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Vignoli F, Mármol GV. Cryolipolysis for fat reduction using Cooltech® Define technology: A large-sample retrospective clinical study. J Cosmet Dermatol 2023; 22 Suppl 3:15-24. [PMID: 37654091 DOI: 10.1111/jocd.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Cryolipolysis is a noninvasive technique for localized fat reduction, which induces selective apoptosis of the adipocytes using controlled exposure to intense cold. During the past 10 years, this technique has been shown to be safe and effective and its application has significantly increased. In this context, Cooltech® devices have been widely used around the world. AIMS The purpose of this retrospective study was to evaluate the efficacy and safety of the removal of localized fatty tissue in different body areas using the new Cooltech® Define controlled cooling system. METHODS This single-center study was carried out on 287 patients, both female and male, treated with Cooltech® Define on different body areas for a total of 1118 procedures. Follow-up evaluations were conducted to estimate efficacy and safety. Efficacy was evaluated through plicometry and photographs. Side effects were also reported. RESULTS Fold thickness showed a significant reduction (-69.91 ± 12.55%) after cryolipolysis treatment (fold thickness before: 35.33 ± 8.41 mm; fold thickness after: 10.69 ± 5.27 mm). Few side effects were reported, they included posttreatment pain (1.70%) and one case of paradoxical adipose hyperplasia (0.09%). CONCLUSION The Cooltech® Define cryolipolysis device is a safe, effective, and well-tolerated nonsurgical procedure for reducing localized fat.
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Nagel SS, Rauh A, Siegwart LC, Hundeshagen G, Kotsougiani-Fischer D, Kuepper S, Kneser U, Hirche C. From Esthetic Medicine to Optimizing Reconstructive Outcome: A Feasibility Trial on Secondary Refinement of Fasciocutaneous Anterolateral Thigh Flaps with Cryolipolysis. J Reconstr Microsurg 2023; 39:156-164. [PMID: 36150694 DOI: 10.1055/s-0042-1755259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Free adipocutaneous anterolateral thigh (ALT) flaps have evolved as workhorse flaps to reconstruct complex, multicompound defects. While coverage is safely achieved, flaps may remain bulky. As a standard of care, flaps are refined with liposuction, partial excision, or combination of both. Cryolipolysis is widely used for fat reduction in esthetic medicine. This pilot comparative study analyses whether cryolipolysis may serve as a safe alternative method to effectively reduce volume in fasciocutaneous flaps. Moreover, patients' satisfaction with the procedure is evaluated. METHODS In this single-center, retrospective, interventional comparative cohort study, 10 patients with free subfascial ALT flaps for distal extremity reconstruction underwent cryolipolysis (60 minutes, -9°C). Circumference of the extremities and subcutaneous fat thickness were determined before (T1) and 12 weeks (T2) after cryolipolysis. Patient satisfaction was evaluated with a questionnaire of Likert's scale questions. Duration of hospital stay, intervention time, costs, and possible complications were analyzed and compared with surgical flap contouring (n = 12). RESULTS All patients undergoing cryolipolysis were male, with a median age of 52 years without arterial disease-like state or deep vein thrombosis (DVT). At T2, a significant reduction of circumference of 1.8 ± 0.9 cm (p < 0.001) and subcutaneous fat layer of 7.7 ± 3.0 mm (p < 0.0001) was recorded. Overall, 90% of the patients were satisfied with the result. Cryolipolysis was well tolerated. One patient developed a second-degree frostbite which healed without further intervention. Cryolipolysis proofed to be as safe as surgical flap contouring. Hospital stay was significantly shorter (p < 0.01) and personal resources were spared when flap contouring was performed with cryolipolysis. CONCLUSION This is a novel application of evolving body-contouring cryolipolysis from esthetic medicine into optimizing outcomes in reconstructive surgery. Cryolipolysis has been shown to be relatively safe and effective to reduce ALT's volume with high patients' satisfaction. This successful pilot study encourages further investigation with a prospective randomized control trial.
