoholic fatty liver disease have been modified by aerobic exercise, its combination with focused ultrasound cavitation causes more notable effects on the reduction of abdominal and intrahepatic fat, making it a superior option.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04161703.

Efficacy and safety of a novel combined 1060-nm and 635-nm laser device for non-invasive reduction of abdominal and submental fat

The aim of this study was to evaluate the safety and efficacy of combined 1060-nm diode laser and 635-nm low-level laser therapy (LLLT) device for non-invasive reduction of the abdominal and submental fat. Forty-two healthy subjects received single laser treatment on both the abdomen and submental area. Ultrasound images measuring the thickness of abdominal and submental fat were taken at baseline, follow-up at 4, 8, and 12 weeks after treatment. Waist circumference and body weight were also measured at all visits. Adverse events were recorded at all visits. Subjects completed a satisfaction questionnaire at the end of the trial. Twelve weeks after a single treatment with the investigational device, ultrasound images showed statistically significant (P < 0.0001) reductions in abdominal and submental fat by 18.62 and 26.4%, respectively. In addition, significant (P < 0.0001) reduction in waist circumference was observed. Ninety-six percent of subjects rated that they were satisfied. Noted side effects were transient mild to moderate tenderness which subsided within 1 to 3 weeks. No serious treatment-related adverse events were reported. The dual wavelength device combining 1060-nm diode laser with 635-nm LLLT was safe and effective for non-invasive reduction of both abdominal and submental fat.

The effects of extracorporeal shock wave therapy vs hand massage on serum lipids in overweight and obese women

Background

The purpose of our study was to investigate the effects of extracorporeal shock wave therapy (ESWT) and hand massage therapy (HMT) on serum lipids and body composition in Korean women.

Materials and methods

We randomly classified 60 participants into overweight and obese groups. Subjects received ESWT and HMT twice a week for six weeks (a total of 12 sessions).

Results

Body weight and body mass index decreased significantly in obese women from both groups. Waist circumference significantly declined in obese women and overweight women in both treatment groups (p < 0.001). Body fat significantly decreased in the ESWT group of obese women (p < 0.01), while a significant reduction in abdominal obesity was noted only in the HMT group of overweight women (p < 0.01) and the ESWT group of obese women (p < 0.01). There was a significant decrease in triglycerides in the ESWT group of obese women (p < 0.01).

Conclusions

These results suggest that ESWT and HMT could be helpful for the management of people with excess abdominal fat and obesity. Moreover, ESWT is more effective than HMT for improving abdominal obesity and triglyceride levels in obese women as compared to overweight women.

•

ESWT has the effect of reducing triglycerides in obese people.

•

ESWT on weight loss were more pronounced in obese participants than overweight.

•

The reduction of BMI in ESWT was more pronounced in obese patients than overweight.

Heat Shock Lipolysis: Radiofrequency Combined with Cryolipolysis for the Reduction of Localized Subcutaneous Fat

Introduction. Noninvasive procedures such as cryolipolysis, noncontact selective radiofrequency (RF), and laser selective fat heating have been shown to be safe and effective for the reduction of localized subcutaneous fat. Material and Methods. In this retrospective study, we describe the safety and efficacy of combining RF with cryolipolysis for localized unwanted fat after one single session. 69 patients, 61 females, and 8 males for a total of 75 treatments were included in this study. All patients underwent RF prior to and following cryolipolysis. Pictures (n = 24), taken before and after treatment, were used to clinically assess the physician Global Aesthetic Improvement Scale (PhGAIS). In parallel, patients were asked to subjectively evaluate the efficacy of the treatment using the same scale (PaGIAS).

Effects of cryolipolysis on lower abdomen fat thickness of healthy women and patient satisfaction: a randomized controlled trial

OBJECTIVE

To analyze the effects of cryolipolysis on the fat thickness of the lower abdomen of healthy women and patient's satisfaction.

METHODS

Design and setting: a randomized controlled trial, with concealed allocation and blinded assessor.

