Miss Jonquille Chantrey discusses body contouring indications and provides an introduction to suitable treatments
The global body contouring market reportedly reached a value of US $7.3billion in 2021. It is expected that the market will reach US $11.1 billion by 2027, exhibiting at a compound annual growth rate of 6.9% during 2022-2027.1 This exponential growth is unsurprising when considering that a 2021 YouGov body image study revealed that the overwhelming majority of Britons (89%) say physical appearance matters in today’s society and that 51% of 2,271 UK adults feel pressured to have a certain body type, with women in their 20s and 30s feeling the most pressure.2
Formally, body contouring procedures were strictly surgical in nature including abdominoplasty, body lifts and liposuction, and there are still many patients who want this more permanent, if more invasive option available to them. However, non-invasive device assisted procedures have become more popular, with a 50% increase in demand for treatments since 2019 alone.3
There are many reasons that could be attributed to why the trend has skewed more towards either a combined or totally non-invasive approach. However, one key contributory factor is the widely reported and growing consumer trend for instant gratification. It is a trend that spans many industries, and one that I’ve witnessed first-hand in my clinics. Patients want procedures that are faster, offer substantially less downtime, give results more quickly and that are ultimately less painful. The popularity of the category is being significantly driven by social media led millennials with a combined 700+ million views for the terms ‘body sculpting’4 and ‘body contour’5 on TikTok alone. An apparent increased acceptance of procedures within this group encourages this cohort to be less nervous about presenting to aesthetic clinics. In my personal experience, late Generation X individuals are also large consumers of body contouring procedures, with post-partum and perimenopausal body concerns dominating that particular demographic.
Skin laxity, especially on the abdominal, brachium and suprapatellar areas of the skin present as common areas of patient concern. A consequence of intrinsic and extrinsic ageing factors, diminished muscle mass and reduction of collagen synthesis and elastin reserves present as structural degradation and skin laxity.6 Intrinsically, type I collagen, produced by mesenchymal fibroblast cells located in the extracellular matrix (ECM) represents 80-90% of skin collagen. Reduced synthesis of type I collagen is characteristic of chronically aged skin.6 Additionally, fibroblasts contribute to elastin protein production and are critical to the maintenance of skin elasticity.7 Extrinsically, over exposure to ultraviolet (UV) radiation contributes significantly to skin laxity issues. Not only does it assist in accelerating the degradation of collagen synthesis, but it also renders elastic fibres in the papillary dermis non-functional via a process known as solar elastosis.8,9
Cellulite (gynoid lipodystrophy) is a prevalent multifactorial condition that affects up to 90% of post pubertal women in the majority of stages of the life cycle and approximately 10% of men.10,11 Due to its prevalence, it remains a major aesthetic concern for women, with 57% of women reportedly feeling judged for their cellulite.12
Caused by subcutaneous adipose papillae herniating into the dermis and altering the cutaneous topography of the skin,13 it commonly presents on the gluteal and abdominal areas, as well as the breasts, brachium and femoral areas. A common method of assessing cellulite is to use photo numeric classification scales such as the Cellulite Severity Scale (CSS).14 This particular scale considers five clinical and morphological features of significance that include the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite.15 These scales are used alongside 3D imaging technology that analyses the skin and identifies textural irregularities.
Research tells us that body shape is one of the most prevalent concerns to present in clinic.16 This is predominantly caused by the differing distribution of subcutaneous white adipose tissue across the body and that contributes approximately 80-90% of total body fat across the abdominal, subscapular, gluteal and femoral areas.17 In addition to genetic, hormonal and gender-specific factors, adipose distribution is also affected by extrinsic factors such as diet, stress and physical activity.
Even with a palpable movement towards ‘natural enhancement’ as opposed to ‘antiageing’, particularly within the over 50s demographic, wrinkle reduction still presents as a common concern amongst many patients.17 One of the most visible signs of the ageing process, wrinkles can start to appear from as early as 25, although in my experience most patients don’t present for treatment until they are in their 30s and 40s.