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Affiliation(s)
- Sarah S Nagel
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
| | - Annika Rauh
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
| | - Laura C Siegwart
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
| | - Simon Kuepper
- Department of Plastic Surgery and Burn Center, BG Hospital Berlin, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany.,Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation Center, BG Unfallklinik Frankfurt am Main GmbH, Goethe University of Frankfurt, Germany
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Swanson E. Cryolipolysis: A Reconsideration of Efficacy, Safety, and the Risk of Paradoxical Adipose Hyperplasia. Aesthet Surg J 2023; 43:NP68-NP69. [PMID: 36111396 DOI: 10.1093/asj/sjac255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023] Open
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Cox EA, Nichols DS, Riklan JE, Pomputius A, Mehta SD, Mast BA, Furnas H, Canales F, Sorice-Virk S. Characteristics and Treatment of Patients Diagnosed With Paradoxical Adipose Hyperplasia After Cryolipolysis: A Case Series and Scoping Review. Aesthet Surg J 2022; 42:NP763-NP774. [PMID: 35961054 DOI: 10.1093/asj/sjac219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Paradoxical adipose hyperplasia (PAH), a rare side effect of CoolSculpting (cryolipolysis), is characterized by fatty enlargement of the treatment area occurring months after the procedure. OBJECTIVES The purpose of this study was to report a retrospective case series of patients diagnosed with PAH at the authors' institution, increase the collective understanding of this complication and subsequent management, and raise the question of who should ethically perform cryolipolysis. METHODS All participants diagnosed with PAH by a plastic surgeon at a large academic medical center were identified. Demographic information, medical history, procedure details, time to PAH diagnosis, and corrective surgical intervention details were collected. Mean duration of time from cryolipolysis treatment to diagnosis of PAH was calculated, along with other descriptive statistics. A scoping review of all PAH literature published in PubMed, Embase, and Web of Science was also conducted. RESULTS Four patients diagnosed with PAH after cryolipolysis were identified for inclusion in this study. The calculated incidence of PAH at our center was 0.67%. All patients requested therapy for PAH and subsequently underwent either liposuction, abdominoplasty, or both. The mean duration of in-person follow-up time after final surgical treatment of PAH was 13.8 + 19.8 months (range, 2.8-43.5). Fortunately, no patients showed signs of PAH recurrence, and 3 out of 4 patients did not show signs of residual deformity. CONCLUSIONS Findings from this patient cohort and scoping review provide evidence that although revisions may be required, conventional body contouring methods, not in the armamentarium of non-plastic surgeon practitioners, effectively alleviated PAH. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Elizabeth A Cox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA, USA
| | - D Spencer Nichols
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Joshua E Riklan
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ariel Pomputius
- Health Science Center, George A. Smathers Libraries, University of Florida, Gainesville, FL, USA
| | - Sonia D Mehta
- Department of Anesthesia, University of Florida, Gainesville, FL, USA
| | - Bruce A Mast
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, USA
| | - Heather Furnas
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA, USA
| | | | - Sarah Sorice-Virk
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, USA
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Altmann J, Burns AJ, Kilmer SL, Lee C, Lim T, Metelitsa A, Stevens WG, Taub A, Welsh K, Kazem F. Global Expert Opinion on Cryolipolysis Treatment Recommendations and Considerations: A Modified Delphi Study. Aesthet Surg J Open Forum 2022; 4:ojac008. [PMID: 35592181 PMCID: PMC9113840 DOI: 10.1093/asjof/ojac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cryolipolysis is an increasingly popular nonsurgical fat-reduction procedure. Published treatment guidance and adverse event (AE) management protocols are limited. Objective A modified Delphi study aimed to establish global expert consensus on the use of CoolSculpting (Allergan Aesthetics, an AbbVie Company, Irvine, CA), a noninvasive cryolipolysis treatment system. Methods A literature search informed survey topics for an 11-expert Delphi panel. Panelists completed an online 39-question survey. An interim panel discussion, with open-ended questions and yes/no voting, informed a second survey containing 61 statements, for which panelists rated agreement using a 5-point Likert scale. Topics included treatment outcome and responder definitions, patient evaluation and selection, treatment protocols, patient satisfaction, and AEs. Results Panelists achieved consensus on 38 final guidelines and recommendations. They reached moderate to complete consensus on 4 statements on defining responders (ie, patients with a range of visible improvement) and 6 statements on patient factors contributing to treatment outcomes (eg, how well the applicator conforms to patient body region). Panelists defined minimum numbers of treatment cycles to achieve visible clinical outcomes for 12 body regions, with moderate to complete consensus on 31 statements. They achieved a strong to complete consensus on 7 statements about patient satisfaction (eg, importance of patient expectations, visible improvement, and before-and-after photographs). Panelists defined management strategies for AEs, with moderate to complete consensus on 15 statements. Conclusions A modified Delphi process yielded multiple guideline recommendations for cryolipolysis, providing a needed resource for the broad range of clinicians who perform this noninvasive fat-reduction procedure. Level of Evidence 5
