Dr Claire Oliver presents two female case studies on her approach to body contouring
The desire for patients to improve their silhouette has led to an ever-increasing demand for non-invasive treatments that improve the body’s contours. This can be one of the most rewarding treatments to provide, both for patients and practitioners. Having personally undertaken more than 9,000 cryolipolysis treatments, I have found that men are almost exclusively concerned about their lower abdomen and flanks, whilst women are keen to look at treatment over a much wider range of areas including the lower and upper abdomen, the flanks, the inner and outer thighs, the arms, and the back.
The development behind cryolipolysis stems from the clinical observation of cold-induced panniculitis.1 These observations led to the concept that lipid-rich tissues are more susceptible to cold injury than the surrounding water-rich tissue. With these historical observations in mind, Manstein et al. introduced a novel non-invasive method for fat reduction by freezing in 2007, termed cryolipolysis.2 This technique is performed by applying an applicator to the targeted area set at a specific cooling temperature for a pre-set period of time. This targets adipocytes while sparing the skin, nerves, vessels, and muscles.
On average, fat cells in treated areas can be reduced by up to 27% and the results are permanent if a stable weight is maintained.3
A retrospective multicentre study by Dierickx et al. found that out of 518 participants, 73% reported being satisfied with the outcomes of cryolipolysis and 82% would recommend to a friend.3 In my experience, patient satisfaction is very high and there are minimal non-responders.
This article outlines the successful treatment of two patients using the newest cryolipolysis device on the market and explains my approach to consultation and treatment protocols for optimum outcomes.
The first step when I begin working with a new patient is to schedule a 60-minute complimentary initial consultation. The key to this process is really understanding the patient’s primary concerns and identifying which treatment results will impact their lives in a positive way. After talking to the patient, I then take a full medical history. A detailed process of cryolipolysis is shared alongside examples of patient results. During a physical examination, I then discuss and establish realistic expectations for fat reduction, the sites for applicator placements and the number of cycles planned, based on a whole-body assessment.
The majority of patients I find who enquire about cryolipolysis present to clinic after conducting research across a wide range of treatment options including liposuction. In my experience, these patients typically fall into three groups
The best candidates are those within their ideal weight range and those who engage in regular exercise, eat a healthy diet, have noticeable subcutaneous fat bulges on the treatment area, have realistic expectations, and are willing to maintain the results of cryolipolysis with a healthy, active lifestyle.
The treatment areas are then further prioritised to establish a plan to satisfy the patient’s needs, in keeping with their budgetary restrictions and lifestyle.
Once the consultation is completed, information is provided together with a suggested treatment plan. The patient will have a minimum cooling-off period of 14 days, after which the clinic will contact them again to answer any further questions or to arrange treatment.
In my experience, the majority of female patients opt to treat their main area of concern in the first instance and gauge the results before seeking additional treatments in the main area or before moving to a new area, whereas male patients tend to prefer to undergo multiple treatments at once. In my clinic we use the CoolSculpting Elite, which is my preference because the treatment is comfortable for patients and can be managed without constant supervision, as well as having no downtime and instant results.
On the day of treatment, the patient’s medical history is reviewed and updated, and baseline photographs and weight measurements are taken. We use a floor template to ensure consistency with before and after images is achieved and the treatment area is marked onto the skin using templates replicating the size of the applicators.
The new CoolSculpting Elite system has a redesigned range of dual applicators. The applicator areas are thoroughly cleaned, and a gel pad is placed over the area to protect the skin’s surface, followed by the placement of the applicators. These are positioned centrally to the peak of the bulge to ensure maximum results. A small amount of vacuum-pressure draws skin and adipose tissue into the cup (an increase of 18% with the new Elite applicators) securing placement and cryolipolysis begins.
Each treatment cycle lasts for 35 minutes. Once the patient is comfortable, they can be left alone to rest, read, or watch a film while other patients are seen. If the patient needs assistance or the treatment cycle is nearing completion, we have an easily accessible call bell and a pager so the patient can alert the practitioner.
