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Stam R. New developments in cosmetic applications of electromagnetic fields: Client and occupational hazard assessment. Bioelectromagnetics 2024; 45:251-259. [PMID: 38533721 DOI: 10.1002/bem.22503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Energy-based devices are used to improve features of appearance for aesthetic reasons while avoiding more invasive methods. Examples of treatment targets are the reduction of wrinkles, sagging, unwanted skin lesions, body hair and excess fatty tissue, and the enhancement of muscle tissue. One treatment modality is the use of electromagnetic fields (EMF, 0‒300 GHz). The present work aims to give an up-to-date survey of cosmetic applications of EMF for professional use with an assessment of client and worker exposure and possible adverse effects. A systematic search was conducted for peer-reviewed articles (2007-2022), patents, premarket notifications, manufacturer data, and adverse effects reports. Five categories of cosmetic EMF device with increasing frequency were identified: sinusoid low frequency magnetic fields for lipolysis; pulsed low frequency magnetic fields for skin rejuvenation; pulsed low frequency magnetic fields for muscle building; radiofrequency EMF for lipolysis or skin rejuvenation; microwaves for hair removal or hyperhidrosis. In the vicinity of the last four device categories, there is a potential for exceeding the occupational exposure limits in the European Union EMF Directive, which could lead to nerve or muscle stimulation, burns or overheating. There are also potential hazards for clients or workers wearing active or passive medical devices. The severity of reported adverse effects increases with EMF frequency.
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Affiliation(s)
- Rianne Stam
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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2
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Deligonul FZ, Yousefian F, Gold MH. Literature review of adverse events associated with cryolipolysis. J Cosmet Dermatol 2023; 22 Suppl 3:31-36. [PMID: 37988712 DOI: 10.1111/jocd.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Cryolipolysis is a noninvasive procedure for localized fat reduction and body contouring. This technique utilizes controlled cooling to induce adipocyte apoptosis without damage to overlying skin and other tissue. Although the procedure was once thought to be relatively harmless, recent studies have shed light on the risks of adverse effects (AEs). AIMS The aim of this article was to review AEs in cryolipolysis as published in clinical data. METHODS A comprehensive search was performed in PubMed, using relevant keywords such as "cryolipolysis," "CoolSculpting," "adverse effects," "complications," and "side effects" with no set data range. The search was limited to studies published in English. The selected studies encompassed a variety of study designs, including randomized controlled trials, prospective cohort studies, case series, case reports, and reviews. CONCLUSIONS Since its FDA approval in 2010, our understanding of the potential risks and complications associated with cryolipolysis has grown significantly, and shown that the procedure may not be as harmless as once thought. Continued post-market surveillance of cryolipolysis devices combined with documenting of AE cases help providers better understand the true risks associated with this procedure. As "cryolipolysis" and "CoolSculpting" are often used interchangeably, further research is needed to understand if AEs such as paradoxical adipose hyperplasia (PAH) that occur both inside and outside the United States are CoolSculpting cases or linked to other devices. Additionally, further studies are needed to understand the pathophysiology of such sequelae as PAH, and to better recognize the risks and potential complications associated with cryolipolysis so that we can more accurately inform patients.
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Affiliation(s)
| | - Faraz Yousefian
- University of Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA
- Goodman Dermatology, Roswell, Georgia, USA
| | - Michael H Gold
- Gold Skin Care Center, Nashville, Tennessee, USA
- Tennessee Clinical Research Center, Nashville, Tennessee, USA
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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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Tran BNN, Didzbalis CJ, Chen T, Shulzhenko NO, Asaadi M. Safety and Efficacy of Third-Generation Ultrasound-Assisted Liposuction: A Series of 261 Cases. Aesthetic Plast Surg 2022; 46:2310-2318. [PMID: 35896731 DOI: 10.1007/s00266-022-02992-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The introduction of third-generation ultrasound-assisted liposuction (3rd UAL) allows for a less invasive modality of both deep and superficial lipectomy while offering improved skin retraction and reduced rate of complications. This study examined the efficacy and safety profile of this technology over 15 years of clinical experience. METHODS A consecutive series of patients treated from 2005-2020 by the senior author were reviewed for demographic and anthropometric measurements, intraoperative settings, surgical outcomes, and complications via retrospective chart review. Body-Q survey was used to assess patient satisfaction. RESULTS A total of 261 patients underwent 3rd UAL in 783 areas. There were 238 female and 23 male patients with an average age of 43.5 years and BMI of 27.4 kg/m2. The most frequently treated areas were the trunk and lower limbs. An average of 2840 mL of wetting solution was used with an average of 2284 mL of lipocrit aspirate. About 65% of the cases were done in conjunction with another procedure. Overall complication rate was 4.6%, contour irregularity (1.9%), seroma (0.8%), cellulitis (0.8%), pigmentation changes (0.4%), and electrolyte imbalance (0.4%), with a minimum follow-up of 6 months. 78% of patient would undergo the procedure again and 86% would recommend it. CONCLUSION Third-generation ultrasound-assisted liposuction can be used effectively and safely, either alone, or in conjunction with other plastic surgery procedures. VASER liposuction allows surgeons to address superficial fat plane and enhanced skin tightening. Rate of complications are lower than that of traditional liposuction with equivalent or higher patient satisfaction. 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)
- Bao Ngoc N Tran
- Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christopher J Didzbalis
- Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tiffany Chen
- Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Nikita O Shulzhenko
- Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mokhtar Asaadi
- Plastic and Reconstructive Surgery, Cooperman Barnabas Medical Center, Livingston, NJ, USA. .,Department of Plastic and Reconstructive Surgery, Cooperman Barnabas Medical Center, 101 Old Short Hills Road, Suite 504, West Orange, NJ, 07052, USA.
