Fat removal procedures

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Fat removal procedures are used mostly in cosmetic surgery with the intention of removing unwanted adipose tissue. The procedure may be invasive, as with liposuction, [1] or noninvasive using laser therapy, radiofrequency, ultrasound or cold (cryoablation or cryolipolysis) to reduce fat, sometimes in combination with injections. [2] [3]

Contents

Fat is sometimes removed from one location to another on a person in an autograft, such as in some breast reconstruction and breast augmentation procedures. [4] These techniques are distinct from bariatric surgery, which aims to treat obesity by minimizing food consumption or by interfering with the absorption of food during digestion, and from injection lipolysis, which relies solely on injections marketed as causing lipolysis. [2]

Invasive

Liposuction

Liposuction is a type of cosmetic surgery that removes fat from the human body in an attempt to change its shape. [5] Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect obesity related problems. [6] [7] In the United States it is the most commonly done cosmetic surgery. [8] [9]

Serious complications include deep vein thrombosis, organ perforation, bleeding, and infection. [10] Death occurs in about one per ten thousand cases. [11]

The procedure may be performed under general, regional, or local anesthesia and involves using a cannula and negative pressure (suction) to suck out fat. [8] It is believed to work best on individuals of normal or near normal weight and good skin elasticity. [8]

Post operational downtime can last anywhere from 2 – 4 weeks to 3 full months for patients to fully heal and be able to resume normal activities. [12]

Noninvasive

Ultrasound

Focused thermal ultrasound techniques work by raising the tissue temperature up to 48 °C, [13] resulting in coagulative necrosis of adipocytes, with sparing of vessels and nerves. Passive heating of the skin may also induce collagen remodeling. [14] [15] [16]

Hydrolipoclasy is a technique that is being studied as an alternative to liposuction. [17] It involves injecting a hypotonic solution into an area of fat and then subjecting it to ultrasound waves. [17]

Low level laser light

Low level laser light reduces the stability of adipocyte cell membranes, allowing cells to release their stores of fat without damaging the cell. [18]

Cryolipolysis

Patient with cryolipolysis applicator Patient receiving CoolSculpting procedure.jpg
Patient with cryolipolysis applicator

Cryolipolysis, for instance with CoolSculpting, is a method intended to remove fat by freezing. [19] [20] [21] It involves controlled application of cooling within the temperature range of −11 to +5 °C (+12.2 to +41 °F) for the localized reduction of fat deposits, intended to reshape the contours of the body. [19] [20] The degree of exposure to cooling causes cell death of subcutaneous fat tissue, without apparent damage to the overlying skin. [20] [22] It appears primarily applicable to limited discrete fat bulges. [19] [20] [23]

Adverse effects include transient local redness, bruising and numbness of the skin, and these are expected to subside. [20] [23] Typically, sensory deficits (numbness) will subside within a month. The effect on peripheral nerves was investigated and failed to show permanent detrimental results. [22]

Another adverse effect is paradoxical adipose hypertrophy (PAH) which causes fat tissue to grow larger rather than become reduced in size as a consequence of the procedure. [24] [25] Supermodel Linda Evangelista has initiated legal action for damage caused by PAH. [26] [27] Some studies indicate that PAH side effects are common on a per-patient basis, since a typical patient receives multiple treatments. [28]

Based on the premise that fat cells are more easily damaged by cooling than skin cells (such as popsicle panniculitis), cryolipolysis was developed to apply low temperatures to tissue via thermal conduction. [29] In order to avoid frostbite, a specific temperature level and exposure are determined, such as 45 minutes at −10 °C (14 °F). [20] [30] While the process is not fully understood, it appears that fatty tissue that is cooled below body temperature, but above freezing, undergoes localized cell death ("apoptosis") followed by a local inflammatory response that gradually over the course of several months results in a reduction of the fatty tissue layer. [20] [22] [30]

Typical cost per treatment area varies depending on location. Price in the US ranges from $750 to $1,500, [31] with UK prices about £750 per area to be treated and in India, the Coolsculpting cost typically ranges from ₹60,000 to ₹115,000. [32] In the U.S., the CoolSculpting procedure is FDA-cleared for the treatment of visible fat bulges in the submental area, thigh, abdomen and flank, along with bra fat, back fat, underneath the buttocks, and upper arm. [21]

