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Noninvasive Body Sculpting Technologies with an Emphasis on High-Intensity Focused Ultrasound

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Abstract

Background

Body-sculpting procedures are becoming increasingly popular in the United States. Although surgical lipoplasty remains the most common body sculpting procedure, a demand exists for noninvasive alternatives capable of reducing focal adiposity without the risks of adverse events (AEs) associated with invasive excisional body-sculpting procedures.

Methods

This report describes the mechanism of action, efficacy, safety, and tolerability of cryolipolysis, radiofrequency ablation, low-level external laser therapy, injection lipolysis, low-intensity nonthermal ultrasound, and high-intensity focused ultrasound (HIFU), with an emphasis on thermal HIFU. The articles cited were identified via a PubMed search, with additional article citations identified by manual searching of the reference lists of articles identified through the literature search.

Results

Each of the noninvasive treatments reviewed can be administered on an outpatient basis. These treatments generally have fewer complications than lipoplasty and require little or no anesthesia or analgesia. However, HIFU is the only treatment that can produce significant results in a single treatment, and only radiofrequency, low-level laser therapy, and cryolipolysis have been approved for use in the United States. Early clinical data on HIFU support its efficacy and safety for body sculpting. In contrast, radiofrequency, laser therapy, and injection lipolysis have been associated with significant AEs.

Conclusions

The published literature suggests that noninvasive body-sculpting techniques such as radiofrequency ablation, cryolipolysis, external low-level lasers, laser ablation, nonthermal ultrasound, and HIFU may be appropriate options for nonobese patients requiring modest reduction of adipose tissue.

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References

  1. National Clearinghouse of Plastic Surgery Statistics (2010) Report of the 2009 STATISTICS. American Society of Plastic Surgeons, Arlington Heights

  2. Hughes CE III (2001) Reduction of lipoplasty risks and mortality: an ASAPS survey. Aesthet Surg J 21:120–127

    Article  PubMed  Google Scholar 

  3. Jewell M (2001) Commentary. Aesthet Surg J 21:125–127

    Article  Google Scholar 

  4. Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU (2008) Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg 121:396e–403e

    Article  PubMed  Google Scholar 

  5. Triana L, Triana C, Barbato C, Zambrano M (2009) Liposuction: 25 years of experience in 26,259 patients using different devices. Aesthet Surg J 29:509–512

    Article  PubMed  Google Scholar 

  6. Iverson RE, Pao VS (2008) MOC-PS(SM) CME article: liposuction. Plast Reconstr Surg 121(4 Suppl):1–11

    Article  PubMed  Google Scholar 

  7. Gingrass MK (1999) Lipoplasty complications and their prevention. Clin Plast Surg 26:341–354, vii

    Google Scholar 

  8. Sasaki GH (2010) Quantification of human abdominal tissue tightening and contraction after component treatments with 1064-nm/1320-nm laser-assisted lipolysis: clinical implications. Aesthet Surg J 30:239–245

    Article  PubMed  Google Scholar 

  9. Sasaki GH, Tevez A (2009) Laser-assisted liposuction for facial and body contouring and tissue tightening: a 2-year experience with 75 consecutive patients. Semin Cutan Med Surg 28:226–235

    Article  PubMed  CAS  Google Scholar 

  10. Coleman KM, Coleman WP III, Benchetrit A (2009) Noninvasive, external ultrasonic lipolysis. Semin Cutan Med Surg 28:263–267

    Article  PubMed  CAS  Google Scholar 

  11. Atiyeh BS, Dibo SA (2009) Nonsurgical nonablative treatment of aging skin: radiofrequency technologies between aggressive marketing and evidence-based efficacy. Aesthetic Plast Surg 33:283–294

    Article  PubMed  Google Scholar 

  12. Manuskiatti W, Wachirakaphan C, Lektrakul N, Varothai S (2009) Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study. J Eur Acad Dermatol Venereol 23:820–827

    Article  PubMed  CAS  Google Scholar 

  13. Caruso-Davis MK, Guillot TS, Podichetty VK, Mashtalir N, Dhurandhar NV, Dubuisson O, Yu Y, Greenway FL (2010) Efficacy of low-level laser therapy for body contouring and spot fat reduction. Obes Surg [Epub ahead of print]

