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During pregnancy, you dream of your life with your new baby and you think about how wonderful it will be to fit into your old clothes again. Then you give birth, experience excruciating fatigue, emotional unrest and adjust to your new exhausting schedule. Finally, you get to your favorite clothing store only to have the salesperson say, “What month are you in?” No wonder – you’re still carrying around stomach fat that makes you look at least five months pregnant.

Or, you may be an exercise junkie, with a near perfect body except for a layer of fat around the midsection and some extra weight on your hips. Your mom has it, her mom has it and it has now been given to you. You’re drenched in sweat, daily, battling your bulge, only to find your muffin top persists in hanging over your jeans.

If one of these women is “you,” you may be excited about new technologies that promise to wipe out undesirable fat deposits in your abdomen, flanks, back and thighs. Unlike liposuction, these procedures require no incisions, involve minimal discomfort, work for all skin types and require little or no downtime.

Losing fat without surgery sounds almost too good to be true. If you are obese, it is too good to be true. Nonsurgical fat removal is best for those who are already fit but want to tackle those few extra inches.

Two popular noninvasive FDA-approved modalities for localized fat reduction are Liposonix and CoolSculpting (Zeltiq). CoolSculpting uses cold therapy to reduce fat cells in areas that can be pinched between two paddles. Liposonix uses focused ultrasound energy to destroy fat tissue in precise areas that are mapped out beforehand. With both procedures, the fat cells that have been destroyed are permanently reabsorbed by the body.


The manufacturers of Liposonix don’t make claims about specific weight loss, but their tagline is: “One treatment, one hour, one size smaller.” Liposonix heats fat to 55˚C, the temperature at which it melts. This stimulates the immune system to come in and eat up the damaged fat cells and take that damaged fat to the liver until the body gets rid of it. Some patients see results within four to six weeks; most require seven to 12.

To be a candidate for Liposonix, you need to have at least one inch of fat under the skin. You should be close to your ideal body weight and have a BMI of less than 30. Since this treatment doesn’t affect visceral fat, you will not have a change in blood levels of fats. One or more treatments may be needed. Liposonix received FDA approval in December 2011 for treatment of the abdomen and love handles.

You can think about ultrasound energy like sunlight. A magnifying glass can focus sunlight to ignite paper. Above and below the point of focus, paper does not burn. Similarly, by focusing ultrasound energy, only fat near the focus point is injured. Your skin (above the focus point) and tissue below the focus point are protected. High intensity focused ultrasound (HIFU) has already been used to destroy prostate tumors, fix atrial fibrillation and treat uterine fibroids.

During the Liposonix procedure, the device is placed on the treatment area, focusing the ultrasound energy on targeted fat areas. You will have a thin layer of gel applied to your skin. Your session may last anywhere from a half hour to several hours. Pain may be minimal to moderate. Pain medication may be given for some treatment. According to a prominent plastic surgeon you can expect a one to two inch reduction in waist circumference.


During a CoolSculpting (Zeltiq) session, a molded cup is placed over your lower stomach or love handles and heavy-duty suction pulls the bulge inside the cup, where it’s chilled to 5˚C (41˚F). Some of the fat cells in the selected area are destroyed and ultimately disposed of by the liver.

This treatment disrupts fat using a form of controlled frostbite, cryolipolysis, cold destruction of fat, in which the fat is chilled for about an hour. During frostbite, research shows that fat cells freeze before skin freezes. Cryolipolysis works in the same way, freezing fat, but not overlying skin. The frozen fat dies and is absorbed by your body over time. As with the ultrasound devices, there is little risk of skin injury and no change in your blood levels of fats. One or more treatments may be needed depending upon the amount of fat treated.

The best patients for CoolSculpting will have fat that can be pinched and literally drawn into the CoolSculpting paddles. Once the fat is secured inside the CoolSculpting machine, it is cooled down to the point where it is broken down. A session takes less than an hour and no anesthesia is needed. Once an area has been treated the next area can be started.

Results take from two to four months to appear and some people experience redness, mild pain and bruising for a few days afterward. You can generally expect a 20 percent fat reduction but this may take two treatments to achieve.


●It is difficult to use CoolSculpting in areas where the handpiece does not fit the body contour. These areas are easy to reach with LipoSonix. Liposonix can be theoretically used on (off-label) areas like the arms, thighs and other body parts inaccessible to CoolSculpting paddles.

●It’s important to realize that these devices are way less aggressive than liposuction and only appropriate for small isolated areas. If you need many repeat treatments, you may be better off with liposuction. Those with large bellies and loose skin will get much better results from surgery.

●Nonsurgical fat reduction usually requires little, if any, recovery. For most patients, full activity may be resumed immediately.

●As with any treatment, ask your doctor if you’re a candidate for non-surgical fat reduction. Your discussion should include risks, benefits and treatment alternatives. Both treatments work well when the right candidate is selected by an appropriate board-certified specialist. A good idea is to meet with a practitioner who offers both modalities.

●As long as you maintain your weight with your normal diet and exercise, your long-term results should remain stable.

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26, October, 2012Dr. Richard SchwartzTags:

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