The effects of COVID-19 on the industry have been profound and interesting, according to plastic surgeon Lina Triana, MD (Cali, Colombia), who has been lecturing on the subject. “The market has been growing in a very healthy way for several years now and the industry weathered the pandemic very well overall,” she explained. “Before COVID we were seeing a more dramatic rise in the number of nonsurgical body shaping therapies versus surgeries. As the pandemic has transitioned to where we are now, we saw a significant increase in the number of surgical body contouring procedures as people became less concerned about pandemic-related risks. We expected to see this continue, but economic and geopolitical instability have each played a role in slowing this down. We will see how this plays out as we continue through 2023.”
The growth of the market lies not just in the number of procedures performed, Dr. Triana explained, but in the different types of procedures available, both surgical and nonsurgical, and how this can be reflected – for better or worse – in how the physician’s philosophy of care is presented to the patient. “The doctor-patient relationship and patient satisfaction are of great importance. Our understanding has evolved, and we more readily embrace this growing armamentarium individually and in combination,” she shared.
“Physicians offering body contouring procedures do better when they have a larger spectrum of alternatives available,” Dr. Triana indicated. “The era in which the doctor tells the patient what to do is gone. Now we must offer patients the best alternatives so they can make informed choices based on our expert guidance, making trust so important.” This is where the wholistic, or wellness-based paradigm comes into the picture. “In the 80s and 90s everything was surgical, heralding the emergence of valid nonsurgical procedures trending alongside patient desires for convenience with less risk and downtime,” Dr. Triana continued. “With so many tools at our disposal now, and a global view of treating the whole patient rather than just a particular problem, we see better results as well as a stronger doctor-patient relationship.”
“In 2023 we are seeing the emergence of the more natural body shaping result, after a good five years of moving away from surgical into the nonsurgical and less invasive,” added cosmetic surgeon Daisy Ayim, MD, director of Ayim Surgical Arts (Houston, Texas). She also homes in on the wholistic approach that examines lifestyle, including nutrition and exercise, before body contouring devices or surgery are employed. “My patients will tell you: I will turn people down when I get the sense that they will not have the lifestyle in place because they need to maintain what we are working for,” she expressed. “Once we are good there, I guide them toward technologies and adjunctive therapies best suited to address their unique body contouring concerns.” Dr. Ayim does not see surgery as excluded from a wholistic, wellness-based care philosophy. “To me it is not about non-invasive, although that plays a role; it is about longevity and sustainability of outcomes that affect patients in a deeply personal way.”
For non-invasive technologies, Dr. Ayim uses BodyTite (InMode) for addressing skin laxity, depending on the case, often adding other energy-based therapies in a dual-modality approach on top of liposuction as a go-to procedure. “After tumescent liposuction we use radiofrequency (RF) technology to smooth out the result and stimulate the production of collagen and elastin, to improve overlying laxity.” Massage to improve lymphatic drainage speeds recovery and improves the result further, she added. “We have maybe a week of downtime before the patient is back in the swing of things, and the result holds – with the lifestyle in place they do not need repeat treatment.”
Azza Halim, MD, is an aesthetic and regenerative medicine physician with practices in Boca Raton, Fla., Chicago, Ill. and Newport Beach, Calif. “With practices in different areas of the country, and distinctly different aesthetic markets, the popularity of combination therapies is unquestionable,” she noted. Dr. Halim shared her novel trademarked combination therapy using polydioxanone (PDO) threads and carboxytherapy (subcutaneous microinjections of CO2) in conjunction with an energy-based device. “This is for the many patients who have laxity following a liposuction or other body shaping treatment, but do not want additional surgery for any number of reasons. It is especially popular in the warm weather states I practice in – Florida and California – because people want minimal downtime and to be ‘summer ready,’ but are less eager to tolerate compression garments for the number of weeks needed during recovery from some surgical procedures. Carboxytherapy has been very popular in Europe for decades.”
She starts with an energy-based nonsurgical modality to smooth out the area as well as address skin laxity and underlying fat. “We implant PDO threads to lift the area and stimulate the generation of new collagen. The addition of carboxy therapy adds more subtle but vital improvements that work synergistically with the whole,” explained Dr. Halim. “We get great results without the downtime, which is what patients are looking for. This protocol excels for patients who want to further reshape a postliposuction result, or those with stubborn pockets of fat who had not had prior surgery.”
Part of the rationale behind this approach is that traditionally, there have been two major aspects to body contouring: Addressing the contours themselves and dealing with tissue laxity and quality. “I have a specific device I use for that reason, and I may opt to add in a more aggressive energy-based treatment if needed,” Dr. Halim continued. “I can also spot-treat using this method. Its versatility and flexibility are reasons why this has done well in my practice.”
Dermatologist Amy Lewis, MD (New York City, N.Y.) has also spoken in lectures about the trend toward combination therapies gaining traction. “This is perfectly understandable because as the number and diversity of facial aesthetic therapies increased, we quickly learned that the best global outcomes came from multi-modal approaches,” she said. “The number and variety of safe, effective body contouring treatments on the market has grown rapidly these last few years so we are seeing the same trend and getting greater results. This also allows physicians to differentiate themselves from potential competition with their own favored combinations.
“Recently we have used Coolsculpting (Allergan Aesthetics) and Emsculpt Neo from BTL Aesthetics (Marlborough, Mass.), to address fat and underlying muscle from the top down and bottom up, respectively,” Dr. Lewis continued. In that case, she explained, the cryolipolysis is often done first and given several weeks, but this can be managed differently depending on the time demands of the patient.
The growing variety of devices also have allowed a more diverse population access to treatment. Heavier patients and those with more prominent pockets of fat in the stomach can still benefit, when for a long time, body shaping was for the more ideal candidate, according to Dr. Lewis. “What we see in these cases is the prospect for a more profound result.”