  14. Jackson RF, Dedo DD, Roche GC, Turok DI, Maloney RJ (2009) Low-level laser therapy as a noninvasive approach for body contouring: a randomized, controlled study. Lasers Surg Med 41:799–809

    Article  PubMed  Google Scholar 

  15. Atiyeh BS, Ibrahim AE, Dibo SA (2008) Cosmetic mesotherapy: between scientific evidence, science fiction, and lucrative business. Aesthetic Plast Surg 32:842–849

    Article  PubMed  Google Scholar 

  16. Ascher B (2010) Safety and efficacy of UltraShape Contour I treatments to improve the appearance of body contours: multiple treatments in shorter intervals. Aesthet Surg J 30:217–224

    Article  PubMed  Google Scholar 

  17. Moreno-Moraga J, Valero-Altes T, Riquelme AM, Isarria-Marcosy MI, de la Torre JR (2007) Body contouring by noninvasive transdermal focused ultrasound. Lasers Surg Med 39:315–323

    Article  PubMed  CAS  Google Scholar 

  18. Teitelbaum SA, Burns JL, Kubota J, Matsuda H, Otto MJ, Shirakabe Y, Suzuki Y, Brown SA (2007) Noninvasive body contouring by focused ultrasound: safety and efficacy of the Contour I device in a multicenter, controlled, clinical study. Plast Reconstr Surg 120:779–789 discussion 790

    Article  PubMed  CAS  Google Scholar 

  19. Fatemi A (2009) High-intensity focused ultrasound effectively reduces adipose tissue. Semin Cutan Med Surg 28:257–262

    Article  PubMed  CAS  Google Scholar 

  20. Fatemi A, Kane MA (2010) High-intensity focused ultrasound effectively reduces waist circumference by ablating adipose tissue from the abdomen and flanks: a retrospective case series. Aesthetic Plast Surg 34:577–582

    Article  PubMed  Google Scholar 

  21. Coldiron B, Coleman WP III, Cox SE, Jacob C, Lawrence N, Kaminer M, Narins RS (2006) ASDS guidelines of care for tumescent liposuction. Dermatol Surg 32:709–716

    Article  PubMed  CAS  Google Scholar 

  22. Haeck PC, Swanson JA, Gutowski KA, Basu CB, Wandel AG, Damitz LA, Reisman NR, Baker SB (2009) Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg 124(4 Suppl):28S–44S

    PubMed  CAS  Google Scholar 

  23. Jewell M (2010) Commentary. Aesthet Surg J 30:246–248

    Article  PubMed  Google Scholar 

  24. Sasaki GH, Tevez A, Gonzales M (2010) Histological changes after 1,440-nm, 1,320-nm, and 1,064-nm wavelength exposures in the deep and superficial layers of human abdominal tissue: acute and delayed findings. Cynosure, Inc, Westford

  25. Ng EY, Chua LT (2000) Mesh-independent prediction of skin burns injury. J Med Eng Technol 24:255–261

    Article  PubMed  CAS  Google Scholar 

  26. ZELTIQ homepage (2010) http://www.coolsculpting.com/. Accessed 31 Aug 2010

  27. Avram MM, Harry RS (2009) Cryolipolysis for subcutaneous fat layer reduction. Lasers Surg Med 41:703–708

    Article  PubMed  Google Scholar 

  28. Klein KB, Zelickson B, Riopelle JG, Okamoto E, Bachelor EP, Harry RS, Preciado JA (2009) Noninvasive cryolipolysis for subcutaneous fat reduction does not affect serum lipid levels or liver function tests. Lasers Surg Med 41:785–790

    Article  PubMed  Google Scholar 

  29. Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J (2009) Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg 33:482–488

    Article  PubMed  Google Scholar 

  30. Zelickson B, Egbert BM, Preciado J, Allison J, Springer K, Manstein D (2008) Noninvasive cooling of fat cells to induce lipolysis for noninvasive adipocyte cell death: initial results from a pig model (poster 25). In: ASDS 2008—American Society of Dermatologic Surgeons, Orlando, 6–9 Nov

  31. Dover J, Burns J, Coleman S, Fitzpatrick R, Garden J, Goldberg D, Geronemus R, Kilmer S, Mayoral F, Weiss R, Zelickson B, Tanzi E (2009) A prospective clinical study of noninvasive cryolipolysis for subcutaneous fat layer reduction: interim report of available subject data (abstract). Lasers Surg Med 41:706