Injection lipolysis

Injection lipolysis is a procedure that reduces localized subcutaneous fat deposits, most commonly submental fat (double chin). This technique involves the injection of lipolytic substances, such as deoxycholic acid (branded as Kybella in the United States), directly into the targeted fat tissue. Deoxycholic acid is a naturally occurring bile acid that aids in the breakdown and absorption of dietary fat. When injected into subcutaneous fat, it causes the dissolution of the fat cell membranes, causing them to die. The destroyed fat cells are then gradually eliminated by the body's natural metabolic processes over the following weeks. [33] [34] While the procedure is generally considered safe when performed by a qualified healthcare professional, potential side effects may include swelling, bruising, numbness, and rarely, nerve injury in the treated area. [33] [34] [35]

Regulatory status

In 2010, Zerona, another low-level laser treatment, was cleared for marketing by the FDA as an infrared lamp. [36] Zeltiq obtained FDA marketing clearance for cryolipolysis of the flanks, and in 2012 received marketing clearance for cryolipolysis of the abdomen. [20] This treatment has also been cleared for the treatment of the upper arm, back fat, bra fat, banana roll, submental area, and thighs. [37]

Various lipolysis techniques including injection lipolysis, RF, laser, ultrasound, and cryolipolysis were forbidden in France by a decree of the French Public Health Authority in 2011. The decree was revised in 2012, distinguishing invasive techniques, which remain forbidden, from permitted non-invasive techniques; laser, RF, ultrasound and cryolipolysis that did not penetrate the skin became legal, and injection lipolysis and mesotherapy remained illegal. Laser devices that involve inserting the probe through the skin transcutaneously but do not suck out the liquefied material are also prohibited. Surgeons are permitted to perform surgical liposuction techniques using laser-assisted lipolysis so long as suction is performed. [38] [39]

Related Research Articles

<span class="mw-page-title-main">Plastic surgery</span> Medical surgical specialty

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims to improve the appearance of it. A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.

<span class="mw-page-title-main">Lipolysis</span> Metabolism involving breakdown of lipids

Lipolysis is the metabolic pathway through which lipid triglycerides are hydrolyzed into a glycerol and free fatty acids. It is used to mobilize stored energy during fasting or exercise, and usually occurs in fat adipocytes. The most important regulatory hormone in lipolysis is insulin; lipolysis can only occur when insulin action falls to low levels, as occurs during fasting. Other hormones that affect lipolysis include leptin, glucagon, epinephrine, norepinephrine, growth hormone, atrial natriuretic peptide, brain natriuretic peptide, and cortisol.

Mesotherapy is a form of alternative medicine which involves intradermal or subcutaneous injections of pharmaceutical preparations, enzymes, hormones, plant extracts, vitamins, and/or other ingredients such as hyaluronic acid. It has no proven clinical efficacy and poor scientific backing. Mesotherapy injections allegedly target adipose fat cells, apparently by inducing lipolysis, rupture and cell death among adipocytes. The stated aim of mesotherapy is to provide the skin with essential nutrients, hydration, and other beneficial compounds to rejuvenate and revitalize its appearance.

<span class="mw-page-title-main">Breast augmentation</span> Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Although in some cases augementation mammoplasty is applied to correct congenital defects of the breasts and the chest wall in other cases it is used purely as a cosmetic surgery, primary breast augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

<span class="mw-page-title-main">Breast reduction</span> Plastic surgery procedure

Reduction mammoplasty is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the patient's body, the critical corrective consideration is the tissue viability of the nipple–areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold – physical, aesthetic, and psychological – the restoration of the bust, of the patient's self-image, and of the patient's mental health.

<span class="mw-page-title-main">Reconstructive surgery</span> Surgery to restore form and function

Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition.

<span class="mw-page-title-main">Blepharoplasty</span> Surgical modification of the eyelids

Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle and tendon tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the periorbita, which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK.

<span class="mw-page-title-main">Buttock augmentation</span> Cosmetic and corrective surgery

Gluteoplasty denotes the plastic surgery and the liposuction procedures for the correction of congenital, traumatic, and acquired defects/deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement of the contour of the buttocks.

Injection lipolysis is a controversial cosmetic procedure in which drug mixtures are injected into patients with the goal of destroying fat cells. This practice, using drugs generally based on phosphatidylcholine and deoxycholate (PCDC), evolved from the initial intravenous use of those drug formulations to treat blood disorders.

Carboxytherapy is a non-surgical cosmetic medicine treatment for dermatology. Carboxytherapy employs injections or transdermal application to infuse gaseous carbon dioxide below the skin into the subcutaneous tissue through a needle or skin. It has a necrotizing effect on fat tissue fat cells, stimulates blood flow, improves the skin's elasticity and reduces the appearance of cellulite. It has also become a popular treatment for stretch marks. It is non-toxic and less invasive than operations like liposuction. Carboxytherapy leads to a temporary decrease in subcutaneous fat but has shown to reoccur again after a 28 week period. It can be applied for those with androgenic alopecia or alopecia areata.