PARTICIPANTS

34 healthy women between 18 and 48 years, skinfold in the lower abdomen ≥3cm, BMI between 18.5 and 27kg/m², low level of physical activity, and no contraindication to cryolipolysis were allocated to intervention group (IG, n=17) or control group (CG, n=17).

INTERVENTIONS

The IG received one session of cryolipolysis with -10°C of temperature for 50min. The CG was not submitted to any kind of intervention. Both groups did the evaluation protocols at baseline, 30, 60 and 90 days after the intervention.

MAIN OUTCOME MEASURES

fat thickness was measured by ultrasonography (US), skinfold (SF) and abdominal circumference (AC1 and AC2).

RESULTS

No significant differences between the IG and CG were demonstrated at any evaluation at any time of follow up for the variables US (30 days: 0.05cm (95%CI: -0.12; 0.22), 60 days: 0.05cm (95%CI: -0.11; 0.20) and 90 days: 0.04cm (95%CI: -0.7; 0.25)), SF (30 days: -0.09cm (95%CI: -0.25; 0.08), 60 days: -0.14cm (95%CI: -0.36; 0.09) and 90 days: -0.001cm (95%CI: -0.237; 0.234)), AC1 (30 days: 0.42cm (95%CI: -1.1; 1.9), 60 days: -0.1cm (95%CI: -1.74; 1.54) and 90 days: -0.007cm (-1.9; 1.9)) and AC2 (30 days: 0.183cm (95%CI: -0.84; 1.20), 60 days: -0.13cm (95%CI: -1.61; 1.35) and 90 days: -0.31cm (95%CI: -1.61; 1.00)).

CONCLUSIONS

The current study showed that a single application of the utilized protocol of cryolipolysis does not produce any significant effect on fat thickness of the lower abdomen of healthy women.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03160976 (https://clinicaltrials.gov/ct2/show/NCT03160976). Contribution of the Paper: the study is one of the first studies in the literature with methodological rigor to report an unfavorable result for localized abdominal fat treatment with a single session of cryolipolysis.

Utilisation of Cryolipolysis among Asians: A Review on Efficacy and Safety

Cryolipolysis is a non-invasive fat reduction method that is capable of reducing subcutaneous fat significantly without damaging surrounding tissues, by applying cold temperature to induce adipocyte apoptosis. Most of the clinical studies in cryolipolysis were conducted in the Caucasian population, and only a few numbers in Asian, who has darker skin with Fitzpatrick skin type III to V. Higher rate of pigmentary changes were reported with the use of cryotherapy in darker skin. Therefore, this report is aimed to provide a comprehensive review regarding utilisation, efficacy and safety profiles of cryolipolysis among Asians. Currently, there are only four clinical trials conducted exclusively in an Asian population. Two studies were conducted in Korea, whereas others in China and Thailand. Cryolipolysis was performed in the abdomen, arm, inner thighs, and submental regions. The reported side effects were mild and transient, including erythema, hematoma, numbness, and pain. There were no pigmentary changes reported. Although only limited data available, those studies have proved that cryolipolysis utilisation among Asians or darker skin types provides the same efficacy and safety profiles as in Caucasians. Therefore, cryolipolysis might be proposed as the first treatment choice for Asian patients who opted to do body contouring.

Effective noninvasive body contouring by using a combination of cryolipolysis, injection lipolysis, and shock waves

BACKGROUND

Cryolipolysis combined with shockwave therapy has been previously shown to have synergistic effects in body contouring results.

OBJECTIVE

This open-label, prospective, multicenter, comparative study investigated the safety and efficacy of combined cryolipolysis, shockwave therapy with cryolipolysis, shockwave therapy, and injection polyenylphosphatidylcholine-based lipolysis.

METHODS

Enrolled patients were treated in the abdominal or flank area with cryolipolysis, shockwave therapy and injection lipolysis (n = 10) or cryolipolysis and shockwave therapy (n = 4). All treatments were conducted the same day. Evaluations were conducted 3 months after treatment and included histological analysis, standardized photography, blinded-investigator efficacy, and safety ratings, as well as patient ratings of satisfaction and tolerance.