    Google Scholar 

  32. Dover J (2008) A prospective clinical study of noninvasive cold-induced apoptotic fat cell death for subcutaneous fat layer reduction (poster 23). In: ASDS 2008—American Society of Dermatologic Surgeons, Orlando, 6–9 Nov

  33. Avelar J (1989) Regional distribution and behavior of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic Plast Surg 13:155–165

    Article  PubMed  CAS  Google Scholar 

  34. Goldberg DJ, Fazeli A, Berlin AL (2008) Clinical, laboratory, and MRI analysis of cellulite treatment with a unipolar radiofrequency device. Dermatol Surg 34:204–209 discussion 209

    Article  PubMed  CAS  Google Scholar 

  35. Wanitphakdeedecha R, Manuskiatti W (2006) Treatment of cellulite with a bipolar radiofrequency, infrared heat, and pulsatile suction device: a pilot study. J Cosmet Dermatol 5:284–288

    Article  PubMed  Google Scholar 

  36. Ruiz-Esparza J (2006) Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients. Dermatol Surg 32:601–610

    Article  PubMed  CAS  Google Scholar 

  37. Dierickx CC (2006) The role of deep heating for noninvasive skin rejuvenation. Lasers Surg Med 38:799–807

    Article  PubMed  Google Scholar 

  38. Fitzpatrick R, Geronemus R, Goldberg D, Kaminer M, Kilmer S, Ruiz-Esparza J (2003) Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med 33:232–242

    Article  PubMed  Google Scholar 

  39. Meridian Medical homepage (2010) http://www.meridianmedical.ca/. Accessed 26 Aug 2010

  40. Erchonia Ltd (2010) FDA grants market clearance for Erchonia’s Zerona laser (press release). http://www.erchonia.com/news/press-releases/fda-grants-market-clearance-for-erchonias-zerona-laser

  41. Neira R, Arroyave J, Ramirez H, Ortiz CL, Solarte E, Sequeda F, Gutierrez MI (2002) Fat liquefaction: effect of low-level laser energy on adipose tissue. Plast Reconstr Surg 110:912–922 discussion 923–915

    Article  PubMed  Google Scholar 

  42. Matarasso A, Pfeifer TM (2009) Mesotherapy and injection lipolysis. Clin Plast Surg 36:181–192, v; discussion 193

    Google Scholar 

  43. Rotunda AM, Kolodney MS (2006) Mesotherapy and phosphatidylcholine injections: historical clarification and review. Dermatol Surg 32:465–480

    Article  PubMed  CAS  Google Scholar 

  44. Yagima Odo ME, Cuce LC, Odo LM, Natrielli A (2007) Action of sodium deoxycholate on subcutaneous human tissue: local and systemic effects. Dermatol Surg 33:178–188 discussion 188–179

    Article  PubMed  Google Scholar 

  45. Salti G, Ghersetich I, Tantussi F, Bovani B, Lotti T (2008) Phosphatidylcholine and sodium deoxycholate in the treatment of localized fat: a double-blind, randomized study. Dermatol Surg 34:60–66 discussion 66

    Article  PubMed  CAS  Google Scholar 

  46. American Society for Aesthetic Plastic Surgery (2004) Fat-melting fad: to good to be true? (press release). http://www.cosmeticsurgeons.com/media/news-releases/fat-melting-fad--too-good-to-be-true

  47. Davis MD, Wright TI, Shehan JM (2008) A complication of mesotherapy: noninfectious granulomatous panniculitis. Arch Dermatol 144:808–809

    Article  PubMed  Google Scholar 

  48. Quistgaard JU, Desilets C, Martin P (2010) High-intensity focused ultrasound. http://digital.miinews.com/publication/?i=34631&page=1. Accessed 12 July 2010

  49. Haar GT, Coussios C (2007) High-intensity focused ultrasound: physical principles and devices. Int J Hyperth 23:89–104

    Article  Google Scholar 

  50. Kim YS, Rhim H, Choi MJ, Lim HK, Choi D (2008) High-intensity focused ultrasound therapy: an overview for radiologists. Korean J Radiol 9:291–302