Numerous non-invasive therapies and combination protocols are emerging in response. Cutera, Inc. (Brisbane, Calif.) has put forth the truBody Trim & Tone protocol: one session using its truSculpt® non-invasive, monopolar RF device,
with four truFlex® muscle-sculpting bioelectric current treatments. This customizable fat-reducing and muscle-toning aesthetic duo delivers results with high patient satisfaction. Versatile and efficient, the complete truBody experience can be performed in 30 minutes or less. Offering an average 24% fat reduction per treatment area and up to 30% increase in muscle mass1,2, truBody is designed to help patients – and your practice – reach its full potential. “The two distinct devices, used together, deliver a synergistic effect to address unwanted body fat and skin quality,” said facial plastic surgeon Arash Moradzadeh, MD (Beverly Hills, Calif.). “Combining them creates a highly customizable treatment, very specific to the patient’s goals.”
SLIMUS from Hironic (Gyeonggi-do, South Korea) is a non-invasive lipolysis device using the 1060 nm diode laser for the abdomen, back, arms and thighs. Its unique patented vibration effect – available on all handpieces – increases fat cell metabolism, stimulating and accelerating fat cell drainage to enhance the laser effect. As the laser is irradiated and absorbed into the fat layer, the vibration minimizes discomfort and mild muscle pain that may occur during the approximately 25-minute treatment session. Features include cradle extension, voice instruction, Sub-LCD and an emergency button for patients.
Harnessing non-invasive direct electrical muscle stimulation, Accufit from Lutronic, Inc. (Billerica, Mass.) is designed to enhance the aesthetic appearance of the body by providing electrical stimulation to nerves and muscles. It also offers multiple advantages over other muscle stimulation devices including three times the power of indirect functional magnet stimulation, anatomically correct muscle movements and the ability to move muscle groups in a natural way. Accufit’s integrated intelligence consistently delivers energy and comfort, regardless of body mass index (BMI), by changing the workout based on the targeted muscle group. With four pre-programmed treatment regimens, users can mimic common physical exercises to achieve their desired goals. A typical protocol involves four treatments performed over two to four weeks. “Accufit technology is unique in addressing not only aesthetic needs, but also muscle recovery, fitness and endurance,” shared rheumatology specialist Shariar Cohen-Gadol, MD (Thousand Oaks, Calif.) “It builds muscle and strengthens the core utilizing electro-muscular technology without exposing patients to any radiation sources.”
Safe for all skin types, Ultracontour NG from MedixSysteme AG (Ruggell, Liechtenstein) boasts eight key benefits in one machine, from hands-free use to numerous applicators and painless non-invasive treatment with thermal, mechanical and vibrating effects. Up to 20 piloted and custom-programmed emitters may be placed at various body locations simultaneously to treat subcutaneous fat in the arms, belly, legs, buttocks and love handles delivering highly focalized fractionated ultrasound (termed sonodynamic therapy) for point-by-point targeting at the precise depth of local adiposity from between 0.8 cm and 1.3 cm, but with the unique ultrasonic mechanical drainage (UMD) effect automatically delivering intense pulses to the fat in larger areas automatically. Dermatologists Evşen Altunay, MD and Ömür Tekeli, MD practice aesthetic medicine together in Istanbul, Turkey. “Ultracontour NG is a non-invasive, energy-based device which offers a painless, walk in-walk out procedure,” Dr. Altunay stated.
“Most of our patients are successful businesspeople. Being a quick, non-invasive procedure is an asset for our busy patients,” Dr. Tekeli added, “and we combine it with other technologies.”
UltraSlim® from Ward Photonics (Cocoa Beach, Fla.) is a revolutionary fat reduction technology that offers non-invasive, permanent fat loss. Its patented mechanism of action uses high-powered medical-grade light to create temporary pores in the fat cell membranes through which fatty acids escape and are eliminated naturally through lipid metabolism. Listed as a Risk Group 1 device, UltraSlim has no side effects or BMI restrictions, and patients do not experience any discomfort during the procedure. The company’s clinical studies show that patients lost an average of 1580 cc of fat (3.5 inches combined waist, hips and thighs) in just one 32-minute treatment.3 With this innovative technology and lasting results, UltraSlim is setting a new standard for non-invasive fat reduction treatments. “Non-invasive fat loss and skin tightening are the future of all skin care, and the device is the safest and most effective of these modalities I have seen so far,” said Sheila Barbarino, MD, founder and medical director of Barbarino Surgical Arts in Austin, Texas and Redondo Beach, Calif. “I continue to be impressed by the results I see on a daily basis with the device.”
Non-invasive Z Wave Radial Pulse Technology by Zimmer MedizinSystems GmbH (Irvine, Calif.) is FDA cleared to reduce the appearance of cellulite and improve blood circulation in the treatment area. A short, comfortable procedure delivers pulsed radial wave therapy to the treatment area. Improvement in the appearance of cellulite may be seen after only two to three sessions. Improving local blood circulation may also be used to treat or manage erectile dysfunction, accelerate tattoo clearance with laser tattoo removal, and improve body contouring procedure results. As an adjunct to body sculpting procedures like cryolipolysis and liposuction, Z Wave can also improve the patient experience, and speed results and recovery time.
1. Somenek MT, Ronan SJ, Pittman TA. A multi-site, single-blinded, prospective pilot clinical trial for non-invasive fat reduction of the abdomen and flanks using a monopolar 2 MHz radiofrequency device. Lasers Surg Med. 2021;53(3):337-343.
2. Ronan SJ. A Novel Bio-Electric Current Stimulation Device For Improvement Of Muscle Tone [white paper, Cutera Inc.]. 7/2019.
3. NCT02867150 at ClinicalTrials.gov