There’s big demand for noninvasive neck tightening and contouring, and treatment options are expanding, according to dermatologist E. Victor Ross, M.D., who presented on what’s new in technologies and procedures to tighten and contour the neck this morning at the 36th Annual Conference of the American Society for Laser Medicine & Surgery, Boston, Mass.

While many patients in their 50s and older have taken steps to protect their faces and have had rejuvenating procedures like Botox and fillers, their necks still bear the signs of sun damage and time.

Watch: The most important technological advances

This is evident at his Scripps Clinic Carmel Valley practice in San Diego, where he says almost all his patients have aging necks that they’d like to improve.  

“We can’t treat the neck as aggressively as the face … but I think we’re broadening the number of things we can do nonsurgically,” Dr. Ross told colleagues.

Skin tightening

Some of today’s most exciting new approaches for neck tightening involve the use of needles, including Infini by Lutronic, Intensif by Endymed and Factora by Inmode, he says. All of these devices, according to Dr. Ross, require that physicians apply the needles in skin from about a half millimeter to three millimeters deep and apply radiofrequency energy at the tip of the needles — in some cases, the entire length of the needles — to achieve skin tightening.

Watch: Can skin tightening be measured objectively?

“That approach continues to evolve. I think we’re still working out the best parameters to achieve the best tightening with needles,” Dr. Ross says.

Fat removal

Then, there’s the issue of submental fat removal. Dr. Ross says there are new, exciting devices in this space, too, including CoolMini (Zeltiq Aesthetics), which is the new attachment for CoolSculpting’s technology, as well as the newer Body FX-MiniFX (Inmode). The MiniFX, which is part of the BodyFX system, heats the skin under the chin to tighten the submental area.

“BodyFX Mini just came out, so I don’t think anybody has much experience with that,” Dr. Ross says.

But CoolSculpting’s Mini fared well for safety and efficacy in a study published January 2016 in Lasers in Surgery and Medicine.1 Researchers studied cryolipolysis for non-invasive reduction of submental fat using a prototype small volume CoolMini vacuum applicator to treat 60 subjects in the submental area. Among the patients, 83% reported they were satisfied with the treatment; 77% reported visible fat reduction and that they felt that their appearance improved post treatment. More than three quarters said the procedure was comfortable, and the researchers found no device- or procedure-related serious adverse events.

The evolution of applying heat

In addition to using needles to tighten the submental area, Dr. Ross uses ThermiTight (Thermi), which, he says, is a little more invasive.

“We have a radiofrequency cannula that sits several millimeters under the skin, parallel to the skin, and we go back and forth much like a liposuction cannula. But rather than sucking, you’re applying heat to the skin in a controlled fashion. You can use it on other body parts, too …,” Dr. Ross says.

ThermiTight, according to the dermatologist, offers sophisticated feedback on temperature during treatment.

“In the past, when people tried to heat the skin from inside out using these types of cannulas (whether the laser or radio frequency) they would just hold their hand on the surface or measure the skin temperature from the surface. Sometimes, patients occasionally would get blisters and scars as a result,” he says. “This device measures the skin temperature simultaneously under the skin with the tip of the cannula. It also measures the skin with a pretty sophisticated thermal camera from the surface. So, you’re getting a two-pronged view of the temperature. By simultaneously measuring these temperatures in real time as you perform the procedure, you’re much less likely to get into trouble.”

The newer devices are in addition to less invasive options, including Thermage (Valeant Pharmaceuticals) and Ultherapy (Ulthera), as well as more invasive surgery for severely aged necks with redundant skin. All continue as part of the armamentarium of treatments for the submental area, according to Dr. Ross.

Disclosure: Dr. Ross receives research support and is a consultant for Lutronic and Inmode. 