RESULTS

Compared to baseline, the 3-month follow-up histological analysis revealed a more profound subcutaneous adipose tissue reaction with the triple combination therapy (cryolipolysis, injection lipolysis, radial shock wave) than with the double combination with regard to adipocyte damage and grade of inflammation. Waist circumference was significantly reduced in patients of both groups, but patients in the triple combination group were shown to have a significantly more pronounced reduction in subcutaneous fat. Factors that were shown to influence treatment outcome included baseline BMI and waist circumference. Age and gender had no effect. The abdominal area reacted better to the treatment compared to flanks. No significant side effects or adverse events were reported. The procedure was well-tolerated, and the majority of patients were satisfied with the treatment results.

CONCLUSIONS

Combination of cryolipolysis, radial shockwave, and injection lipolysis is a safe, well-tolerated treatment for reduction in subcutaneous fat.

The Effect of Repeated Whole-Body Cryostimulation on the HSP-70 and Lipid Metabolisms in Healthy Subjects

The aim of this study was to evaluate the effects of exposure to 30 daily whole body cryostimulation (WBC) on lipid metabolic parameters and serum HSP-70 concentration. The study involved 45 volunteers, homogeneous in terms of diet and daily physical activity. Blood samples were collected before and after the 10th, the 20th, and the 30th session and one month after the intervention. Total cholesterol, HDL, TG concentrations and Apolipoprotein A-I, ApoB and HSP-70 protein levels were determined in serum. Additionally, the LI (Lipid Index) and the LDL level were calculated. During exposure, positive changes in the lipid profile that included a decrease in the TCh, initiated after the 20th WBC session with a simultaneous decrease in TG and LDL levels, and an increase in the HDL concentration were observed. These changes were accompanied by a downward trend in the ApoB concentration and a decrease in the ApoB:ApoA-I ratio after 30 sessions. The nature of these changes persisted for a month after the exposure. The obtained results indicate metabolic benefits that result from prolonged exposure to cryogenic temperatures, confirming the postulate of using WBC in the regulation of lipid metabolism and the prevention of cardiovascular diseases.

Cryolipolysis: patient selection and special considerations

Cryolipolysis is considered a safe and effective procedure, with high patient satisfaction rates, especially when compared to other procedures for localized adiposity, such as high-intensity focused ultrasound and shock waves. Although this statement is present in the literature, the importance of the selection of suitable patients for this type of treatment is not well known. The objective of this study was to discuss the criteria to be considered in the selection of patients who are candidates for cryolipolysis and assess their profile regarding their anthropometric data, age, skin characteristics, cutaneous sensitivity, and risk pathologies for this type of treatment. Assessing the amount of localized adiposity requires safe and validated methods that are significant in measuring results. The aim is to achieve success in the process of reducing adiposity guaranteeing patient satisfaction and assurance of results.

Safety and efficacy of a novel high-intensity focused electromagnetic technology device for noninvasive abdominal body shaping

BACKGROUND

Thermal fat reduction technologies are leading the market for nonsurgical abdominal contouring. However, they are ideal principally for patients with fat bulges.

OBJECTIVES

Our study investigates the effects of a novel nonthermal technology affecting the abdominal musculature and subcutaneous adipose tissue.

MATERIALS AND METHODS

A total of 22 patients (avg. BMI 23.8 kg m^-2 ) underwent 4 treatments on abdomen with high-intensity focused electromagnetic (HIFEM) field device. Treatments took 30 minutes and were spaced apart by 2-3 days. Photographs, weight, and waist measurements were taken at the baseline, after the last treatment, and at month 3 follow-up. Patient satisfaction was noted. Photographs were evaluated by blinded evaluators.

RESULTS

The study protocol was completed by 19 patients. At month 3, the average waist size reduction was 4.37 ± 2.63 cm (P < 0.01). The evaluators identified the before image from the 3-month image 89.47% of the time. About 91% of patients reported their abdominal appearance improved, and 92% stated they are satisfied with treatment results at month 3. No adverse events occurred.