    Article  PubMed  Google Scholar 

  51. Dijkmans PA, Juffermans LJ, Musters RJ, van Wamel A, ten Cate FJ, van Gilst W, Visser CA, de Jong N, Kamp O (2004) Microbubbles and ultrasound: from diagnosis to therapy. Eur J Echocardiogr 5:245–256

    Article  PubMed  CAS  Google Scholar 

  52. Wong RA, Schumann B, Townsend R, Phelps CA (2007) A survey of therapeutic ultrasound use by physical therapists who are orthopaedic certified specialists. Phys Ther 87:986–994

    Article  PubMed  Google Scholar 

  53. Gam AN, Johannsen F (1995) Ultrasound therapy in musculoskeletal disorders: a metaanalysis. Pain 63:85–91

    Article  PubMed  CAS  Google Scholar 

  54. UltraShape Ltd (2010) FDA agrees to UltraShape 510(k) pathway: expected to shorten FDA clearance process (press release). http://www.ultrashape.com/ru/press_releases.aspx?newsId=24812

  55. Brown SA, Greenbaum L, Shtukmaster S, Zadok Y, Ben-Ezra S, Kushkuley L (2009) Characterization of nonthermal focused ultrasound for noninvasive selective fat cell disruption (lysis): technical and preclinical assessment. Plast Reconstr Surg 124:92–101

    Article  PubMed  CAS  Google Scholar 

  56. Kennedy JE, Ter Haar GR, Cranston D (2003) High-intensity focused ultrasound: surgery of the future? Br J Radiol 76:590–599

    Article  PubMed  CAS  Google Scholar 

  57. Ferraro GA, De Francesco F, Nicoletti G, Rossano F, D’Andrea F (2008) Histologic effects of external ultrasound-assisted lipectomy on adipose tissue. Aesthetic Plast Surg 32:111–115

    Article  PubMed  Google Scholar 

  58. Dubinsky TJ, Cuevas C, Dighe MK, Kolokythas O, Hwang JH (2008) High-intensity focused ultrasound: current potential and oncologic applications. AJR Am J Roentgenol 190:191–199

    Article  PubMed  Google Scholar 

  59. Duck FA (1990) The physical properties of tissue. Academic Press, London

    Google Scholar 

  60. Fodor PB, Smoller BR, Stecco KA, Desilets CS (2006) Biochemical changes in adipocytes and lipid metabolism secondary to the use of high-intensity focused ultrasound for noninvasive body sculpting. In: American Society for Aesthetic Plastic Surgery Annual Meeting, Orlando, 21–25 Apr

  61. Gadsden E, Aguilar MT, Smoller BR, Jewell ML, Glogau RG (2009) Clinical safety and histological changes associated with the use of a novel high-intensity focused ultrasound device for noninvasive body sculpting. In: 5th European Masters in Aesthetic and Anti-aging Medicine, Paris, 2–3 Oct

  62. Garcia-Murray E, Rivas OA, Stecco KA, Desilets CS, Kunz L (2005) Evaluation of the acute and chronic systemic and metabolic effects from the use of high-intensity focused ultrasound for adipose tissue removal and noninvasive body sculpting. In: American Society of Plastic Surgeons Annual Meeting, Chicago, 24–25 Sep

  63. Garcia-Murray E, Rivas OA, Stecco KA, Desilets CS, Kunz L (2005) The use and mechanism of action of high-intensity focused ultrasound for adipose tissue removal and noninvasive body sculpting. In: American Society of Plastic Surgeons Annual Meeting, Chicago, 24–25 Sep

  64. Smoller BR, Garcia-Murray E, Rivas OA, Stecco KA, Desilets CS, Fodor PB (2006) The histopathological changes from the use of high-intensity focused ultrasound (HIFU) in adipose tissue. In: American Academy of Dermatology 64th Annual Meeting, San Francisco, 3–7 Mar

  65. Ikeda T, Yoshizawa S, Tosaki M, Allen JS, Takagi S, Ohta N, Kitamura T, Matsumoto Y (2006) Cloud cavitation control for lithotripsy using high intensity focused ultrasound. Ultrasound Med Biol 32:1383–1397

    Article  PubMed  Google Scholar 

  66. Yoshizawa S, Ikeda T, Ito A, Ota R, Takagi S, Matsumoto Y (2009) High-intensity focused ultrasound lithotripsy with cavitating microbubbles. Med Biol Eng Comput 47:851–860