Reference:

Kilmer SL, Burns AJ, Zelickson BD. Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat. Lasers Surg Med. 2016 Jan;48(1):3-13. https://www.ncbi.nlm.nih.gov/pubmed/?term=kilmer+s+cryolypolisis+submental

The 36th Annual Conference of the American Society for Laser Medicine and Surgery promises new sessions, speakers and events that illustrate advances, challenges and new areas of therapeutic use with lasers and energy-based devices. In new workshops and courses, attendees will learn from the top experts in the field about the the rapidly expanding use of lasers and devices in women's health, pediatrics and the latest options for non-invasive body contouring, as well as laser safety topics, including how to prevent and manage complications. Watch here as we cover highlights from the sessions.

The Aesthetic Meeting of the American Society of Aesthetic Plastic Surgery will take place this year in Las Vegas, April 2 through April 7. The meeting boasts exceptional educational opportunities in aesthetic medicine, first-hand access to strategic practice managment solutions and the latest information on industry innovations. This year's meeting embraces a panel vs single-speaker format to provide a broad spectrum of views on the issues that affect the way you practice and run your business. Watch this space for notable highlights brought to you by Cosmetic Surgery Times from this four-day scientific program.

Can you get improvements in the appearance of cellulite with CoolSculpting? Grant Stevens, M.D., and Jason Pozner, M.D. talk about their experience. Video panel recording courtesy X-Medica.

Dr. KatzBruce E. Katz, M.D., who performed FDA trials for Cynosure’s noninvasive fat reduction device SculpSure, compares the success of SculpSure to the iPhone.

“SculpSure is not the first noninvasive fat removal device to come out. But it has the best outcomes,” Dr. Katz says. “It’s like the iPhone. The iPhone wasn’t the first mobile phone, but [Apple] got it right.”

Dr. Katz, who has been using SculpSure for about a year and a half, says demand for the treatment has taken off.

“We had about five patients on Friday. It’s getting traction now,” says Dr. Katz, clinical professor, Icahn School of Medicine at Mt. Sinai; director, Juva Skin & Laser Center; and director, Cosmetic Surgery & Laser Clinic, Mt. Sinai Hospital, New York.

Cosmetic Surgery Times advisor plastic surgeon Jason N. Pozner, M.D., Boca Raton, Fla., says his practice offers the spectrum of technologies for noninvasive fat removal, including SculpSure, CoolSculpting (CynoSure), UltraShape (Syneron Candela) and Vanquish (BTL).

“I think there is a role for all of these with some being better for some areas than others,” Dr. Pozner says. “…CoolSculpting [may be] better for flanks and SculpSure may be better for other areas, but time and experience in the real-world will determine this, as well as non-responder rates, etc. Early data suggests that the results with each device are similar, but real-world experience is needed.”

NEXT: Side Effects and Timing

Side Effects and Timing

Dr. Katz doesn’t use CoolSculpting at his practice, but he says he has seen patients with paradoxical adipose hyperplasia from CoolSculpting.

“Last week, we saw two patients who had this major side effect from CoolSculpting, where instead of taking the fat away, you get an increasing amount of fat. People, then, have to have liposuction to get rid of it,” Dr. Katz says.

Researchers reported on paradoxical adipose hyperplasia, as a “rare, previously unreported adverse effect of cryolipolysis,” March 2014 in JAMA Dermatology.  At the time of the study, more than 650,000 cryolipolysis treatment cycles had been performed worldwide. The researchers reported paradoxical adipose hyperplasia as having an incidence of 0.0051%, no unifying risk factors and no evidence of spontaneous resolution.

The side effect aside, Dr. Katz says he chose SculpSure over CoolSculpting based on clear advantages of the newer device.

Related: SculpSure turns up the heat in noninvasive fat reduction

“With SculpSure, you can treat up to four areas at one time and it only takes about 25 minutes per treatment. With CoolSculpting it takes an hour per area. So, if you’re going to treat people’s flanks, you can do both flanks at the same time with SculpSure, and it takes 25 minutes. With CoolSculpting it takes an hour on each side, so it takes two hours. SculpSure is a big time saver for patients and also for staff,” Dr. Katz says. “And patients don’t have the pins and needles and numb sensation after, like you do with CoolSculpting.”