CONCLUSION

Observed waist size reduction and aesthetic improvement appear to be a combination of fat reduction and increased muscle definition of abdominal wall. In lower BMI patients, the increased abdominal muscle definition was largely responsible for the improvement. This novel energy device provides an additional tool for body contouring with primary application for lower and medium BMI patients.

Accelerated tattoo removal with acoustic shock wave therapy in conjunction with a picosecond laser

BACKGROUND

Conventional tattoo removal consists of single-pass treatments, spaced 7-8 weeks apart, for a total of 7-10 sessions. A major limiting factor of this procedure is the development of cavitation bubbles and vacuoles within the epidermis and dermis that result from the rapid heating of tattoo particles by the laser. While multiple-pass methods using the R20 protocol or the PFD patch enhance tattoo removal through epidermal clearance, they have no effect on deep-intradermal pigment associated vacuoles that arise from treatment with lasers such as the Q-switched laser.

METHODS

A 28-year-old female with Fitzpatrick skin Type V presented for treatment of a 6-year-old professional black tattoo on the left ventral wrist. She underwent three treatment sessions at 6-8 week intervals using a commercial 1,064-nm picosecond Nd:YAG laser (PicoWay; Candela, Wayland, MA) and a perfluorodecalin (PFD) patch (Merz; Raleigh, NC). At each treatment session, she received two passes with 1,064-nm, 4-mm spot size, a fluence ranging from 2.8 to 3.2 J/cm² and a laser repetition rate of 2 Hz. Between laser passes and following the final laser pass, the medial portion of the tattoo was treated with acoustic shock wave therapy (ASWT) using the Zwave device (Zimmer Medizin Systems; Irvine, CA) with 90 mJ, 22 Hz, and 1,200 pulses.

RESULTS

After three treatment sessions, there was 80% clearance of the medial portion of the tattoo that received the ASWT compared with 60% clearance of the lateral portion of the tattoo that was treated with the picosecond 1,064-nm Nd:YAG laser and PFD patch alone. In the days following each treatment session, the patient noted consistently less edema, erythema and epidermal crusting on the portion of the tattoo that received the ASWT.

CONCLUSION

We report a case of 80% tattoo clearance with ASWT in a patient with Fitzpatrick type V skin compared with 60% clearance with the picosecond 1064-nm Nd:YAG laser and PFD patch alone. The concurrent use of the PFD patch, which facilitated multi-pass treatments, may have also increased tattoo fading in this patient. ASWT may enhance tattoo clearance by increasing lymphatic drainage and increasing metabolic activity in the treated area, thereby accelerating the clearance of dermal pigment vacuoles produced by the picosecond laser and minimizing epidermal side effects such as erythema, edema, and crusting. Lasers Surg. Med. 50:890-892, 2018. © 2018 Wiley Periodicals, Inc.

High-intensity focused ultrasound treatment after cryolipolysis may be used to reduce pain: Two case report

In recent years, interest in body sculpting has increased and various technologies have been used and developed. In the present study, we assessed the efficacy and safety of combination treatment using high-intensity focused ultrasound (HIFU) and cryolipolysis. The findings show that not only HIFU but also combination treatments are safe and well-tolerated options for the treatment of central abdominal subcutaneous adipose tissue (SAT). Interestingly, the pain associated with HIFU when it was performed after cryolipolysis was significantly reduced.

Comparative thermographic analysis at pre- and postcryolipolysis treatment: Clinical case report

INTRODUCTION

Although the exact cryolipolysis mechanisms on adipose tissue remain unknown, the current literature indicates that it may occur a crystallization followed by an ischemic reaction which generates an inflammatory process.

OBJECTIVE

To evaluate thermographically, the tissue's circulatory pattern of a patient submitted to the cryolipolysis technique and the beginning of the inflammatory process, through variations of temperature gradients and the evaluation of the pains degree of the patient in these same moments.

