MAUI, HAWAII — Noninvasive selective cooling of subcutaneous fat is a novel and particularly promising method of getting rid of love handles, back fat, and cellulite, according to Dr. Christopher B. Zachary.
The fat-freeze method, cryolipolysis, was developed by Dr. R. Rox Anderson and his colleagues at the Wellman Center for Photomedicine at Massachusetts General Hospital, Boston, and is being commercially developed by Zeltiq Aesthetics.
The project is being advanced with a level of scientific rigor and openness traditionally lacking in the field of excess fat removal, Dr. Zachary said at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation. Dr. Zachary isn't involved with the cryolipolysis project but is working on other next-generation, energy-based methods for removing subcutaneous fat.
Cryolipolysis crystallizes the lipids in fat cells when temperatures are above the freezing point of water. Dr. Anderson and his colleagues have developed a device for controlled energy extraction that's applied to the skin surface to accomplish this. The result is adipocyte death by apoptosis without damage to surrounding nerves, vasculature, or the skin surface.
Histologic studies in both pigs and people have documented that a cryolipolysis session lasting 60 minutes or less results in a low-grade inflammatory process that continues for 3 months, during which fat cells are engulfed and digested by inflammatory cells and a dermal fibrotic response occurs.
Pig studies have documented—both by ultrasound and histology—a 40% reduction in subcutaneous fat layer thickness over 90 days in treated areas, which is a dramatic effect, noted Dr. Zachary, professor and chair of dermatology at the University of California, Irvine. He added that he found the procedure “totally convincing.”
An ongoing, initial, multicenter cryolipolysis clinical trial has enlisted over 120 of a planned 240 dermatology and plastic surgery patients.
An initial subset of 32 patients with discrete love handles was treated with one-time conservative energy extraction (intensity ranging from −33 mW/cm2 for 60 minutes to −72 mW/cm2 for 45 minutes). At 4-month follow-up, 27 of the 32 patients (84%) demonstrated reproducible, visually-evident improvement of the treated area, compared with the untreated contralateral love handle. The study design eliminated diet or exercise as potential explanations for the change.
Ultrasound assessment documented a mean 22% reduction in the treated fat layer thickness, compared with baseline, with the shrinkage coming primarily from the suprafascial fat component.
A total of 30 of 32 patients (94%) indicated they felt no or minimal discomfort during and after the procedure. “It's not like you need anesthesia for this. People can be working on their computers or whatever,” Dr. Zachary noted. The lipids in the destroyed fat cells are gradually resorbed. Importantly, serial blood lipid measures have shown no increase in lipid levels post treatment.
The investigators are cautiously introducing higher energy extraction parameters while expanding the trial to include participants with excess body fat at other locations, including the abdomen, back, thighs, and upper arms.
The duration of benefit from cryolipolysis, or any of the other emerging fat-removing technologies, remains to be seen. It may turn out that the treatments need to be repeated periodically, akin to a haircut, said Dr. Zachary. That would be fine as long as physicians and patients are informed, he added.
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