To reduce CoolSculpting treatment time, some practices offer DualSculpting, the use of two machines simultaneously.

NEXT: Will SculpSure Edge Out CoolSculpting?

Will SculpSure Edge Out CoolSculpting?

Dr. Pozner says it’s too early to tell if demand for SculpSure will edge out that for CoolSculpting.

“…patient demand is starting for SculpSure,” Dr. Pozner says. “But there is more direct-to-consumer advertising with CoolSculpting at present. Early adopter patients, however, who do their homework are asking for SculpSure.”

That said, cosmetic and plastic surgeons looking to add any of these devices to their practices should first do a competitor analysis to determine which would be best. For example, if there are lots of CoolSculpting devices already in a market, SculpSure might be the way to go, according to Dr. Pozner.

While a public relations spokesperson for SculpSure says the company won’t share physician uptake on the technology, he says patient satisfaction in studies for the technology were high: 96% of subjects were satisfied with their treatment results in SculpSure’s clinical trial evaluating the flanks, and 91% of subjects were satisfied with their treatment results in its clinical trial evaluating the abdomen.

Dr. Katz says he has not seen side effects from SculpSure. Some of his patients, he says, find SculpSure uncomfortable, and when they do, he lowers the settings.

“Like with any of the other body contouring procedures, this is for people who have localized fat deposits; for people who are not overweight, that workout regularly and have a good diet and exercise program but just can’t lose tummies, love handles, saddlebags on the thighs or puffy knees. And that’s where this technology works best,” Dr. Katz says.

What’s interesting about SculpSure, according to Dr. Pozner, is that it works on lean people, whereas, CoolSculpting needs fat that one can grab onto.

“So, the fitness crowd may embrace [SculpSure],” Dr. Pozner says.

SculpSure might expand its reach from the abdomen and flank areas, according to E. Victor Ross, M.D., dermatologist, at Scripps Clinic Carmel Valley, San Diego, Calif.

“It’s likely that SculpSure is positioning itself to eventually treat all of the popular areas that other noninvasive technologies are treating,” says Dr. Ross, who is presenting on tightening and contouring of the neck at the end of March at ASLMS 2016, the 36th Annual Conference of the American Society for Laser Medicine & Surgery, Boston, Mass.

For now, Dr. Pozner says, CoolSculpting is established, with a good RealSelf rating and enough patients treated so that word is out. As of March 16, CoolSculpting had a 72% worth-it rating, with 570 reviews on RealSelf.com. SculpSure had a 92% worth-it rating based on 26 responses on the same day.

Disclosure: Dr. Katz performs research for SculpSure. Dr. Pozner has done workshops for Cynosure but not on SculpSure. Dr. Ross is a consultant and researcher with Cynosure. 

With growing patient demand for non-surgical skin tightening solutions, it's a question every aesthetic practitioner wants to have answered. Drs. Jason Emer, Jason Pozner, Barry DiBernardo, Andrew Campbell, Michael Persky, Renato Saltz, Grant Stevens offer their perspective during Vegas Cosmetic Surgery 2015.

There’s no question that labiaplasty is growing in popularity among patients and plastic surgeons. The question is, are you thinking about adding it to your practice?

Dr. HazenIn the right hands, the procedure is safe, effective and ranks high in patient satisfaction, according to plastic surgeon Alexes Hazen, M.D., associate professor of plastic surgery, NYU Langone Medical Center.

But there are best practices that help surgeons avoid complications and optimize outcomes, Dr. Hazen says.

Labiaplasty, or labia minora reduction, is the most common procedure for women who are concerned with the appearance of their vulva areas. It’s usually performed by trimming the labia minora and, sometimes, the labia majora; then sewing them shut, according to Dr. Hazen.

