Fat-Reduction Treatments

Patients usually need around three sessions of treatment, each lasting for around 45 minutes depending on the area of stubborn fat to be frozen. On the body, it can be used to treat the abdomen, flanks, inner and/or outer thighs, upper arms, and the back, though cryolipolysis is probably most used on the submental area for a reduction in under-chin fat. A major appeal of this approach to fat reduction is that once the cells have been frozen and eliminated, they’re gone for good.

The treatment recently received some negative press after model Linda Evangelista suffered a rare complication known as paradoxical adipose hyperplasia (PAH) after undergoing CoolSculpting. She settled a $50 million lawsuit against Zeltiq Aesthetics (a subsidiary of Allergan) in July 2022.

CoolSculpting Elite

Arguably the most well-known fat-reduction device among consumers, Allergan Aesthetics released an upgrade to its original CoolSculpting device in 2021. CoolSculpting Elite has been redesigned and re-engineered for an improved patient and practitioner experience, with enhanced features including improved cooling distribution to treat a greater percentage of targeted tissue, and the ability to use two applicators at once. 

Both of these improvements mean practitioners can essentially perform twice the number of treatments in the same amount of time while reducing time spent in the clinic for patients. The new CoolSculpting Elite also has seven new lightweight, detachable applicators with fewer parts for faster set-up, C-shaped cups to sit comfortably on the body’s natural curves; and a removable gel trap to make clean up easier – cup liners are no longer required. 

Deleo Cristal Pro

French medical aesthetic devices manufacturer Deleo may be new to the UK market, but its Cristal Pro cryolipolysis machine is already getting impressive feedback from practitioners. It uses a patented homogenous freezing technology that cools fat cells to -12°C, while four handpieces can be used simultaneously to save time for both patient and practitioner. Cristal Pro also features a built-in ultrasound scanner – at a central frequency of 7.5 MHz – which allows practitioners to precisely measure fat tissue before and after treatment. 

There are eight applicators indicated for very small areas of fat mass like the jowls, all the way through to the largest for the abdomen. There is also a special flat applicator for arms, saddlebags, inside and outside of thighs, and calves. Practitioners can also control the suction level of the applicators for optimum results and better management of patient comfort.

Laser lipolysis  

We’re used to thinking about laser in terms of skin resurfacing, hair removal and getting rid of benign lesions, but laser lipolysis, low-level laser therapy (LLLT), or cold laser (depending on which term you want to use) is emerging as a real contender in the fat reduction and body-contouring market. Unlike rival technologies, laser lipolysis doesn’t have a thermal mechanism of action on fat cells – instead, it creates microscopic holes in the cells that emulsifies them, so the contained lipids leak out and are metabolised. 

Thanks to this ‘draining’ effect, many patients experience an instant result immediately after treatment, but because the fat cells aren’t actually destroyed – no apoptosis or necrosis occurs – the chance of the fatty deposit coming back is increased. However, this fat-reduction method does appeal to patients who want to avoid discomfort during treatment, and side effects are very minimal compared to rival technologies. There are few different ‘types’ of cold laser, and so treatable areas, recommended frequency of treatments and treatment times vary. 

Emerald Laser

One of the most talked-about launches in aesthetic medicine of the past couple of years, Emerald Laser from Erchonia is a completely contactless fat-reduction device that employs ten green cold lasers at a wavelength of 532nm. The effect of laser creates a transitory pore for emulsified free fatty liquids in the fat cells to seep out, before the body then processes it through the lymphatic system. 

Emerald laser is FDA cleared to treat patients with a BMI over 30 – meaning that unlike other fat-reduction methods, it can actually achieve results on morbidly obese patients. It can be used on the abdomen, back, hips, neck, chin and thighs and is totally painless. Each treatment only takes around 30 minutes, but patients do need to return to clinic for weekly sessions. A course of six treatments is usually recommended but varies depending on how much fat there is to be treated. 

SculpSure

Cynosure’s FDA-cleared SculpSure works differently to Emerald Laser and other devices in the cold laser or LLLT category because it does use thermal energy in its mechanism of action. It employs a 1060nm diode laser to induce hyperthermic disruption of fat cells using heat, which is highly absorbed by adipose tissue but largely ignored by cells in the dermis, making it safe to treat all skin types. The laser energy is delivered subcutaneously to raise the temperature of the fat to between 42-47°C, damaging the structural integrity of fat cells and leading to their collapse. 

The body’s lymphatic system then naturally evacuates the destroyed cells – unlike other laser lipolysis devices, SculpSure does remove the fat cells, so they are unable to regenerate. Up to four applicator heads are secured to the patient and attached to the body with a belt. No suction is required, as the diode lasers rest flat against the skin. The built-in Contact Cooling system keeps the skin comfortable throughout the session, which is completed in just 25 minutes. Patients may experience some discomfort from the fluctuations in temperature from deep warmth to cold. 

