How do I get rid of this fat? I don’t want to diet and exercise so what is the best technology to decrease my waist? Are the newer innovations any better than liposuction? What do you suggest?
Once a week I am asked these or similar questions. Surgical liposuction came first (1983) where fat was directly removed from the body using a small tube attached to a suction machine. This has been followed by non-surgical techniques (2008). These techniques traumatize the fat under the skin and depend upon the body to remove the traumatized fat. This was first noted by trauma surgeons dealing with limb crush injuries. The fat is crushed between a hard substance (car bumper) and the bone. The traumatized fat is removed by the body leaving an indentation at the place of trauma. Later lipo-dissolve was injected into the fat under the skin thereby dissolving the protective lining over the fat cell. The body recognizes this fat cell as injured and attempts to eliminate the traumatized fat cell.
The non-surgical, non-invasive treatment of fat has increased exponentially over the last decade. The idea was first conceived by a dermatologist who observed that frost bite limbs lost fat because of the differential blood flow to the fat and more rapid blood flow to the dermis of the skin. If the skin is protected, it is possible to deliver energy to traumatize the underlying fat and thereby allowing the body to remove the injured fat without harming the skin. Subsequent delivery systems were developed to protect the skin yet use energy deep to traumatize the fat cells.
CoolSculpting was one of the first delivery systems and probably is the best known. It freezes the fat between two heated paddles which protect the skin. EmSculpt uses high intensity focused electro-magnetic energy to traumatize fat cells. SculpSure uses the heat produced by a laser and works best in small areas. UltraShape directs ultrasound energy under the skin to target underlying fat cells and Vanquish employs targeted radiofrequency energy to heat up undesirable fat cells.
Again all these technologies need the human body to uniformly remove the fat cells. Unfortunately the body does not always cooperate and we often see patients in the office after these non-invasive procedures with no or only a slight improvement, lumps, indentations and damaged skin from the energy delivered. Although many technologies use “sculpt” in their name, mechanical liposuction is the only method which allows “sculpting of the fat” because fat is removed in a controlled fashion.
To make it worse, the reported cases of paradoxical adipose hyperplasia (PAH) keeps going up (previous <1% and now almost 3% incidence); i.e., more fat comes back after the non-invasive treatments.
