Cryolipolysis Offers Results for Fat Removal

Naples, Fla. - Effective, noninvasive fat removal is here, according to Dr. Mathew Avram.

"Efficacy is limited but it is real," he said regarding cryolipolysis, a noninvasive cooling and removal of subcutaneous fat.

It is important for dermatologists to assess all emerging noninvasive fat-reduction technologies critically. 

"Patients will ask you about this," Dr. Avram said. "There is a lot of snake-oil salesmanship in this field."

Cryolipolysis (CoolSculpting, Zeltiq Aesthetics) selectively kills fat cells at temperatures above freezing without affecting surrounding tissues. This selective crystallization of fat cells leads to apoptotic death and, ultimately, gradual dissolution of fat over 2-4 months, Dr. Avram said.

In 2009, researchers reported a 22% reduction in "love handles" on the side treated with cryolipolysis, compared with the side with no treatment at 4 months in an unpublished study with 32 participants.

"Whether or not that is clinically relevant is up to you to decide," Dr. Avram said at the meeting.

Results of animal studies are more robust. For example, one study conducted by researchers at the Wellman Center for Photomedicine in Boston demonstrated a 40% decrease in fat layer of pigs over 90 days on ultrasound and gross pathology (Laser Surg. Med. 2008;40:595-604).

Cryolipolysis has been approved by the Food and Drug Administration for various skin cooling applications during dermatology procedures, but the CoolSculpting device is not FDA cleared for marketing as a fat removal device, Dr. Avram said, although regulatory approval for noninvasive fat reduction is pending.

Cryolipolysis is not a weight loss device, nor is it intended as a replacement for liposuction, said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center.

Cryolipolysis is best suited for local fat removal in areas resistant to exercise, such as love handles or the lower abdomen, Dr. Avram said, and "patient selection is crucial." Relatively thin, weight-stable people who have localized fat areas and realistic expectations are appropriate candidates. "Otherwise, patients will be disappointed. We avoid that with very careful patient selection," he said.

"We got this device at Mass General a few months ago," said Dr. Avram, who tried it himself.

Dr. R. Rox Anderson applied the gel sheet "over my love handle area [and] left it on for an hour," he said, noting that it got a little cold and the area became anesthetized after 7-8 minutes.

He reported a minor urticarial plaque on the area immediately after treatment. Redness for a few minutes to a few hours is a common postprocedure effect, as is bruising for up to a few weeks, although "not all will get it," Dr. Avram said.

A temporary dulling of sensation in the treated area that typically resolves in 1-8 weeks can also occur. No changes in pigmentation have been reported.

Dermatologists are the perfect physicians to perform cryolipolysis, Dr. Avram said. "Subcutaneous fat is a fundamental part of dermatology, and the fact that it has not been claimed by any specialty makes it ours."

Disclosures: Dr. Avram said he owns stock options and is a consultant for Zeltiq Aesthetics, Inc.

Naples, Fla. - Effective, noninvasive fat removal is here, according to Dr. Mathew Avram.

"Efficacy is limited but it is real," he said regarding cryolipolysis, a noninvasive cooling and removal of subcutaneous fat.

It is important for dermatologists to assess all emerging noninvasive fat-reduction technologies critically. 

"Patients will ask you about this," Dr. Avram said. "There is a lot of snake-oil salesmanship in this field."

Cryolipolysis (CoolSculpting, Zeltiq Aesthetics) selectively kills fat cells at temperatures above freezing without affecting surrounding tissues. This selective crystallization of fat cells leads to apoptotic death and, ultimately, gradual dissolution of fat over 2-4 months, Dr. Avram said.

In 2009, researchers reported a 22% reduction in "love handles" on the side treated with cryolipolysis, compared with the side with no treatment at 4 months in an unpublished study with 32 participants.

"Whether or not that is clinically relevant is up to you to decide," Dr. Avram said at the meeting.

Results of animal studies are more robust. For example, one study conducted by researchers at the Wellman Center for Photomedicine in Boston demonstrated a 40% decrease in fat layer of pigs over 90 days on ultrasound and gross pathology (Laser Surg. Med. 2008;40:595-604).

Cryolipolysis has been approved by the Food and Drug Administration for various skin cooling applications during dermatology procedures, but the CoolSculpting device is not FDA cleared for marketing as a fat removal device, Dr. Avram said, although regulatory approval for noninvasive fat reduction is pending.