METHODS

A descriptive study, of an interventional case report, performed in an 18-year-old patient who had clearly visible fat in the lower abdomen area, with a skin fold greater than 2 centimeters and body mass index ≤ 30 kg/m² .

RESULTS

Comparing the maximum temperatures showed on the last thermography with the pre-application image, an increase of 0.4°C was observed, which is suggestive of abnormality. Regarding the minimum temperatures verified, there was a significative decrease in the temperature with the procedure, which was observed on the last 5 minutes (ΔT = 9.8°C). However, in 48 hour, the minimum temperature began to recover (ΔT = 0.3°C).

CONCLUSION

The observed data indicate that there was a significant decrease in the temperature during the cooling phase, whereas in the recovery phase, the inverse was found.

Skin Necrosis of the Thigh After a Cryolipolysis Session: A Case Report

Level of Evidence 5

Morphology alterations of skin and subcutaneous fat at NIR laser irradiation combined with delivery of encapsulated indocyanine green

The goal of this study is to quantify the impact of the in vivo photochemical treatment of rats with obesity using indocyanine green (ICG) dissolved in saline or dispersed in an encapsulated form at NIR laser irradiation, which was monitored by tissue sampling and histochemistry. The subcutaneous injection of the ICG solution or ICG encapsulated into polyelectrolyte microcapsules, followed by diode laser irradiation (808 nm, 8 ?? W / cm 2 , 1 min), resulted in substantial differences in lipolysis of subcutaneous fat. Most of the morphology alterations occurred in response to the laser irradiation if a free-ICG solution had been injected. In such conditions, membrane disruption, stretching, and even delamination in some cases were observed for a number of cells. The encapsulated ICG aroused similar morphology changes but with weakly expressed adipocyte destruction under the laser irradiation. The Cochran Q test rendered the difference between the treatment alternatives statistically significant. By this means, laser treatment using the encapsulated form of ICG seems more promising and could be used for safe layerwise laser treatment of obesity and cellulite.

Geometrical characterization of the cavitation bubble clouds produced by a clinical shock wave device

This study was to optically visualize the cavitation bubbles produced by a clinical shock wave and to look into their geometric features of the resulting cavitation bubbles in relation to the driving shock wave field. A clinical shock wave therapeutic system was taken for shock wave production. The shock wave induced cavitation bubbles were captured by a professional camera under the illumination of a micro-pulse LED light. The light exposure was set to last for the whole life time of bubbles from formation to subsequent collapses. It was shown that the cavitation bubbles appeared mostly in the vicinity of the focus. The bubbles became more and larger as approaching to the focus. The cavitation bubbles formed jet streams which became enlarged (stronger) as the shock wave device output setting increased. The bubble cloud boundary was reasonably fitted to an elongated ellipsoid characteristically similar to the acoustic focal area. The bubble clouds were enlarged as the output setting increased. The geometric features of the cavitation bubbles characteristically similar to those of the focusing acoustic field have potential to provide the therapeutic focal information without time consuming hydrophone measurements of the shock wave field causing damages of the expensive sensor. The present study is limited to the static afterimages of the cavitation bubbles and investigation including the bubble dynamics is suggested to deliver the more realistic therapeutic area of the shock wave therapy.

Effects of Cryolipolysis on Abdominal Adiposity

Cryolipolysis is a noninvasive technique of localized fat reduction. Controlled cold exposure is performed in the selective destruction of fat cells. The aim of this study was to investigate the effects of cryolipolysis on adipocytes elimination through histological and sonographic analyses. This study reports the case of a 46-year-old female patient, with complaint of localized abdominal fat and in the preoperative period of abdominoplasty. The patient was submitted to a single 60-minute application of cryolipolysis, temperature of -5°C, on the hypogastrium area, 5 cm below the umbilicus. To study the effects of this treatment, ultrasound images taken before the session and 7, 15, 30, and 45 days after the therapy were analysed. After the abdominoplasty, parts of the treated and the untreated withdrawn abdominal tissues were evaluated macro- and microscopically. In ultrasound images, as well as in macroscopic and histological analyses, significant adipocytes destruction was detected, with consequent fat layer reduction and integrity of areas that were adjacent to the treated tissue. The presence of fibrosis observed during therapy and acknowledged through performed analyses encourages further studies to clarify such finding.