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Farid Kazem
- Corresponding Author: Dr Farid Kazem, Boeing Avenue 203, 1119 PD, Schiphol-Rijk, The Netherlands. E-mail:
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Nikolis A, Enright KM. A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryolipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients. Aesthet Surg J 2021; 41:932-941. [PMID: 33216910 PMCID: PMC8279305 DOI: 10.1093/asj/sjaa310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Paradoxical adipose hyperplasia (PAH) is a rare, moderate-to-severe adverse event associated with cryolipolysis (CoolSculpting, CS). Objectives The aim of this study was to describe the incidence, diagnosis, and treatment of PAH occurring after CS for nonsurgical fat reduction. Methods A multicenter evaluation of all patients who underwent CS treatment between January 2015 and December 2019 at 8 Canadian medical centers was conducted. Data abstracted included symptoms, management strategy, outcome, operator characteristics, device characteristics, patient characteristics, body region, and CS treatment details. Incidence of PAH was calculated based on the number of treatment cycles. Results Our findings revealed incidence rates between 0.05% and 0.39%, which are slightly higher than the manufacturer’s quoted rate of 0.025% (1 per 4000 cycles). Incidence rates at all sites were dramatically reduced by over 75% with the implementation of newer models of CS units. Of patients who developed PAH, 55% were male and 77.8% were of European ethnic origin. The majority of cases (76.9%) were associated with older models of CS units. Conclusions Development of PAH may be related to a combination of factors, including older models of CS units and applicators, as well as individual characteristics that predispose certain patients. Level of Evidence: 4
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Nikolis A. Response to: Shockwave Therapy for the Prevention of Paradoxical Adipose Hyperplasia After Cryolipolysis: Myth or Reality? Aesthet Surg J 2021; 41:NP1139-NP1140. [PMID: 33884403 DOI: 10.1093/asj/sjab176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andreas Nikolis
- Division of Plastic Surgery, McGill University, Montreal, Canada
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Michon A. Shockwave Therapy for the Prevention of Paradoxical Adipose Hyperplasia After Cryolipolysis: Myth or Reality? Aesthet Surg J 2021; 41:NP1137-NP1138. [PMID: 33615378 PMCID: PMC8279303 DOI: 10.1093/asj/sjab097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alain Michon
- Corresponding Author: Dr Alain Michon, 349 St Laurent Blvd, Ottawa, ON K1K 2Z7, Canada. E-mail:
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Paradoxical Temporal Enlargement: An Expansion of Superficial Temporal Fat Pad Following Interfacial Technique for Pterional Craniotomy. J Craniofac Surg 2021; 32:2597-2602. [PMID: 34183631 DOI: 10.1097/scs.0000000000007730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Contour irregularities in the temporal region have been reported previously after procedures involving temporal dissection. In this study, we report paradoxical temporal enlargement (PTE) following interfascial pterional craniotomy. METHODS A retrospective review of patients who underwent a unilateral transcranial procedure with frontotemporal approach at our institution between September 2013 and December 2017 was performed. Patients with a previous craniotomy or bilateral craniotomy were excluded. Radiological imaging series including computed tomography and magnetic resonance imaging were utilized to calculate temporal soft tissue volumes both preoperatively and postoperatively by using advanced software technology. Relative soft tissue volume differences between the operative side and the contralateral side were calculated at different time-points including preoperative, 3-months follow-up (3M), 12-months (12M) follow-up, and the last follow-up (LFU, over 1-year). RESULTS Forty-three patients were included. Mean age was 52.7 ± 4.5 years. Mean follow-up was 27.9 ± 15.8 months. Significant changes of temporal fat pad relative-volume difference were observed between the preoperative and the corresponding 3M (t [82] = -2.8865, P = 0.0050); 12M (t [77] = -4.4321, P < 0.0001), and LFU (t [74] = -4.9862, P < 0.0001) postoperative time points. No significant change of the temporalis muscle was observed between the preoperative and the corresponding 3M (P = 0.3629), 12M (P = 0.1553), or LFU (P = 0.0715). Soft tissue volume showed a significant increase on the operative side between the preoperative and the corresponding LFU (t [74] = -2.5866, P = 0.0117). CONCLUSIONS Paradoxical temporal enlargement with more than 10% volumetric change was observed in 24% of the patients at their LFU (>1-year). This change was not due to temporalis muscle changes. Paradoxical temporal enlargement was due to hypertrophy of the superficial temporal fat pad. Before surgical correction of postoperative temporal contour changes, it is important to obtain imaging and characterize the etiology of the deformity.