Radiofrequency  

A hugely versatile technology, radiofrequency energy is delivered through electrodes in either mono-polar (most commonly used for fat reduction), bi-polar or multi-polar forms and works by creating a focused heating of the fatty layer under the skin up to around 45ºC) to increase blood circulation, tissue tightening and fat cell apoptosis, whereby the fatty lipids are then drained through the lymphatic system. Radiofrequency has a simultaneous skin-tightening effect – hence its versatility and popularity as a smoothing and tightening facial treatment – thanks to its neocollagenesis-stimulating action, which also makes it particularly effective for use on the buttocks and thighs to target cellulite.

BTL EmSculpt Neo

BTL’s popular EmSculpt device has been upgraded to work on stubborn fat as well as muscle tone. EmSculpt Neo launched onto the market in 2021 with the addition of radiofrequency to its existing HIFEM+ technology for muscle building. Both technologies work in synchronicity, with the RF energy delivered shortly after the muscles are warmed up and the supramaximal contractions begin. It is the only device of its kind available in the UK that combines both technologies. Suitable for patients with a BMI of up to 35, Neo claims to achieve an average fat reduction of 30% in four 30-minute sessions. It can be used to treat the abdomen, buttocks, outer, inner, front and back of thighs, biceps, triceps and calf muscles. 

Lumenis NuEra Tight

NuEra Tight from Lumenis uses multiple RF frequencies to target the depth of energy specifically for different indications and tissue thicknesses, allowing practitioners to truly personalise treatments. The device’s FocalRF technology can deliver energy from 6MHz for superficial heating to 470kHZ for deep heating, depending on if the goal is to remove stubborn fat cells, remodel cellulite or tighten the skin. Practitioners can also customise treatments in terms of temperature, time and electrode size. There are three lightweight handpieces and eight electrodes ranging from 20-100mm. 

BTL truSculpt iD

truSculpt iD is a monopolar RF platform that treats up to a 300cm2 area on the abdomen and flanks with a fast, 15-minute protocol. truSculpt iD treatments can be tailored to patients’ individual body contouring desires and features a hands-free and hand-held solution to treat a full abdomen or multiple body areas simultaneously. Real-Time Temperature Control enhances patient experience providing a comfortable, yet effective treatment resulting in an average of 24% fat reduction. This non-invasive procedure is ideal for busy individuals giving them the freedom to return to their daily activities immediately following the treatment.

Perfecte’ me Body HIFU

The HIFU modality in the Perfecte’ Me Non-surgical Body and Face System can be used for targeted fat removal, body sculpting and cellulite treatment. Adipocytes are exposed to HIFU energy at a depth of 7mm or 13mm to temperatures of 60-65°C, and the treatment is suitable for fat on the abdomen and flanks.

Only one treatment is needed. The Perfecte’ Me platform also incorporates HIFU for the face, cryolipolysis, cavitation, RF and shockwave therapy.

Baldan HIFU Lab

A dedicated HIFU device, HIFU Lab from Italian manufacturer Baldan Group has specific cartridges for treating both the face and body.

The body cartridge reaches 13mm below the dermis to target adipocytes and achieve a reduction in fat in the treatment area – the abdomen, hips, outer thighs, buttocks and inner arms. It can also be used for targeted cellulite and skin tightening treatments. Patients can expect results to last for around 18 months.

Microwaves  

Microwaves technology is a bit of an underdog in the fat reduction and body-contouring arena.

Microwave energy – a form of electromagnetic radiation that is preferentially absorbed by fat molecules as opposed to water molecules – is employed at an optimum frequency to induce lipolysis, bypassing the uppermost layers of skin tissue to deliver more energy directly to where it’s needed in the subcutaneous fat layer.

Because the heat is focused in the subdermal fatty layer, heating of the surface tissue of the skin is reduced.

DEKA ONDA Coolwaves (Lynton)

The only microwaves device for aesthetic indications available in the UK, ONDA Coolwaves from manufacturer DEKA (distributed by Lynton) uses microwave energy at 2.45 GHz to achieve fat reduction, a decrease in cellulite and skin tightening.

Localised fat deposits are targeted using ONDA’s deep handpiece, which penetrates with 80% of the Coolwaves energy and dissolves subcutaneous adipose cell membranes. The Coolwaves integrated cooling system ensures that the skin remains cool for maximum patient comfort.

Between three and nine treatments are usually required, and each takes between 20 minutes to one hour depending on the size of the treatment area.