Lisa Littlehales discusses the mechanisms and benefits of the new device from BTL Aesthetics for the abdomen and flanks
Previously, when a patient had a large abdomen, the only option for them was liposuction or abdominoplasty, which can both cause pain and discomfort. Additionally, anaesthesia poses a risk on an obese patient, and the chance of scarring and seroma is high. As a result, many plastic surgeons do not want to perform liposuction on patients with a BMI over 28/29. Vanquish radio frequency, F.D.A. approved, offers an alternative form of fat loss for those who need debulking of the abdomen and flank areas. It is a contactless device that uses selective high radio frequency to generate heat only in subcutaneous adipose tissue. At Beyond Medispa, we have used it successfully in combination with cryolipolysis technology Zeltiq’s CoolSculpting, which can be used to shape after the endpoint is achieved. Previously patients were recommended to lose weight prior to undergoing CoolSculpting, which could then be used to shape and reduce pockets of fat. By using Vanquish, the patient can reach their endpoint much more quickly. The treatment programme for Vanquish is quick and effective, comprised of four half an hour sessions ideally spaced a week apart, with very little downtime. Patients typically see results at two weeks, and the endpoint is three months after their fourth treatment. The patient is then called back to clinic for reassessment, to either continue with the technology or move on to another non- surgical fat reduction treatment. Clinical trials demonstrated that the system is safe without serious adverse events and produces consistent, statistically significant reduction in circumference of the abdomen. 20 patients from 18 to 70 years of age underwent the four weekly treatments; results showed the mean circumferential reduction for the abdomen was 4.8cm (measured 5cm above umbilicus), 5.4cm (measured over umbilicus) and 4.9cm (measured 5cm below umbilicus).1 The circumferential reduction was measured at baseline and after the fourth treatment. There were no significant changes in patients’ body weight during the therapy.
Figure A shows a 29-year-old female patient who underwent five sessions of Vanquish, demonstrating uniform reduction of fat by equal diffusion of heat. Anecdotally, one patient has claimed that the treatment has improved her stretch marks, and others have claimed their skin tone has improved: this could be due to thermal injury in the area treated, which has stimulated fibroblasts to produce collagen and elastin, improving the quality of the skin. However, there are no studies to support these claims. Patients are weighed prior to the treatment, and photographs taken. This is essential, so patients’ consent must be obtained. They are placed on their back, and an applicator placed on them to protect the skin. The head of the machine is placed over the abdomen. The patient’s skin temperature needs to reach 40°C for successful treatment.
They should not be left unattended through- out treatment; the clinician should regularly ask patients to score their comfort level between one and 10 and regularly measure the temperature of their skin to ensure it doesn’t exceed 42°C, as this could cause scarring. Abdominoplasty or appendix scars must be monitored, as the numbness associated with surgical incisions can impair the patient’s ability to feel heat. The selective high frequency (HF) generates heat in subcutaneous adipose tissue only, with no effect on the skin, and targets structures with high impedance, namely the adipose tissue. HF causes electron movement, resulting in movement of atoms and molecules in the adipose tissue. This generates friction, which is transformed into heat. The tissue temperature rises to 44-45°C, at which point apop- tosis, the natural death of fat cells,occurs due to polar molecule oscillation. The fat cells are then macrophaged away by the liver. Unlike cryolipolysis, which triggers a slow metabolism of fat, radio frequency results in instant treatment. As metabolism is rapid, it is advised that for 24 hours before and after treatment, patients have a low-fat diet and do not drink alcohol, due to the heavy workload of the liver. Unlike liposuction, there is no scarring because the heat produced targets fat cells and bypasses the skin. The temperature therefore rises in the fatty tissue, but surrounding tissue stays protected from reaching high temperatures. The device also measures the hydration levels of the areas being treated. Patients need to be well hydrated before treatment, as water is essential to allow polar molecule oscillation to occur. In summary, Vanquish is a contactless device, which uses selective HF to target subcutaneous adipose tissue specifically, allowing for quick and safe treatment. We opted for it at Beyond Medispa because it can treat the largest area compared to other machines, and focuses on the abdomen and flanks, the most requested areas for fat loss treatment. Additionally, it has increased the range of patients we can treat, and complements our current sculpting device CoolSculpting and skin tightening devices, which we hope to invest in in the future.
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