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McKeown DJ, Payne J. Significant improvement in body contour with multiple cycles of CoolSculpting: Results of a prospective study. Dermatol Ther 2021; 34:e14850. [PMID: 33533560 PMCID: PMC8047906 DOI: 10.1111/dth.14850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 01/17/2023]
Abstract
Cryolipolysis is a nonsurgical body sculpting technique that uses controlled cooling for localized fat reduction. The aim of the present study was to assess whether an intensive regimen of CoolSculpting based on multiple cycles/sessions on the same body area(s) could yield greater (more clinically significant) improvements in body contour. This was a prospective analysis of consecutive, healthy, adult patients undergoing CoolSculpting in routine practice across a variety of treatment areas. Patients underwent ≤4 cycles of CoolSculpting per body area during an initial treatment session, and ≤4 further cycles 4 weeks later (if required). They were followed up for ≥12 weeks. Twenty‐eight patients were enrolled (n = 26 female; mean age: 51.6 ± 9.0 years; mean body weight: 69.4 ± 13.7 kg). They were treated across 58 body areas: 48 in a single session; 10 across two sessions. The mean number of cycles per area was 2.8 ± 1.5. Twenty‐seven patients (54 body areas) were considered as treatment “responders.” In these individuals, mean skinfold thickness decreased from 35.4 ± 9.9 mm pretreatment to 22.2 ± 7.6 mm at 12 weeks (mean change: −40%; P < .001). Mean change in skinfold thickness was greater with ≥3 vs 1 to 2 cycles of CoolSculpting (P = .01). Patient satisfaction was high (n = 51/58; 88%). No adverse events were recorded. The study shows that multiple cycles/sessions of CoolSculpting can safely improve overall treatment benefit in body contouring, with greater decreases in skinfold thickness than have typically been previously observed.
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Galanin I, Nicu C, Tower JI. Facial Fat Fitness: A New Paradigm to Understand Facial Aging and Aesthetics. Aesthetic Plast Surg 2021; 45:151-163. [PMID: 32914326 DOI: 10.1007/s00266-020-01933-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022]
Abstract
Traditionally, facial adipose tissue has been perceived and treated as a homogenous volume-occupying subcutaneous depot. However, recent research from across disciplines is converging to reveal a far more anatomically organized and functionally dynamic role of facial adipose tissue. In this narrative review, we will discuss new insights into adipocyte function and facial adipose anatomy that have far-reaching implications for the practice of aesthetic facial plastic surgery. These concepts are synthesized into a "facial fat fitness" model which can be used to explain clinical observations in facial aging and aesthetic surgery. Fat fitness relates to the quality of facial adipose tissue, as opposed to quantity, and describes whether adipose tissue is in a predominantly healthy hyperplastic or unhealthy hypertrophic state. Fat fitness is modulated by lifestyle factors, and may be impacted positively or negatively by facial aesthetic treatments. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Carina Nicu
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jacob I Tower
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, 130 East 77th Street, 10th Floor, New York, NY, USA.