<span class="mw-page-title-main">Liposuction</span> Surgery to remove unwanted fat

Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, liposuction is the most common cosmetic surgery.

Aesthetic medicine is a branch of modern medicine that focuses on altering natural or acquired unwanted appearance through the treatment of conditions including scars, skin laxity, wrinkles, moles, liver spots, excess fat, cellulite, unwanted hair, skin discoloration, spider veins and or any unwanted externally visible appearance. Traditionally, it includes dermatology, oral and maxillofacial surgery, reconstructive surgery and plastic surgery, surgical procedures, non-surgical procedures, and a combination of both. Aesthetic medicine procedures are usually elective. There is a long history of aesthetic medicine procedures, dating back to many notable cases in the 19th century, though techniques have developed much since then.

<span class="mw-page-title-main">Cellulite</span> Medical condition

Cellulite or gynoid lipodystrophy (GLD) is the herniation of subcutaneous fat within fibrous connective tissue that manifests as skin dimpling and nodularity, often on the pelvic region, lower limbs, and abdomen. Cellulite occurs in most postpubescent females. A review gives a prevalence of 85–98% of women of European descent, but it is considerably less common in women of East Asian descent. It is believed to be physiological rather than pathological. It can result from a complex combination of factors, including diet, sedentary lifestyle, hormonal imbalance or heredity, among others.

CoolSculpting is the brand name for a type of cryolipolysis procedure. Cryolipolysis is a non-invasive method of fat removal which uses extreme cold to freeze subcutaneous adipose tissue in certain localized areas of the body to reduce areas of fat. It is Food and Drug Administration (FDA)-approved for treatment of the submental area, under the jawline, the upper arms, lumbar rolls, brassiere rolls, flank area, abdomen, thighs, and under the buttocks. CoolSculpting is among the most widely used forms of cryolipolysis. Often the terms "cryolipolysis" and "CoolSculpting" are used synonymously or interchangeably.

<span class="mw-page-title-main">Jan Stanek</span>

Jan Stanek is a British cosmetic surgeon, lecturer and broadcaster. He is a Fellow of the Royal College of Surgeons, a member of the British Medical Association, the Royal Society of Medicine and The American Academy of Cosmetic Surgery. He has a private practice in central London.

Zeltiq Aesthetics is a subsidiary of AbbVie based in Pleasanton, California that markets and licenses devices used for cryolipolysis procedures. The company was founded in 2005 and raised $75 million in funding before going public in 2011. It was acquired by Allergan in February 2017 for $2.48 billion. Which was then acquired by AbbVie in 2020 for $63 billion.

Facial Autologous Muscular Injection is also known as Fat Autograft Muscular Injection, as Autologous Fat Injection, as Micro-lipoinjection, as Fat Transfer and as Facial Autologous Mesenchymal Integration, abbreviated as FAMI. The technique is a non-incisional pan-facial rejuvenation procedure using the patient's own stem cells from fat deposits. FAMI is an Adult stem cell procedure used to address the loss of volume in the face due to aging or surgery repair in restoring facial muscles, bone surfaces and very deep fat pads. The procedure involves removing adult stem cells of fatty tissue from lower body, and refining it to be able to re-inject living adipose stem cells into specific areas of the face without incision. FAMI is an outpatient procedure and an alternative to artificial fillers, blepharoplasty or various face lifts. The procedure does not require general anesthesia and risks of an allergic reaction are minimal due to the use of the patient's own tissue used as the facial injection.

Radio-frequency skin tightening is an aesthetic technique that uses radio frequency (RF) energy to heat skin with the purpose of stimulating cutaneous collagen, elastin and hyaluronic acid production in order to reduce the appearance of fine lines and loose skin. The technique induces tissue remodeling and production of new collagen and elastin. The process provides an alternative to facelift and other cosmetic surgeries.

<span class="mw-page-title-main">Stem cell fat grafting</span>

Stem cellfat grafting is autotransplantation of adipose-derived stem cells (ADSCs) extracted from fat-abundant donor sites to other areas such as the face, breast, and hip to reconstruct the operative areas into desirable shapes. ADSCs are multipotent stem cells found in adipose tissues, displaying similar differentiation potentials to bone marrow-derived mesenchymal stem cells (BM-MSCs).