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Goodman GJ, Ho WWS, Chang KJ, Ling YF, Sheu AY. 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. Aesthet Surg J 2022; 42:NP662-NP674. [PMID: 35709509 PMCID: PMC9384315 DOI: 10.1093/asj/sjac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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
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Affiliation(s)
| | | | | | - Yu-Fang Ling
- Caliway Biopharmaceuticals Co., Ltd., New Taipei City, Taiwan
| | - An-Yi Sheu
- Corresponding Author:An-Yi Sheu, 32F-7, No. 99, Sec. 1, Xintai 5th Rd, Xizhi District, New Taipei City, 221, Taiwan E-mail:
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Fiala T, Lavin P. Safety of a 1064-nm robotic laser system for noninvasive lipolysis of the flanks. Lasers Surg Med 2022; 54:672-681. [PMID: 35266172 DOI: 10.1002/lsm.23532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/05/2022] [Accepted: 02/21/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The primary objective of this pilot study was to confirm the safety of a 1064-nm laser device with a novel robotic arm for noninvasive subcutaneous fat reduction in the flank area. Secondary objectives included: assessing the extent of subject discomfort during treatment, overall subject satisfaction with the results of the procedure, and a determination of subcutaneous fat reduction in the treated area, in preparation for larger upcoming trials. MATERIALS AND METHODS A 110-cm2 area on both flanks of enrolled subjects (N = 11; 22 flanks) was treated for 20 minutes with a Food and Drug Administration-cleared robotic noncontact 1064-nm laser system (EON®; Dominion Aesthetic Technologies, Inc.). Patients were followed for 12 weeks, and examined routinely at 2 weeks, 12 weeks, and additionally as needed, posttreatment. Ad hoc surveys were administered to assess patient satisfaction. A 2-week posttreatment ultrasound scan was used to check for changes in the treated area. Ultrasound measurements were also used to determine the subcutaneous adipose tissue thickness at a center of each treatment zone before treatment and at 12 weeks posttreatment for efficacy determination, with mean thicknesses calculated per subject. RESULTS The treatment had a low incidence of adverse effects, with only one subject developing a palpable thickening in the subcutaneous tissue following treatment. This was noted at the 2-week time period and had resolved by the 12-week posttreatment exam. No other predefined adverse effects were noted. On a scale of 0-10, the mean pain score during the procedure was 1.95, decreasing to 0.9 at 30 minutes postprocedure. Subject satisfaction was "Excellent" for all subjects (100%). At Week 12 after one treatment, the mean reduction in subcutaneous adipose thickness on the treated flanks was 6.1 mm per patient (-15%; p < 0.01). CONCLUSION Similar to a prior abdominal study with the same robotic laser device, this pilot study confirms the safety of this 1064-nm noncontact laser device for treating subcutaneous fat on the flanks. The procedure is well tolerated with a high degree of subject satisfaction. The amount of subcutaneous fat reduction in the flank area appears similar to that seen in the abdomen, but larger studies are required for confirmation. CLINICALTRIALS gov Identifier: NCT04797988.
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Affiliation(s)
- Thomas Fiala
- Department of Surgery, Fiala Aesthetics, University of Central Florida College of Medicine, Altamonte Springs, Florida, USA
| | - Philip Lavin
- Division of Biostatistics, Boston Biostatistics Research Foundation, Inc., Framingham, Massachusetts, 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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Kream E, Boen M, Fabi SG, Goldman MP. Nonsurgical Postpartum Abdominal Rejuvenation: A Review and Our Experience. Dermatol Surg 2021; 47:768-774. [PMID: 33867470 DOI: 10.1097/dss.0000000000003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A significant population of aesthetic patients are postpartum women motivated to achieve a more youthful abdomen. Although traditionally, abdominoplasty was the treatment of choice, minimally invasive procedures have grown in popularity because of minimal downtime and the favorable side effect profile. so many women share concerns regarding their postpartum abdominal appearance, a limited number of studies focus specifically on postpartum abdominal rejuvenation. OBJECTIVE To review pertinent aspects of abdominal anatomy, associated changes with pregnancy, available nonsurgical cosmetic procedures, and to provide our experience to help guide treatment combinations which comprehensively address the concerns of the postpartum patient. MATERIALS AND METHODS A review of the literature surrounding nonsurgical treatment options for postpartum abdominal lipohypertrophy, muscle changes, tissue laxity, and striae gravidarum, along with the authors' experience in this area are provided. CONCLUSION This review summarizes available nonsurgical modalities to address postpartum abdominal defects, including procedures that tone muscles, reduce fat, tighten skin, and improve the appearance of striae. Both the published literature and the authors' experience favor a combination of treatments to address the various lamellae affected by pregnancy. Further clinical trials focusing on the postpartum patient would further help create a standardized approach for postpartum abdominal rejuvenation.
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Affiliation(s)
- Elizabeth Kream
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Monica Boen
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Sabrina G Fabi
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
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