Expected to maintain a significant growth rate over the next eight years1, aesthetic body shaping and contouring treatments are here to stay. These procedures continue trending in the aesthetic arena because patients want non-invasive solutions that reduce fat, tighten skin and tone muscle with little-to-no downtime and effective results.
“Cosmetic body shaping is a huge part of an aesthetic practice because so many patients are seeking nonsurgical options for body contouring,” said cosmetic surgeon Daisy Ayim, MD, who runs a private practice in Houston, Texas. “The convenience, lack of scarring, quick recovery and modest results are attractive to clients, making them willing to trade surgery for non-invasive treatments.”
Aesthetic results are not the only deciding factor for patients considering these procedures. “It is not just a cosmetic thing – we can improve the quality of life for a patient,” noted Suneel Chilukuri, MD, director of cosmetic surgery at Refresh Dermatology (Houston, Texas). “With the right treatments, we are able to target the overall core for improved strength and balance, which brings patients in for body sculpting as they enjoy functional benefits, too.”
Technologies that are Shaping Body Contouring
With the increase in demand for effective, nonsurgical treatments, providers must be versed in a variety of technologies to help patients achieve their body shaping goals. “It is important to consider the various body contouring elements and the aesthetic pathology that we are trying to treat, and then match the best technology options to treat them,” explained Sachin Shridharani, MD, board certified plastic surgeon and medical director of LUXURGERY© (New York City, N.Y.).
Fortunately, the evolution of body contouring has resulted in the creation of many technologies to address specific patient pathologies and concerns:
- Radiofrequency (RF) has become a standard treatment in modern aesthetics for skin tightening, scar revision and cellulite.
- Cryolipolysis remains a popular treatment to reduce stubborn pockets of fat by subjecting fat cells to freezing temperatures to stimulate apoptosis.2
- High-intensity focused electromagnetic (HIFEM)–based devices use fractional ultrasound energy and are the latest technology for focalized fat reduction, mainly for the abdomen and flanks.
- Electrical muscle stimulation (EMS) and magnetic muscle stimulation (MMS) induce muscle hypertrophy and toning to complete the scope of body contouring procedures.
- Acoustic wave therapy (AWT) treats cellulite with ultrasonic waves that break down fibrous tissue and relax the septae.
- Laser treatments are another modality used to break down fat cells in localized areas.
Dr. Chilukuri prefers laser treatments for targeted fat reduction. “For small pockets of fat, I will use a laser, so we can do very focused areas. Anywhere I can do cryolipolysis is where I can use laser,” he clarified. “Quite frankly, I use my laser more than cryolipolysis because I can show predictable results without the risk of idiopathic hyperplasia.”
The Evolution of Cellulite Treatments
Cellulite has long been the bane of the aesthetics world with treatments that have either underperformed or left patients and physicians underwhelmed. Dr. Shridharani has turned to a device called AveliTM (Revelle Aesthetics) to treat cellulite. “This device uses a targeted focal incision, where you place the device underneath the skin to capture the various septae and release them,” he explained. “I think Aveli is ideal if the patient does not want an injection and they want a ‘one and done’ type of treatment.”
If the patient does prefer a less invasive treatment, Dr. Shridharani turns to injectables to treat cellulite. “To get really great outcomes, I use off label Kybella® from Allergan Aesthetics (Irvine, Calif.) to melt away the fat, followed by MMS to improve the quality of the skeletal muscle,” he shared. “I use hyperdilute Radiesse (Merz Aesthetics) for skin quality improvement and a moderate volumizing effect; and I also use plenty of Sculptra (Galderma Laboratories) for the same indication. Then, I use QWO (Endo Aesthetics) for the buttocks.”
Dr. Chilukuri treats cellulite in his practice with a series of acoustic wave devices, including Emtone® by BTL Aesthetics (Marlborough, Mass.) and CellutoneTM (DMH Aesthetics). “The Emtone does a combination of RF plus an acoustic wave or pressure wave to improve the greater fat reduction, overall texture and skin laxity,” he said.
Surgical vs. Nonsurgical Body Shaping Options
While surgical treatments remain the standard for body contouring, they are more expensive with longer downtime and may come with an increased risk of side effects. Nonsurgical treatments offer less risks but, according to some physicians, less impressive outcomes.
“In my practice, patients are coming for a very bespoke contour treatment, and it is a bit difficult to give them that with a device, right now in 2022,” explained Dr. Shridharani. “I am fond of different technologies, but, at the same time, what I find as a surgeon is that patients are coming back and saying, ‘I see an improvement, but I need more.’”