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Adverse Events Associated With Cryolipolysis: A Systematic Review of the Literature. Dermatol Surg 2020; 46 Suppl 1:S8-S13. [PMID: 32976167 DOI: 10.1097/dss.0000000000002524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cryolipolysis is a popular procedure for people seeking noninvasive body contouring. As with any novel therapy, it is critical for providers to familiarize themselves with related adverse events (AEs), to provide appropriate information to patients before treatment. OBJECTIVE To describe reported complications and AEs associated with cryolipolysis. MATERIALS AND METHODS A systematic review was completed using the PubMed database and following search terms: "cryolipolysis" or "lipocryolysis" or "CoolSculpting." Only randomized clinical trials, prospective cohort studies, retrospective studies, case series, and case reports describing AEs related to cryolipolysis as well as studies written in English were included for review. RESULTS Fifty-three articles were included in this review. The most common AEs associated with cryolipolysis were treatment site erythema, numbness/paresthesia, bruising, and edema. More serious complications of cryolipolysis include severe/persistent pain, dysesthesia, skin hyperpigmentation, motor neuropathy, and paradoxical adipose hyperplasia. CONCLUSION Cryolipolysis is a safe option for patients seeking noninvasive body contouring. Most reported AEs are minimal and resolve quickly. It is important that physicians are aware of serious, irreversible AEs and are prepared to counsel patients appropriately before treatment.
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Pugliese D, Melfa F, Guarino E, Cascardi E, Maggi M, Ferrari E, Maiorano E. Histopathological Features of Tissue Alterations Induced by Cryolipolysis on Human Adipose Tissue. Aesthet Surg J 2020; 40:761-766. [PMID: 32240286 DOI: 10.1093/asj/sjaa035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Adipose tissue cooling, under controlled conditions, induces physical effects on subcutaneous tissue called cryolipolysis (CLL), which has been proposed as a method to reduce noninvasively the amount of adipose tissue. Although CLL has been widely utilized in clinical practice and many favorable results have been reported in clinical studies, very few published studies have dealt with the effects of such therapies on human adipose tissue. OBJECTIVES The aim of this study was to evaluate, through histopathological examination, the in vivo effects of CLL on human adipose tissue. METHODS Six patients to be submitted to abdominoplasty were enrolled in the study. Samples were taken from the surgical patch, respectively, 15 days (2 pts), 45 days (2 pts), and 60 days (2 pts) after a single standard session of CLL. Control samples were derived from the nontreated areas of the surgical patch. RESULTS Disruption of the adipocytic membranes was evident in all treated areas, with a reduction of cell dissolution in the 60-day samples. Focal dissolution and homogenization of the collagen fibers was evident, resulting in the dissolution of the interlobular fibrous septa. A mild inflammatory response was observed in the 15- and 45-day samples. Neocapillarizzation was observed in the 45- and 60-day samples. CONCLUSIONS The lesions demonstrated in adipocytes confirm the theoretical premises of a usefulness of CLL in the treatment of localized adiposis. The alterations in the connective stroma could lead to a structural reorganization and consequently to the in vivo external appearance of the treated areas. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Domenico Pugliese
- Internal Medicine Unit, Policlinico Universitario di Bari, Bari, Italy
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Few J, Saltz R, Beaty M, Kelly M, Movassaghi K, Marcus KA, Sieber D, Burns AJ, Sangha S. Cryolipolysis: Clinical Best Practices and Other Nonclinical Considerations. Aesthet Surg J Open Forum 2020; 2:ojaa010. [PMID: 33791637 PMCID: PMC7671251 DOI: 10.1093/asjof/ojaa010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cryolipolysis is a nonsurgical body contouring procedure that involves cooling of fat cells to induce lipolysis while sparing surrounding structures. Plastic surgery practices are increasingly incorporating noninvasive aesthetic procedures (eg, cryolipolysis, fillers, radiofrequency, ultrasound) to offer their patients a wider range of aesthetic treatment options. Here, we report insights from 8 plastic surgeons with regard to cryolipolysis best practices from a clinical perspective and the impact of integrating this noninvasive body contouring procedure into a plastic surgery practice. The authors prefer cryolipolysis over liposuction for patients who are not amenable to surgery or those who desire to avoid downtime, also taking into consideration body mass index, skin laxity, comorbidities, and risk of contour irregularities. Patient counseling is critical for setting realistic expectations regarding outcomes and should focus on the efficacy of cryolipolysis, individual variability in results, potential side effects, time course of treatment response, and the need for multiple treatment cycles. Strategies for reaching new patients and expanding services among current cryolipolysis patients are discussed.