American Society for Aesthetic Plastic Surgery (ASAPS) statistics suggest demand for the procedure is increasing. In its 2014 national totals for cosmetic procedures, ASAPS reported surgeons performed 7,535 labiaplasty procedures. It ranked 19 out of the 20 most performed surgical procedures that year, up from a ranking of 20 in 2009. Labiaplasty increased by 49% in 2014, compared to the prior year, and nearly 90% of those patients were 19 to 50 years old.

By 2013, 29% of ASAPS surgeons reported performing labiaplasties, up from 21% in 2012. http://www.surgery.org/media/news-releases/labiaplasty-and-buttock-augmentation-show-marked-increase-in-popularity

In This Article

What’s Up Down There

Best Operative Practices

Postop Notes

NEXT: What’s Up Down There

What’s Up Down There

Dr. Hazen says she thinks the majority of patients are interested in labiaplasty for cosmetic reasons. One of the drivers could be that women tend to have less pubic hair than in the past. And, specifically, they don’t like the protrusion of the labia minora or the dangling of it beyond the majora.

“Then, there are patients who pursue it for more functional aspects… particularly in activities, such as biking or spin classes, where, if they are a little bit larger, they can be uncomfortable,” Dr. Hazen says.

Surgical Tips

Dr. Hazen offers these tips for safer labiaplasty surgery and better outcomes.

Labiaplasty is best performed in an accredited surgery center or hospital operating room — not in the office. Not only because of sterility, but also because the labia is very vascular, so it can bleed. And surgeons performing the procedure should have access to an operating table that allows them to do the procedure with patients in the lithotomy position.

While labiaplasty can be done with just local anesthetic, it’s better to use a combination of local anesthetic and sedation. And the local should be lidocaine with epinephrine, 1:100,000 injection, to reduce bleeding.

“If you injected with straight lidocaine (no epinephrine) it’s going to bleed a lot,” Dr. Hazen says.

Planning the resection is based on the individual patient’s needs.

“Often, the issue is that there is an asymmetry and one side is larger than the other. So, sometimes, it may be a resection of just one side, while other times it’s both sides,” she says. “It’s important to design the resection so that it will close without any tension. You don’t want to clip off too much, so that you have any tightness on the suture line.”

The good news is that because the labia is so vascular it, not only does it heal well but it typically heals with almost no scar, according to Dr. Hazen.

NEXT: Best Operative Practices

Best Operative Practices

Dr. Hazen numbs the area and starts the resection, making sure there is adequate hemostasis.

“The best way to do that is with electrocautery under direct visualization. Then, you suture it closed,” she says.

Surgeons differ on their approach to the suturing. Many use a two-layer closure, creating deep and superficial sutures.

“The best approach, I think, is to use a suture on the skin that will dissolve on its own, so you don’t have to be removing stitches on the labia, which would be very painful and uncomfortable,” Dr. Hazen says.

The plastic surgeon uses fast-absorbing Vicryl or a fast-absorbing gut suture.

For labial majora resections, surgeons would want to design the scar so that it’s on the mucosal skin junction of the labia, where the scar is undetectable.

“You have to be extremely careful, taking away labia majora, not to make it too tight. You have to be very conservative in your resection. The worst thing you can do is make somebody tight there, so that the suture line could be disrupted or the patient has discomfort,” Dr. Hazen says.

Surgeons can avoid making the area too tight by having it tension free upon closure.

“You would cut one side first and then re-drape it and, then, cut the other side when you’re sure that it will re-drape well,” she says.

NEXT: Postop Notes

Postop Notes

To dress the area, Dr. Hazen typically uses ointment and bacitracin along the suture line; then puts gauze on the area to keep it dry for about 24 hours.

“We don’t usually put a catheter in the patients,” she says.

What patients do need is a water bottle-like device, so they can squirt the area after urination, which prevents urine from getting on the suture line.

“Basically, when patients go to the bathroom, they shouldn’t wipe but can use warm water to spray on the area and pat it dry with the gauze. Typically, they need to do that for about three days,” she says.