For this reason, body shaping treatments require finesse in managing patient expectations. “I tend to be very clear with my patients; I take photos of patients and we go over the photos so that we know we are treating the same thing. I am very clear about what the treatments are going to do so they have a clear expectation,” shared facial plastic surgeon Jennifer Levine, MD (New York City, N.Y.).
Multimodalities for Targeted Body Contouring
According to Dr. Levine, a proper diagnosis treated with a combination of targeted procedures is key for providing optimal results. “I think combining cryolipolysis with biostimulatory fillers is great because usually there are different components of a diagnosis, including a fat component and a texture component – and sometimes that texture is cellulite,” Dr. Levine emphasized. “Another example, the Emtone can improve the texture of the skin while a biostimulatory filler can address laxity.
“The Emsculpt NEO (BTL Aesthetics) is a great foundational device,” Dr. Levine continued. “Overall, I think most people do want to lose fat, but you still need a device that is going to address skin quality and texture, as well as muscle toning, which the Emsculpt NEO provides.”
Continuing with the multimodality theme, Dr. Shridharani has also incorporated Renuvion® (Apyx Medical) in his practice. The device combines cold plasma energy with RF energy in a minimally invasive procedure for optimized tissue contraction. “This system works well for what I like to think of as a shrink-wrapping of the skin. I do it as a standalone or in conjunction with surgical body contouring procedures like liposuction,” he added.
Dr. Shridharani feels the Renuvion is an ideal device for an aesthetic practice to introduce body shaping treatments. “In my opinion, it is the holy grail in body contouring, tightening and skin retraction. With this device, I can reduce fat, augment skeletal muscle and improve the quality of the skin. I have done a mini thigh lift to give the patient the results they want and not give them the full scar burn,” he said.
In Dr. Ayim’s opinion, patients must have a healthy lifestyle with good nutrition and exercise, and should be informed that results they see from body shaping treatments are sustainable only with their commitment. After that, she prefers a device that combines fat reduction with skin tightening.
“In my private practice, BodyTite (InMode) is our go-to body shaping treatment, which is a dual RF-based device for adipose tissue coagulation and dermal contraction,” she explained. “The results are immediate and peak several months after the procedure.”
Dr. Ayim also cautions practitioners to do their due diligence and consider their skill set before choosing any device for their practice. “The BodyTite device requires knowledge and proficiency in liposuction, so it may not be practical for everyone.”
Another great device on the market is truBody from Cutera (Brisbane, Calif.) which is a body sculpting solution featuring two innovative technologies to reduce fat3,4 and build muscle5. By pairing the complementary truSculpt iD and truSculpt flex devices, truBody delivers a personalized and comfortable treatment experience with long-lasting results and high patient satisfaction. truBody provides the benefits of truSculpt iD’s 2 MHz monopolar RF and truSculpt flex’s direct bio-electrical muscle stimulation paired with truControlTM to aid in consistent energy delivery.
Advances and Innovations
According to Dr. Chilukuri, several updated technologies and devices are on the horizon. “First, the new EdgeTM Applicators for the Emsculpt NEO are coming out this month and will treat the lateral rectus muscle or the love handles,” he said. “The Evolve Transform, also called EvolveX (InMode) has a hands-free device to treat small to large areas and uses both RF and EMS. Also, watch for the Ultimate Contour, which uses ultrasound or cavitation to treat mainly the abdomen and love handles, but you can treat thighs, as well. For cellulite, there will be a carbon-based patch, to be used with an Nd:YAG laser to treat the fiber spans on the thighs and buttocks.”
Next on the radar is PHYSIQ by DEKA (Calenzano, Italy) a hands-free device that utilizes sequential thermal and electrical pulse (STEP) technology, available in the U.S. exclusively through Cartessa Aesthetics (Melville, N.Y.). This device delivers variable EMS while the super luminescent diode matrix (SDM) uses deep heat to target tissue during a single session.
According to board-certified plastic surgeon Kenneth Rothaus, MD (New York City, N.Y.), PHYSIQ stands out as the only device that can treat fat and muscle in the same session. “It offers an effective treatment to those patients who are not candidates for surgery or do not wish for surgery, and in my opinion, it has expanded the demographics of patients seeking body contouring,” he said. “We are seeing many more millennials and Gen Z patients who are not candidates for liposuction, but can benefit from the dual action of stimulating and toning muscle and reducing subcutaneous tissue.”