Fat transfer, also known as fat graft, lipomodelling, or fat injections, is a surgical process in which a person's own fat is transferred from one area of the body to another area. The major aim of this procedure is to improve or augment the area that has irregularities and grooves. Carried out under either general anesthesia or local anesthesia, the technique involves 3 main stages: fat harvesting, fat processing, fat injection.

References

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  2. 1 2 Mulholland, RS; Paul, MD; Chalfoun, C (July 2011). "Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level laser therapy". Clinics in Plastic Surgery. 38 (3): 503–20, vii–iii. doi:10.1016/j.cps.2011.05.002. PMID   21824546.
  3. ↑ Ortiz, AE; Avram, MM (September 2015). "Noninvasive body contouring: cryolipolysis and ultrasound". Seminars in Cutaneous Medicine and Surgery. 34 (3): 129–33. doi:10.12788/j.sder.2015.0171. PMID   26566568.
  4. ↑ De Souza, MM; Jewell, AD; Grief, SN; Vail, BA (December 2018). "Plastic Surgery for Women". Primary Care. 45 (4): 705–717. doi:10.1016/j.pop.2018.07.008. PMID   30401351. S2CID   53225345.
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  6. ↑ Seretis, Konstantinos; Goulis, Dimitrios G; Koliakos, Georgios; Demiri, Efterpi (2015). "Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: A Systematic Review". Obesity Surgery. 25 (10): 1950–8. doi:10.1007/s11695-015-1797-1. PMID   26210190. S2CID   37230028.
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  13. ↑ Otto, Morkel J. (October 2016). "The safety and efficacy of thermal lipolysis of adipose tissue via ultrasound for circumference reduction: An open label, single-arm exploratory study". Lasers in Surgery and Medicine. 48 (8): 734–741. doi:10.1002/lsm.22544. ISSN   1096-9101. PMID   27320384. S2CID   46804557.
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  16. ↑ Sklar, Lindsay R.; El Tal, Abdel Kader; Kerwin, Leonard Y. (Apr 2014). "Use of transcutaneous ultrasound for lipolysis and skin tightening: a review". Aesthetic Plast. Surg. 38 (2): 429–41. doi:10.1007/s00266-014-0286-6. PMID   24567045. S2CID   26579022.
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  18. ↑ Nestor, Mark S.; Newburger, Jessica; Zarraga, Matthew B. (March 2013). "Body contouring using 635-nm low level laser therapy". Seminars in Cutaneous Medicine and Surgery. 32 (1): 35–40. ISSN   1085-5629. PMID   24049928.
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  20. 1 2 3 4 5 6 7 8 Derrick, C. D; Shridharani, S. M; Broyles, J. M (2015). "The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature". Aesthetic Surgery Journal. 35 (7): 830–6. doi: 10.1093/asj/sjv039 . PMID   26038367.
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  24. ↑ Stroumza, N.; Gauthier, N.; Senet, P.; Moguelet, P.; Nagel, R.; Barthelemy; Atlan, M. (2017-11-14). "Paradoxical Adipose Hypertrophy (PAH) After Cryolipolysis". Aesthetic Surgery Journal. 38 (4): 411–417. doi: 10.1093/asj/sjx159 . ISSN   1527-330X. PMID   29145587.
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  32. ↑ "CoolSculpting is only cold-based treatment cleared by US FDA for fat loss". 21 March 2016. Retrieved 25 August 2016.
  33. 1 2 Liu M, Chesnut C, Lask G (June 2019). "Overview of Kybella (Deoxycholic Acid Injection) as a Fat Resorption Product for Submental Fat". Facial Plastic Surgery. 35 (3): 274–277. doi:10.1055/s-0039-1688943. PMID   31189201.
  34. 1 2 Farina GA, Cherubini K, de Figueiredo MA, Salum FG (October 2020). "Deoxycholic acid in the submental fat reduction: A review of properties, adverse effects, and complications". Journal of Cosmetic Dermatology. 19 (10): 2497–2504. doi:10.1111/jocd.13619. hdl: 10923/18644 . PMID   32654409.
  35. ↑ Murdock, Joshua (3 May 2022). "The 10 Kybella Side Effects: What to Expect". GoodRx. Retrieved 1 June 2024.
  36. ↑ Louis, Catherine Saint (February 3, 2010). "Zap or Chill? Targeting Fat Without Surgery". The New York Times.
  37. ↑ Department of Health & Human Services (November 21, 2016). "Indications for Use" (PDF).
  38. ↑ "Décret n° 2011-382 du 11 avril 2011 relatif à l'interdiction de la pratique d'actes de lyse adipocytaire à visée esthétique", legifrance.gouv.fr, 2011, retrieved 2015-01-08
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