Shock wave-induced ATP release from osteosarcoma U2OS cells promotes cellular uptake and cytotoxicity of methotrexate

Background

Osteosarcoma is the most prevalent primary malignant bone tumor, but treatment is difficult and prognosis remains poor. Recently, large-dose chemotherapy has been shown to improve outcome but this approach can cause many side effects. Minimizing the dose of chemotherapeutic drugs and optimizing their curative effects is a current goal in the management of osteosarcoma patients.

Methods

In our study, trypan blue dye exclusion assay was performed to investigate the optimal conditions for the sensitization of osteosarcoma U2OS cells. Cellular uptake of the fluorophores Lucifer Yellow CH dilithium salt and Calcein was measured by qualitative and quantitative methods. Human MTX ELISA Kit and MTT assay were used to assess the outcome for osteosarcoma U2OS cells in the present of shock wave and methotrexate. To explore the mechanism, P2X7 receptor in U2OS cells was detected by immunofluorescence and the extracellular ATP levels was detected by ATP assay kit. All data were analyzed using SPSS17.0 statistical software. Comparisons were made with t test between two groups.

Results

Treatment of human osteosarcoma U2OS cells with up to 450 shock wave pulses at 7 kV or up to 200 shock wave pulses at 14 kV had little effect on cell viability. However, this shock wave treatment significantly promoted the uptake of Calcein and Lucifer Yellow CH by osteosarcoma U2OS cells. Importantly, shock wave treatment also significantly enhanced the uptake of the chemotherapy drug methotrexate and increased the rate of methotrexate-induced apoptosis. We found that shock wave treatment increased the extracellular concentration of ATP and that KN62, an inhibitor of P2X7 receptor reduced the capacity methotrexate-induced apoptosis.

Conclusions

Our results suggest that shock wave treatment promotes methotrexate-induced apoptosis by altering cell membrane permeability in a P2X7 receptor-dependent manner. Shock wave treatment may thus represent a possible adjuvant therapy for osteosarcoma.

Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat

CONTEXT

Today, different kinds of non-invasive body contouring modalities, including cryolipolysis, radiofrequency (RF), low-level laser therapy (LLLT), and high-intensity focused ultrasound (HIFU) are available for reducing the volume of subcutaneous adipose tissue or cellulite. Each procedure has distinct mechanisms for stimulating apoptosis or necrosis adipose tissue. In addition to the mentioned techniques, some investigations are underway for analyzing the efficacy of other techniques such as whole body vibration (WBV) and extracorporeal shockwave therapy (ESWT). In the present review the mechanisms, effects and side effects of the mentioned methods have been discussed. The effect of these devices on cellulite or subcutaneous fat reduction has been assessed.

EVIDENCE ACQUISITION

We searched pubmed, google scholar and the cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to February 2015. The keywords were subcutaneous fat, cellulite, obesity, noninvasive body contouring, cryolipolysis, RF, LLLT, HIFU, ESWT and WBV with full names and abbreviations.

RESULTS

We included seven reviews and 66 original articles in the present narrative review. Most of them were applied on normal weight or overweight participants (body mass index < 30 kg/m2) in both genders with broad range of ages (18 to 50 years on average). In the original articles, the numbers of included methods were: 10 HIFU, 13 RF, 22 cryolipolysis, 11 LLLT, 5 ESWT and 4 WBV therapies. Six of the articles evaluated combination therapies and seven compared the effects of different devices.