As each cycle completes, the area should be vigorously massaged for two minutes to help accelerate the elimination process of fat cells. Massage has been shown to improve the clinical outcome, with one study indicating that it can improve results by up to 70%.4
Following the treatment, dead fat cells are permanently eliminated from the body through lymphatic drainage.
A 24-year-old woman (Patient A) presented to my clinic with concerns of a rounded tummy since adolescence and a dissatisfaction with how she looked and felt. She indicated in the consultation that she maintained a healthy balanced diet and exercised four times per week. Despite undertaking a calorie-controlled diet for an extended period she had been unable to significantly reduce her abdomen. During examination, I found the abdomen to be soft, pinchable, subcutaneous fat with no visible skin laxity. I recommended a treatment plan of CoolSculpting Elite consisting of two cycles using C-240 (large) applicators to debulk the abdomen in the first instance. She was reviewed physically, and photos were taken at both week six and 12 where a noticeable reduction was seen. At her review, Patient A said she was delighted with her results, reporting her silhouette was more streamlined, her clothes fit better, and her general and body confidence had increased.
Patient B presented to clinic concerned with her ‘mummy tummy’. Aged 51, her medical records and consultation indicated she maintained a healthy balanced diet, exercised three times per week and is peri-menopausal. She had been unable to reduce the size of her abdomen area and was considering a range of treatments including liposuction.
At examination, I found the abdomen to be soft, pinchable, subcutaneous, stubborn fat with skin showing minimal signs of laxity. A treatment plan was recommended of four cycles of Elite C-150 (medium) applicators to be placed – two in the lower and two in the upper abdomen area. A review at week six indicated a small visible reduction. The follow-up review at 12 weeks indicated a noticeable result and a recommendation to enhance the result with two further cycles of treatment using C-80 (small) applicators in the lower abdomen area. Patient B was very pleased with the results and is confident a follow-on dual sculpting treatment in lower abdomen area will provide the desired silhouette.
After the treatment, patients are able to typically resume normal activities immediately post-treatment, however we recommend avoiding strenuous activity for 24 hours. Post-treatment care instructions are provided, which recommend a short massage of the area for a few days and guide as to possible physical after effects as the body continues to process fat cells. A telephone call is made 48 hours post-treatment to check-in and monitor these where relevant. Reviews are scheduled in week six post-treatment to check progress and week 12 to discuss full results. Photographs are taken at each review to plot the journey and to maintain engagement with the patient.
Cryolipolysis has a high safety profile for body contouring and is accomplished with only minimal discomfort. However, as with any aesthetic procedure, there is always a risk of side effects. The common side effects are temporary and minimal, including erythema, bruising, and transient neuralgia. With a prevalence of 0.1%, late-onset pain is also a reported adverse effect.5 Cryolipolysis is safe for all skin types, with no reported pigmentary changes, and patients can benefit from repeated application.6
Cryolipolysis is contraindicated for patients with cold-induced medical conditions such as cryoglobulinemia and paroxysmal cold haemoglobinuria with sensitivities to inflammatory response as a result of exposure to cold temperatures (-1 to -7°C).6
Patient A and Patient B both reported erythema and swelling, most likely because of the strength of the vacuum and the temperature at which the tissue is kept for extended durations. This poses no threat to the patient. Both resolved between seven to 10 days post-treatment. Patient B reported reduction in sensation, which recovered in less than four weeks. Patient A reported late-onset pain, occurring two weeks post-procedure, and resolving without intervention at week four post-treatment.
Cryolipolysis, when used for localised adiposities, continues to be a popular procedure for non-invasive fat reduction and body contouring and presents a compelling alternative to liposuction and other, more invasive methods. There is flexibility in terms of treatment areas and from my experience, results can be significant. The evolution to the new CoolSculpting Elite device has quickly improved the management of a popular treatment in clinic.
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