Body contouring techniques can be separated into non-invasive and invasive techniques.
Liposuction, though “invasive”, still remains the gold standard in body contouring. The procedure uses small suction cannulas sometimes assisted by lasers, ultrasound, propulsive jet sprays, radiofrequency energy or vibrational movement (power-assisted liposuction) to actively remove fat by suction from localized areas of fatty accumulation. Liposuction, also called suction assisted lipectomy or “lipo”, is still by far the most successful and predictable way to quickly, safely and effectively create the contouring figure that you desire. However, compared to non-invasive techniques there is some risk, increased recovery time, and discomfort associated with liposuction. Less invasive techniques involve inserting a Radiofrequency (RF) probe (e.g. ThermiRF™ to melt fat for smaller areas without liposuction, but still has more risk than non-invasive techniques). This has led to the growth of non-surgical, non-invasive body contouring.
Non-invasive body contouring technologies use an energy delivery system to injure, destroy, “convince cells to die slowly over time” or alter the architecture of the fat cells without any incisions or placing any device under the skin, and without performing any surgery. Other techniques that are evolving include injecting a substance to reduce fat (Kythera®, FDA approved to reduce fat under the chin).
The common non-invasive energy types utilized to create non-surgical body contouring include RF, focused ultrasound, infrared, RF-coupled suction and massage, and diode laser energy. These non-invasive energy sources that reduce areas of enlarged fat concentrations such as tummy, hips, thighs, and the back — reducing fat without harming other structures like nerves and blood vessels. Some are more effective than others. For example, Zerona® claims that its cool diode laser has a generalized “whole body” slimming technology by making fat cells leaky rather than using thermal mechanisms or cavitation energy to alter or break apart the fat cell. To scientist physicians like myself, it is hard to believe that low level cool laser light waves will be able to penetrate more than a millimeter or two, much less where the majority of the fat lies. It is no wonder that at the time I write this it is ranked as only having 28% satisfaction rating on RealSelf.
On the other hand, there are many effective non-invasive fat reduction technologies available.
CoolSculpting® is effective but has some discomfort noted by many patients, and the applicator paddle sizes can only treat a few areas at a time, require several treatments (3–5), have to wait between treatments, and takes several weeks to see the full effect and occasionally fat ridges are seen above the treated areas.
UltraShape® by Syneron Candela uses focused ultrasound energy, can treat at three different levels, and the different size applicators can treat just about anywhere on the body and even do lipo-sculpting. It is painless and the results are seen quickly with treatments a few weeks apart (series of 3 is typical, more depending on desires may be recommended). It is great for localized areas.
BTL Vanquish uses RF energy to heat the fatty layer precisely, painlessly and selectively to a temperature that causes fat cells to undergo early cell death (apoptosis) by destroying the integrity of the fat cell. Like other techniques that accomplish the same effect, the body then clears the remnants by the lymphatic system.
The VelaShape III, is new technology and much more effective than its predecessors (VelaShape I and II). It is a non-invasive body shaping device used to reduce cellulite, and reduce (slim) the area around the tummy, back, hips and thighs. The machine combines four different technologies — infrared, bi-polar RF, pulsed vacuum, and massage rollers — to improve skin texture and reduce the overall volume of the treated area. It is often used alone for cellulite reduction but often used in conjunction with the other devices I mentioned to magnify their efficacy by smoothing and warming the tissues and clearing much of the edema and fat breakdown products using as an advanced lymphatic massage device. Please note RF devices cannot be used for patients with pacemakers.
For large areas of troublesome fat collections as well as specific areas of focal fat and accumulation you may be best served by the various forms of liposuction. The non-invasive focal fat contouring technologies now in the market place may not be as effective, but have reduced risk and recovery time. Deciding between these options should be done on a case-by-case basis between patient and physician.