CONCLUSIONS

Some of the noninvasive body contouring devices in animal and human studies such as cryolipolysis, RF, LLLT and HIFU showed statistical significant effects on body contouring, removing unwanted fat and cellulite in some body areas. However, the clinical effects are mild to moderate, for example 2 - 4 cm circumference reduction as a sign of subcutaneous fat reduction during total treatment sessions. Overall, there is no definitive noninvasive treatment method for cellulite. Additionally, due to the methodological differences in the existing evidence, comparing the techniques is difficult.

Quantification of adipose volume reduction with a prospective study analyzing the application of external radiofrequency energy and high voltage ultrashort pulse duration electrical fields

To date, there have been no objective measurements of subcutaneous volume loss following treatments with a noninvasive radiofrequency (RF)-based device. Twenty female patients were treated with a suction-coupled bipolar RF device using external RF energy combined with pulsed electromagnetic RF energy for subcutaneous fat reduction. Parameters followed included weight, Vectra measurements of abdominal circumference and torso volume, and high-definition ultrasound measurements of fat thickness. Measurements were taken before treatment and three times following treatment. Analysis of the measured parameters showed that mean circumference reduction of 2.30 cm was noted at three months post-treatment. Independent volumetric analysis showed a mean subcutaneous volume reduction of 428 cc three months following RF treatment. High-resolution ultrasound fat thickness was reduced by a mean of 39.6% three months following the final BodyFX treatment. Independent and paired-sample t-tests showed a p value of < 0.05. Repeated measures of analysis of covariance (ANCOVA) adjusted for differences in age, as well as height and weight (proxy for body mass index) to minimize individual differences and control for extraneous variables that may affect the pre- and post-treatment results were analyzed. No confounding variables were found. All analyses were conducted using IBM SPSS 21.0.

Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms

BACKGROUND

Cryolipolysis is a nonsurgical technique for localized fat reduction. With the increased risk of complications from more invasive methods such as liposuction, cryolipolysis presents a promising method for nonsurgical body contouring. This study presents a systematic review of the available clinical data, with an emphasis on the efficacy, methods, safety, and complications of cryolipolysis.

METHODS

To identify clinical studies that assessed outcomes of cryolipolysis, a systematic review of the MEDLINE and Cochrane databases was performed with the search algorithm cryolipolysis OR cool sculpting OR fat freezing OR lipocryolysis.

RESULTS

The primary literature search returned 319 articles. After inclusion criteria were applied and additional articles were idenfied via manual review of article references, 19 studies were selected for review. Average reduction in caliper measurement ranged from 14.67 percent to 28.5 percent. Average reduction by ultrasound ranged from 10.3 percent to 25.5 percent. No significant impact on lipid levels or liver function tests after cryolipolysis treatments was noted in any study. Only mild, short-term side effects, such as erythema, swelling, and pain, were noted. Paradoxical adipose hyperplasia was described in one patient.

CONCLUSIONS

Cryolipolysis is a promising procedure for nonsurgical fat reduction and body contouring and presents a compelling alternative to liposuction and other, more invasive methods. This procedure appears to be safe in the short term, with a limited side effect profile, and results in significant fat reduction when used for localized adiposities. It remains unclear whether posttreatment manual massage and multiple treatments in the same anatomic area enhance the efficacy of cryolipolysis.

Cellulite treatment: a comprehensive literature review

An effective and long-term treatment of cellulite has not been well established. To our knowledge, no review has analyzed the whole range of treatments for this condition. We conducted a review of in vivo studies on humans adopting the key words "cellulite" and "treatment." The studies were included according to eligibility criteria. We performed an analysis to estimate the overall effect of cellulite treatments from clinical studies. Medline library was screened up to December 2014 to identify eligible studies. We included 73 original studies in the present review. All of them were clinical studies, in most of them, only women were recruited. Above the studies searched up, 66 tested the effectiveness of an exclusive treatment performed without the association to other procedures: 11 topical agents, 10 shock-wave therapy, 10 radio frequency, eight laser therapy, five oral therapy, four manual massage therapy, three carbon dioxide therapy, two compressive therapy, two infrared therapy, one dermabrasion, and 11 devices that use an association of multiple treatments. Seven papers tested a combination of two or more treatments. The mean difference of clinical morphologic features and ultrastructural changes between the treated group and the controlled showed significant heterogeneity between studies. It is still difficult to indicate an exclusive and effective single treatment for this condition. Our analysis purposed to obtain a complete overview of the available treatments in cellulite reduction.

