Fat melting has become a melting pot of procedures for many physicians experienced in the art and science of body sculpting.
Beverly Hills, Calif., dermatologic surgeon Jason Emer, M.D., says his practice revolves around using combination therapies to define and enhance patient bodies. And with a pallet of fat melting and skin tightening options available to enhance liposuction’s results, it’s rare that he’ll perform liposuction alone on a patient, he says.
Marie N. DiLauro, M.D., a cosmetic surgeon and board-certified laser specialist who owns and operates a cosmetic medical practice that specializes in liposuction and liposculpture in Columbus, Ohio, also says it’s rare that she’ll use liposuction alone.
“In the past, patients who were overweight or had an excess of fat in a few areas wanted these areas of fat reduced with liposuction. Today’s patients are more health conscious, tend to exercise and work out more [and] may be at their ideal weight but want to appear healthy, fit and more muscular,” Dr. DiLauro says. “In the past decade, liposuction has evolved to address these patients’ needs and desires. Today’s liposuction surgeons perform detailed precision sculpting to accentuate curves and muscle definition and, then, add selective fat transfer as needed to create a more curvaceous figure for a woman, and a more muscular chiseled look or physique for a man.”
NEXT: A Closer Look at Combos
A Closer Look at Combos
There are lots of potential combinations, including off-label combinations, aimed at improving individual patient outcomes.
For patients with small irregularities or others who want to fine-tune post-liposuction results, Dr. Emer often uses Ultrashape (Syneron Candela). Surgeons can start Ultrashape treatments almost immediately after liposuction, although swelling from liposuction takes three to six months to go away. There is no inflammation or swelling from the ultrasound technology, however, he says.
Dr. Emer uses ZWave (Eclipse Aesthetics) shock therapy in all patients post Cellfina (Ultherapy), or after leg and arm liposuction. Doing so, he says, helps prevent irregularities and further improves the appearance of cellulite.
“If I have older patients who need more skin tightening and do not want skin surgery, such as a tummy tuck or arm skin removal, I will do ThermiRF [Thermi] to promote further skin tightening post-liposuction,” Dr. Emer says. “I also do this for abdominal, shoulder and arm etching. This allows me to get very tight contours on muscles and give definition like nobody has seen before.”
Dr. Emer says he gets amazing results on the neck, inner thighs, knee and buttock roll with Kybella, combined with ThermiRF, Thermage (Valeant Pharmaceuticals International) or Ultherapy (Ulthera).
And the dermatologic surgeon commonly combines treatments with noninflammatory options to improve outcomes, using such combinations as "wind, fire and ice" treatment, which is Ultrashape, Velashape (Velashape) or Venus Legacy (Venus Concept) and CoolSculpting (Zeltiq), he says. Dr. Emer adds he is integrating the new FDA-approved Sculpsure (Cynosure), a fat-removal laser device that takes about 25 minutes per treatment, into this combination.
Dr. DiLauro says she added Tickle Lipo (Euromi), which uses nutational infrasonic energy to dissolve fat, to her practice last year.
“The Tickle Lipo makes the infusion of the tumescence and the aspiration phase more comfortable for the patient. It also makes it much easier for me to perform all phases of the procedure because the nutational motion of the cannula gently separates the fat so that much less force is required to move the cannula through the tissue. Patients also seem to recover more quickly after the procedure when compared to other methods of liposuction. Also the fat obtained with the Tickle Lipo is excellent for fat transfer,” Dr. DiLauro says.
Patient results after Tickle Lipo are similar to those that Dr. DiLauro says she gets from using Vaser (Valeant Pharmaceuticals), ProLipo (Sciton) laser lipo, and the Power X (Valient) in combination.
“In men, I now often use the Power X at the end of the Tickle Lipo procedure to obtain increased muscle definition in the chest and abdomen,” she says.
Before purchasing Tickle Lipo, Dr. DiLauro used the Vaser, traditional cannulas and the Power X separately and in combination for body sculpting. She says she often performed Vaser with the Power X, and utilized the Power X, alone, to perform medium- and high-definition liposuction.
“For submental liposuction, I obtained excellent results using the following combinations: the Vaser with the Vent X [Vaser] cannula; Vaser with Power X aspiration; and ProLipo with Power X aspiration. Now, I use the Tickle Lipo alone for the submental area,” she says.
The Vaser is ideal when treating very fibrous areas, areas that have been treated with prior liposuction, and it produces smooth viable fat for performing fat transfers, according to Dr. DiLauro. The Prolipo laser works well for cellulite and is useful for performing liposuction of small areas and for treating small tissue irregularities that can occur after abdominoplasty and prior liposuction, she says.
For patients with very loose or lax skin, Dr. DiLauro recommends one Thermage radiofrequency treatment before and after their procedure to improve skin tightening.
“We also recommend a series of Vaser Shape and SkinTyte BBL [Sciton] treatments, if extra skin tightening is needed after liposuction,” she says.
NEXT: Combos for Comfort
Combos for Comfort
While most of the noninvasive options have little patient comfort issues, technologies, such as CoolSculpting, can cause inflammation, bruising and nerve sensations for weeks to months after the procedure, according to Dr. Emer.
“Lymphatic massage, hyperbaric oxygen treatment, oral [gabapentin] and radiofrequency treatments really help,” he says.
“Everyone gets radiofrequency treatments, like Venus Legacy or Velashape, post liposuction to improve swelling, decrease bruising and help tighten skin,” Dr. Emer says. “We do this immediately, especially after high definition liposuction, which [results in] very little swelling to allow the skin to sculpt to the muscle shape. We are currently testing the use of Vanquish [BLT] to globally heat large areas after liposuction to improve outcomes, as well. The combinations of possibilities are endless with all the new exciting technologies.”
Dr. DiLauro uses a combination approach to improve patient comfort during liposuction and to accelerate recovery after.
“After infusing the tumescent fluid, I usually perform external ultrasound with the Vaser Shape for about 15 minutes while the tumescence is taking effect…,” Dr. DiLauro says. “We have also found that performing ultrasonic massage in a lymphatic drainage pattern with the Vaser Shape or regular therapeutic ultrasound several times a week for the first few weeks after the patient’s liposuction procedure helps to reduce swelling and accelerate healing.”
The Future of Fat Melting
The future will tell whether and how combined therapies might give liposuction-like results, according to Dr. Emer.
“…ultimately, you’ll get better results than a single treatment alone; however, you will never get high definition liposuction results without doing full contouring, harvesting fat and augmenting the muscles like the buttocks, chest, shoulders. This gives permanent full fat reduction and new contour with etched and defined lines that people would never have had with standard noninvasive or even the traditional tumescent approach alone,” Dr. Emer says.
Dr. DiLauro says she doubts there will be one technology that does it all anytime soon.
For now, aesthetic physicians have the options needed to offer patients much more than fat removal, he says.
Dr. Emer is a consultant/luminary and performs clinical trials for Syneron/Candela, Venus, Thermi, BLT and Valeant. Dr. DiLauro has no conflicts.