    Article  PubMed  Google Scholar 

  67. Mitnovetski S, Almeida AA, Goldstein J, Pick AW, Smith JA (2009) Epicardial high-intensity focused ultrasound cardiac ablation for surgical treatment of atrial fibrillation. Heart Lung Circ 18:28–31

    Article  PubMed  Google Scholar 

  68. Ninet J, Roques X, Seitelberger R, Deville C, Pomar JL, Robin J, Jegaden O, Wellens F, Wolner E, Vedrinne C, Gottardi R, Orrit J, Billes MA, Hoffmann DA, Cox JL, Champsaur GL (2005) Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: results of a multicenter trial. J Thorac Cardiovasc Surg 130:803–809

    Article  PubMed  Google Scholar 

  69. Chan AH, Fujimoto VY, Moore DE, Martin RW, Vaezy S (2002) An image-guided high-intensity focused ultrasound device for uterine fibroids treatment. Med Phys 29:2611–2620

    Article  PubMed  Google Scholar 

  70. Fruehauf JH, Back W, Eiermann A, Lang MC, Pessel M, Marlinghaus E, Melchert F, Volz-Koster S, Volz J (2008) High-intensity focused ultrasound for the targeted destruction of uterine tissues: experiences from a pilot study using a mobile HIFU unit. Arch Gynecol Obstet 277:143–150

    Article  PubMed  Google Scholar 

  71. Lenard ZM, McDannold NJ, Fennessy FM, Stewart EA, Jolesz FA, Hynynen K, Tempany CM (2008) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery: imaging predictors of success. Radiology 249:187–194

    Article  PubMed  Google Scholar 

  72. Wu F, Chen WZ, Bai J, Zou JZ, Wang ZL, Zhu H, Wang ZB (2001) Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound. Ultrasound Med Biol 27:1099–1106

    Article  PubMed  CAS  Google Scholar 

  73. Wu F, Wang ZB, Chen WZ, Wang W, Gui Y, Zhang M, Zheng G, Zhou Y, Xu G, Li M, Zhang C, Ye H, Feng R (2004) Extracorporeal high-intensity focused ultrasound ablation in the treatment of 1,038 patients with solid carcinomas in China: an overview. Ultrason Sonochem 11:149–154

    Article  PubMed  CAS  Google Scholar 

  74. Wu F, Wang ZB, Chen WZ, Zou JZ, Bai J, Zhu H, Li KQ, Xie FL, Jin CB, Su HB, Gao GW (2004) Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early Chinese clinical experience. Ultrasound Med Biol 30:245–260

    Article  PubMed  Google Scholar 

  75. Jewell M, Baxter R, Cox SE, Donofrio L, Dover J, Glogau R, Kane M, Weiss R, Martin P, Schlessinger J (2011) Randomized sham-controlled trial to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg, in press

  76. LipoSonix (2010) http://www.liposonix.com/. Accessed 26 Aug 2010

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Acknowledgments

Editorial support for this manuscript was provided by Jeffrey Coleman, MA, and Robert Gatley, MD, of Complete Healthcare Communications, Inc., at Chadds Ford, PA, USA, with funding from Medicis Technologies Corporation, Scottsdale, AZ, USA.

Disclosure

Mark L. Jewell, Nowell J. Solish, and Charles S. Desilets are the sole authors and contributors of the information submitted for publication and have no direct or indirect commercial financial incentive associated with publishing the article. Mark L. Jewell has served as a consultant for Allergan, AorTech, Coapt, Keller Medical, Medicis, New Beauty magazine, and Sound Surgical, and as an investigator for Allergan, Excaliard, Kythera, Medicis, and Mentor. Nowell J. Solish has served as an advisor or consultant for Allergan, Medicis, and Johnson & Johnson and has received grants for clinical research from Allergan and Medicis. Charles S. Desilets is an employee of Medicis Technologies Corporation.

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Jewell, M.L., Solish, N.J. & Desilets, C.S. Noninvasive Body Sculpting Technologies with an Emphasis on High-Intensity Focused Ultrasound. Aesth Plast Surg 35, 901–912 (2011). https://doi.org/10.1007/s00266-011-9700-5

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