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.

An evaluation of the patient population for aesthetic treatments targeting abdominal subcutaneous adipose tissue

A large and growing population of patients currently seeks minimally invasive therapeutic options for the aesthetic treatment of localized, central abdominal subcutaneous adipose tissue (SAT). We sought to evaluate the ideal population for aesthetic treatment of central abdominal SAT, highlight the existing disparities between SAT in obese (body mass index [BMI] ≥ 30; BMI) and nonobese (BMI < 30) patients, and review the available FDA-cleared, minimally invasive treatment options for central abdominal adiposity. The cosmetic issue of localized, central (periumbilical) abdominal adiposity in nonobese individuals is quite distinct from abdominal bulging secondary to obesity. Given the recognized clinical and physiologic differences between obese and nonobese counterparts, the exclusion of obese patients from clinical study by currently available FDA-cleared devices targeting abdominal fat, and the status of obesity as a chronic, systemic disease requiring medical, surgical, and/or lifestyle-altering therapies, minimally invasive therapeutic options for aesthetic reductions in central abdominal SAT must be limited to the nonobese population.

Non-invasive subcutaneous fat reduction: a review

The risks, financial costs and lengthy downtime associated with surgical procedures for fat reduction have led to the development of a number of non-invasive techniques. Non-invasive body contouring now represents the fastest growing area of aesthetic medicine. There are currently four leading non-invasive techniques for reducing localized subcutaneous adipose tissue: low-level laser therapy (LLLT), cryolipolysis, radio frequency (RF) and high-intensity focused ultrasound (HIFU). To review and compare leading techniques and clinical outcomes of non-invasive subcutaneous fat reduction. The terms 'non-invasive', 'low-level laser', 'cryolipolysis', 'ultrasound' and 'radio frequency' were combined with 'lipolysis', 'fat reduction' or 'body contour' during separate searches in the PubMed database. We identified 31 studies (27 prospective clinical studies and four retrospective chart reviews) with a total of 2937 patients that had been treated with LLLT (n = 1114), cryolipolysis (n = 706), HIFU (n = 843) or RF (n = 116) or other techniques (n = 158) for fat reduction or body contouring. A majority of these patients experienced significant and satisfying results without any serious adverse effects. The studies investigating these devices have all varied in treatment regimen, body locations, follow-up times or outcome operationalization. Each technique differs in offered advantages and severity of adverse effects. However, multiple non-invasive devices are safe and effective for circumferential reduction in local fat tissue by 2 cm or more across the abdomen, hips and thighs. Results are consistent and reproducible for each device and none are associated with any serious or permanent adverse effects.

Radial extracorporeal shock wave treatment harms developing chicken embryos

Radial extracorporeal shock wave treatment (rESWT) has became one of the best investigated treatment modalities for cellulite, including the abdomen as a treatment site. Notably, pregnancy is considered a contraindication for rESWT, and concerns have been raised about possible harm to the embryo when a woman treated with rESWT for cellulite is not aware of her pregnancy. Here we tested the hypothesis that rESWT may cause serious physical harm to embryos. To this end, chicken embryos were exposed in ovo to various doses of radial shock waves on either day 3 or day 4 of development, resembling the developmental stage of four- to six-week-old human embryos. We found a dose-dependent increase in the number of embryos that died after radial shock wave exposure on either day 3 or day 4 of development. Among the embryos that survived the shock wave exposure a few showed severe congenital defects such as missing eyes. Evidently, our data cannot directly be used to draw conclusions about potential harm to the embryo of a pregnant woman treated for cellulite with rESWT. However, to avoid any risks we strongly recommend applying radial shock waves in the treatment of cellulite only if a pregnancy is ruled out.