In addition to external aggressors and similarly to skin laxity, cumulative degradation of collagen and elastin, as well as slowing of epidermal cell life cycle and turnover rate coincides with a slower wound healing and less effective desquamation.18 Common treatment areas that present in my clinics for wrinkles include the face (particularly around the nasolabial folds, periorbital area and glabella), neck and décolleté, hands, brachium, forearms and upper knee.
With the aesthetics specialty bursting with an apparently non-exhaustive menu of treatment options, it is perhaps unsurprising that many patients initially present in clinic as unnerved and unsure of what procedure they should choose to achieve the desired results, or by comparison, with a fixed idea of what will solve their concerns. This is why an accurate diagnosis with comprehensive and ethical guidance is the cornerstone of patient care. Below are some of the treatment modalities that I choose to consider when treating my own patients.
Radiofrequency (RF) body contouring treatments are among the most requested aesthetic therapies and one of the latest technological advancements to arrive on the market.19 The technology works on the premise that the RF electromagnetic waves are conducted through the dermis via electrodes to allow localised heating of subcutaneous adipose tissue located in the hypodermis. Heat is generated due to the absorption of energy by target tissues that then may provoke various physiological and thermoregulatory responses, such as collagen denaturation and creation. The collagen remodelling can produce collagen fibres which are tight, dense, and neatly organised.20 This contributes to tighter, firmer-looking skin.
When choosing a device, I would encourage practitioners to research thoroughly and assess clinical data and studies pertaining to the specific device.
Research thoroughly and assess clinical data and studies pertaining to the specific device
Commonly known as ‘fat freezing’, cryolipolysis exploits evidence that adipocytes are more susceptible to cooling than other skin cells. Targeted application of precisely controlled cooling effectively targets and triggers apoptosis of the adipocytes whilst leaving the skin itself unaffected.21 This is a modality I have used extensively in my practice throughout the submentum, brachium, upper back, abdomen, flanks, thighs and supra-patellar compartments.
Traditionally used in physical therapy and urology, electromagnetic muscle stimulation (EMMS) devices have become more popular in aesthetic medicine clinics for body contouring purposes. One 2020 study by Kilmer et al. explains that EMMS has the advantage of not coupling through the patient’s skin, thus minimising discomfort caused by sensory nerve stimulation. Clinical studies have been conducted to show safety and efficacy of EMMS for body contouring in the abdomen and buttocks.25,26 Electromagnetic muscle stimulation has also been used for toning and strengthening thighs.22
Liposuction remains a viable and highly effective outpatient option for fat removal and the procedure removes adipose tissue from the subcutaneous space in order to shape the silhouette. It is advantageous in that it limits future deposition of fat in treated areas.23 I have seen the benefits of surgical interventions for these patients. It’s therefore important that should you consider body contouring treatments in your practice, and that you are also aware of the surgical techniques available so you can refer patients who will not respond to less invasive techniques.
When a patient presents at a body contouring consultation it’s essential to establish how realistic they are about their goals, and that they understand the commitment and investment that they will need to make from the offset as part of their treatment journey. The level of commitment differs between patients, indications and severity of those indications. However, patients could on average expect three to six treatment sessions over a three-to-six-month period using non-surgical methods, alongside a nutrition and exercise plan.
This should be discussed with the individual during the consultation process. As well as looking at the patient’s silhouette, it is crucial that practitioners adopt a holistic approach and treat every case on its individual merit, taking all factors including general health, nutrition, physical activity, genetic, medical co-morbidities and hereditary conditions into account. This is in addition to any life events such as pregnancy, and any weight fluctuations. So, you really need to be looking at the patient as a whole and considering their overall wellness. In my experience, patients that tend to have frequent weight variations and more inconsistent lifestyle factors require more counselling to achieve realistic expectations. This will give an overall synopsis of the patient and what treatment modalities are likely to work best for them resulting in the best patient outcome.
Body contouring continues to be a growth area within the aesthetics industry and a combination of surgical and non-invasive modalities are available to practitioners that work effectively on a wide range of indications including skin laxity issues, fat reduction, wrinkle reduction and cellulite reduction. Practitioners should research all available options, prioritise safety and efficacy and embark on a thorough, personalised consultation prior to agreeing patient treatment plans.
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