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Affiliation(s)
- Julius Few
- Corresponding Author: Dr Julius Few, The Few Institute for Aesthetic Plastic Surgery, 875 N. Michigan Avenue, Suite 3850, Chicago, IL 60611, USA. E-mail:
| | | | | | | | | | | | | | | | - Sara Sangha
- Associate Vice President, Allergan US Medical Affairs, Allergan plc, Irvine, CA
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The Unhappy Cosmetic Patient: Lessons From Unfavorable Online Reviews of Minimally and Noninvasive Cosmetic Procedures. Dermatol Surg 2019; 46:1191-1194. [DOI: 10.1097/dss.0000000000002304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agochukwu‐Nwubah N, Mentz H. Paradoxical adipose hyperplasia after noninvasive radiofrequency treatment: A novel report and review. J Cosmet Dermatol 2019; 19:866-868. [DOI: 10.1111/jocd.13090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/08/2019] [Accepted: 07/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Henry Mentz
- Aesthetic Center for Plastic Surgery Houston Texas
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Khan M. Complications of Cryolipolysis: Paradoxical Adipose Hyperplasia (PAH) and Beyond. Aesthet Surg J 2019; 39:NP334-NP342. [PMID: 30346468 DOI: 10.1093/asj/sjy282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cryolipolysis is a fairly popular procedure performed in North America, Europe, and many other countries. Although it is considered a rather safe procedure, there are underreported side effects such as paradoxical adipose hyperplasia (PAH), contour irregularities, skin and soft tissue atrophy, and asymmetries. Our knowledge regarding the prevalence and treatment of such complications is limited. OBJECTIVES We hereby report a case series of 5 patients treated for various complications of cryolipolysis, including PAH, that persisted for more than 12 months after their last treatment. METHODS Five patients with various complications of cryolipolysis (4 patients with PAH and 1 with atrophy and indentations) presented in our private office between 2015 and 2018. Three of the 4 patients with PAH were treated at other facilities with ultrasonic liposuction, laser lipolysis, and radiofrequency skin tightening devices respectively. The fourth patient developed PAH after liposuction at another facility. The fifth patient developed several areas of indentations and atrophy and received mesotherapy and lymphatic massages at another facility. All 5 patients were subsequently treated in our office by means of a customized approach specific to their underlying complications. RESULTS Near-normal results were achieved in all 5 patients. None of our patients showed any recurrences of their initial complication for which they were treated. All 5 patients were extremely satisfied with their results. CONCLUSIONS Cryolipolysis, just like any other form of lipolysis, has certain specific adverse effects associated with it, including but not limited to PAH. Complications of cryolipolysis must be individually recognized and treated accordingly. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Misbah Khan
- Dermatology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY
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19
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Vogel JE. Comments on "Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis". Aesthet Surg J 2018; 38:NP135-NP137. [PMID: 29982356 DOI: 10.1093/asj/sjy129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James E Vogel
- Department of Plastic Surgery, at The Johns Hopkins Hospital and School of Medicine, Baltimore, MD
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Wang E, Kaur R, Jagdeo J. Commentary on: Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis. Aesthet Surg J 2018; 38:418-420. [PMID: 29145571 DOI: 10.1093/asj/sjx167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Erica Wang
- Dermatology Service, Sacramento VA Medical Center, Mather, CA
| | - Ramanjot Kaur
- Dermatology Service, Sacramento VA Medical Center, Mather, CA
| | - Jared Jagdeo
- Department of Dermatology, University of California Davis, Sacramento, CA
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