Cryolipolysis is not a weight loss device, nor is it intended as a replacement for liposuction, said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center.

Cryolipolysis is best suited for local fat removal in areas resistant to exercise, such as love handles or the lower abdomen, Dr. Avram said, and "patient selection is crucial." Relatively thin, weight-stable people who have localized fat areas and realistic expectations are appropriate candidates. "Otherwise, patients will be disappointed. We avoid that with very careful patient selection," he said.

"We got this device at Mass General a few months ago," said Dr. Avram, who tried it himself.

Dr. R. Rox Anderson applied the gel sheet "over my love handle area [and] left it on for an hour," he said, noting that it got a little cold and the area became anesthetized after 7-8 minutes.

He reported a minor urticarial plaque on the area immediately after treatment. Redness for a few minutes to a few hours is a common postprocedure effect, as is bruising for up to a few weeks, although "not all will get it," Dr. Avram said.

A temporary dulling of sensation in the treated area that typically resolves in 1-8 weeks can also occur. No changes in pigmentation have been reported.

Dermatologists are the perfect physicians to perform cryolipolysis, Dr. Avram said. "Subcutaneous fat is a fundamental part of dermatology, and the fact that it has not been claimed by any specialty makes it ours."

Disclosures: Dr. Avram said he owns stock options and is a consultant for Zeltiq Aesthetics, Inc.

Naples, Fla. - Effective, noninvasive fat removal is here, according to Dr. Mathew Avram.

"Efficacy is limited but it is real," he said regarding cryolipolysis, a noninvasive cooling and removal of subcutaneous fat.

It is important for dermatologists to assess all emerging noninvasive fat-reduction technologies critically. 

"Patients will ask you about this," Dr. Avram said. "There is a lot of snake-oil salesmanship in this field."

Cryolipolysis (CoolSculpting, Zeltiq Aesthetics) selectively kills fat cells at temperatures above freezing without affecting surrounding tissues. This selective crystallization of fat cells leads to apoptotic death and, ultimately, gradual dissolution of fat over 2-4 months, Dr. Avram said.

In 2009, researchers reported a 22% reduction in "love handles" on the side treated with cryolipolysis, compared with the side with no treatment at 4 months in an unpublished study with 32 participants.

"Whether or not that is clinically relevant is up to you to decide," Dr. Avram said at the meeting.

Results of animal studies are more robust. For example, one study conducted by researchers at the Wellman Center for Photomedicine in Boston demonstrated a 40% decrease in fat layer of pigs over 90 days on ultrasound and gross pathology (Laser Surg. Med. 2008;40:595-604).

Cryolipolysis has been approved by the Food and Drug Administration for various skin cooling applications during dermatology procedures, but the CoolSculpting device is not FDA cleared for marketing as a fat removal device, Dr. Avram said, although regulatory approval for noninvasive fat reduction is pending.

Cryolipolysis is not a weight loss device, nor is it intended as a replacement for liposuction, said Dr. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center.

Cryolipolysis is best suited for local fat removal in areas resistant to exercise, such as love handles or the lower abdomen, Dr. Avram said, and "patient selection is crucial." Relatively thin, weight-stable people who have localized fat areas and realistic expectations are appropriate candidates. "Otherwise, patients will be disappointed. We avoid that with very careful patient selection," he said.

"We got this device at Mass General a few months ago," said Dr. Avram, who tried it himself.

Dr. R. Rox Anderson applied the gel sheet "over my love handle area [and] left it on for an hour," he said, noting that it got a little cold and the area became anesthetized after 7-8 minutes.

He reported a minor urticarial plaque on the area immediately after treatment. Redness for a few minutes to a few hours is a common postprocedure effect, as is bruising for up to a few weeks, although "not all will get it," Dr. Avram said.

A temporary dulling of sensation in the treated area that typically resolves in 1-8 weeks can also occur. No changes in pigmentation have been reported.

Dermatologists are the perfect physicians to perform cryolipolysis, Dr. Avram said. "Subcutaneous fat is a fundamental part of dermatology, and the fact that it has not been claimed by any specialty makes it ours."

Disclosures: Dr. Avram said he owns stock options and is a consultant for Zeltiq Aesthetics, Inc.