The surgical area typically heals by five to seven days. That’s when patients no longer have to worry about cleaning the area post urination. Dr. Hazen recommends that patients wait three to six weeks before resuming sexual activity.

“The surgeon wants to look at the area and make sure it’s really healed before starting sexual activity because it could open up again, especially given how vigorous a woman’s sexual activity is. In general, things do not fully heal to their full strength for six weeks. But if it looks perfectly fine at three weeks, we might allow patients to resume sexual activity,” she says.

As for complications, bleeding is probably the most common, Dr. Hazen says.

“It’s not typical to have an infection but it is possible. Dehiscence and the need for re-operation because of under-resection, over-resection or asymmetrical outcomes are other possible complications from labiaplasty, according to Dr. Hazen.

Surgeons who might be reluctant to perform labiaplasty should consider the procedure’s driver: satisfied women, according to Dr. Hazen.

“It can be done very safely, very effectively and you have a very satisfied patient,” she says.

For further reading:

Hamori CA. Aesthetic surgery of the female genitalia: labiaplasty and beyond. Plast Reconstr Surg. 2014 Oct;134(4):661-73.

Disclosure: none

Is it safe to perform fat grafting after mastectomy for breast reconstruction? 

Researchers from the University of Texas M.D. Anderson Cancer Center and the University of Michigan’s Department of Breast Radiation Oncology conducted a study to answer that question. Their research assessed the risk of locoregional and systemic recurrence in patients who underwent lipofilling for breast reconstruction.

The authors identified patients who underwent segmental or total mastectomy for breast cancer (719 breasts, or cases) or breast cancer risk reduction or benign disease (305 cancer-free breasts) followed by breast reconstruction with lipofilling as an adjunct or primary procedure between June 1981 and February 2014. They then identified matched patients with breast cancer treated with segmental or total mastectomy followed by reconstruction without lipofilling (670 breasts) as controls. The authors used Kaplan-Meier to estimate probability of locoregional recurrence.

Related: CAL breast augmentation with SVF

During follow-up times of 60 months for cases, 44 months for controls and 73 months for cancer-free breasts, the authors observed locoregional recurrence in 1.3% of cases (9 of 719 breasts) and 2.4% of controls (16 of 670 breasts). Breast cancer did not develop in any cancer-free breast. The cumulative 5-year locoregional recurrence rates were 1.6% and 4.1% for cases and controls, respectively. Systemic recurrence was seen in 2.4% of cases and 3.6% of controls. The authors found no primary breast cancer in healthy breasts reconstructed with lipofilling.

“With this new important data, plastic surgeons should be more likely to offer fat grafting as a reconstructive option for breast reconstruction, now even in patients who are carriers of the BRCA1/2 gene mutation,” study co-author Steven J. Kronowitz, M.D., tells Cosmetic Surgery Times. “These important new findings will dramatically expand the options for cosmetic breast augmentation using liposuctioned fat only without the need for breast implants.”

The study was published in the February issue of Plastic and Reconstructive Surgery.

In the ongoing debate between surgical or nonsurgical technologies for body contouring, experts agree that there are specific indicators that surgery may be a better option for your patients. This is what they have to say.

Fat melting has become a melting pot of procedures for many physicians experienced in the art and science of body sculpting.

Dr. EmerBeverly 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. 

Dr. DiLauro“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.

Female patient shown before and one month after Tickle Lipo.
Photos courtesy Marie DiLauro, M.D.

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. 

Female patient shown before and three weeks after Tickle Lipo.
Photos courtesy Marie DiLauro, M.D.

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.

Female liposuction patient shown before and after Power X alone.
Photos courtesy Marie DiLauro, M.D.

“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.

Female patient shown before and after submental lipo with the prolipo followed by Power X. Photos courtesy Marie DiLauro, M.D.

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.”

NEXT: The Future of Fat Melting

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.

Disclosures:

Dr. Emer is a consultant/luminary and performs clinical trials for Syneron/Candela, Venus, Thermi, BLT and Valeant. Dr. DiLauro has no conflicts.