STEP programs are customized, 30-minute sequences of timed phases of deep heat and stimulation to reeducate muscles. By changing the energy modality, results are maximized while treatment time is minimized. Providers can use PHYSIQ to give patients the outcomes they want with no perceived discomfort or downtime.
Dermatologist and cosmetic surgeon Michael Gold, MD (Nashville, Tenn.), noted that Venus Bliss MAXTM from Venus Concept, Inc. (Toronto, Ontario, Canada) is a game changer in aesthetics. “This is a go-to option for those needing fat reduction, muscle stimulation and skin tightening – the perfect trifecta,” he expressed. “It has definitely enhanced our practice by delivering consistent and predictable results to our patients. The Venus Bliss Max fat reduction and skin tightening are real, and putting it all together provides great results for our patients, which is great for our practice. ”
Its protocol, called TriBodyTM, features three technologies that reduce fat, tone muscle and tighten skin. The 1064 nm diode laser penetrates the hypodermis for non-invasive lipolysis to provide up to 41% reduction in adipose layer thickness. FlexMAX EMS targets seven different muscle groups at optimized parameters for noticeable muscle definition and toning. And, finally, patented (MP)2 technology, powered by multipolar RF and pulsed electromagnetic fields (PEMF), delivers significant depth of impact on cellulite and induces neocollagenesis, resulting in tighter skin appearance.
Skin Science Solutions (Bedford Hills, N.Y.) has also devised their answer to cellulite with the icoone®, a device to lift, massage and stimulate the connective tissue and reduce the appearance of cellulite, while draining excess liquids and firming the skin. This patented, FDA 510(k) cleared system delivers multiple micro alveolar stimulation (MMAS), combined with dual-wavelength laser energy. According to the manufacturer, what sets icoone apart is that the device can be used daily and provides a completely pain-free experience.
Chris Gojdz, MD, PhD (Miami, Fla.), has been using icoone in his practices for over ten years. “This is the best of the best device for the body’s skin condition, body contouring and for cellulite reduction,” he shared. “I use it after cryolipolysis to help move fat cells out of the body. Two devices cover my whole body contouring practice: one is cryolipolysis and the other is the icoone.”
Water-assisted liposuction (WAL) is a proven technique for body contouring through fat harvesting and may also be an effective solution for cellulite. The body-jet® device from CAREstream (Lake Mary, Fla.) offers lipocontouring and gentle harvesting with the pulsating water-jet. The dual action cannula delivers a pulsating water beam to simultaneously separate adipose from surrounding tissue and evacuate it while preserving micronized fat, leaving minimal impact on surrounding connective tissue, vessels and nerves. The gentle, selective power allows patients to enjoy faster recovery and less bruising with no tumescence, waiting or centrifugation. According to the manufacturer, physicians can harvest low or high volumes of healthy fat in-office with their intuitive WAL portfolio.
All This = An Exciting Future
Patients are ready for minimally invasive and nonsurgical treatments, and according to Dr. Shridharani, physicians should heed the call. “I think the future is really exciting, and we are seeing that body shaping treatments are certainly a huge part of an aesthetic practice. I think as time proceeds, an emphasis on body contouring will be paramount to having a truly successful aesthetic practice.”
1. https://www.researchandmarkets.com/reports/4827935/ medical-spa-market-size-share-and-trends?utm_ source=GNOM&utm_medium=PressRelease&utm_ code=dpms5s&utm_campaign=1671768+-+Assessment+of+ the+Medical+Spa+Global+Market+to+2028+-+Featuring+A llure+Medspa%2c+Bivotal+Medical+Spa%2c+Clinique+La+P rairie+and+Cocoona+Centre+of+Aesthetic+Transformation &utm_exec=shbe20prd
2. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plast Reconstr Surg. 2015 Jun;135(6):1581-1590. doi: 10.1097/ PRS.0000000000001236. PMID: 26017594; PMCID: PMC4444424.
3. Taub A, Bartholomeusz J. Ultrasound Evaluation of a Single Treatment with a Temperature Controlled Multi-Frequency Monopolar Radio Frequency Device for the Improvement of Localized Adiposity on the Abdomen and Flanks. J Drugs Dermatol. 2020;19(1):28-34
4. 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 Mar;53(3):337-343
5. Stephen J. Ronan M.D. A Novel Bio-Electric Current Stimulation Device for Improvement Of Muscle Tone 7/2019.