Dr Galyna Selezneva details how she uses cryolipolysis to break down fat cells and reduce body fat in patients
Non-invasive procedures to reduce fat through targeted apoptosis or necrosis of adipocytes have grown in popularity, challenging liposuction as the dominant body contouring procedure.1 These procedures include the use of focused ultrasound, radiofrequency, laser techniques, and cryolipolysis (fat freezing). They are quick, affordable, mostly involve no anaesthesia, and avoid the risk and side effects of surgery. Body contouring procedures vary in terms of response rates, side effects, discomfort or pain they may cause, as well as the number of treatments required. However, I have seen impressive results and high levels of patient satisfaction when using cryolipolysis on my patients. Cryolipolysis exploits the premise that fat cells freeze before skin.2 Targeted cooling triggers apoptosis, followed by an inflammatory response in which lipid cells are destroyed by macrophages, while leaving overlying skin intact. Within two to three months following treatment, the volume of fat in the treated area should have decreased.3 In this article, I will detail how cryolipolysis is applied, the results that patients can expect to see and its safety.
Treatment process
Before any treatment starts, I engage in a full consultation with the patient, examining their medical history, eligibility for treatment and result expectations. As with any treatment, there will be those deemed unsuitable for cryolipolysis, such as patients with visceral fat, rather than subcutaneous fat or abdominal hernias. In such cases, we may be able to recommend an alternative treatment, such as radiofrequency, that uses heat to target fat cells, or a consultation with our in-house dietitian and personal trainer to achieve weight-loss in a more traditional way. I agree a treatment plan with the patient, which will be structured according to the person’s shape, areas of concern and desired outcome. We tend to agree on a one-off treatment of one area, but with some patients, we may agree on two to three treatments, aimed first at volume loss, and thereafter at body contouring. The most commonly treated areas are the abdomen, arms, flanks and thighs. Treatment begins by measuring their dimensions, such as waist, thigh or arm circumference, depending on the area of concern. This is followed by baseline 360-degree photographs or, as our clinic has recently introduced, 3D images.
Figure 1: Female menopausal woman in her early 50s treated with a large cryolipolysis applicator on the lower and upper abdomen, and with a smaller applicator on the flanks
Photographs are taken prior to the first treatment and give the patient a much better idea of their initial body shape, as well as helping us to keep a record of how treatment is developing. 3D imaging is of particular benefit to the patient because, as the results of cryolipolysis are gradual, they can sometimes forget how they looked before. So far, feedback about this protocol has been very positive. I mark the targeted area and apply the cryolipolysis applicators – moulded cups with cooling panels that adhere through suction, drawing tissue in and chilling it. When treatment begins, patients feel some pulling and, inevitably, feel cold. The optimum temperature is 4 degrees Celsius; to freeze fat cells and leave non-fat cells unharmed.11
Images are taken prior to the first treatment and give the patient a much better idea of their initial body shape, as well as helping us to keep a record of how treatment is developing
Although no anaesthesia is needed, suction can initially be uncomfortable as the targeted area goes numb. However, patients soon settle down and can fall asleep, read, answer emails or undergo complementary treatments. Each area requires an hour under the machine; this length of time appears to be standard. After treatment, I vigorously massage the affected area for at least two minutes. This improves the outcome by helping to break down the crystallised layer of fat beneath the skin. We prefer not to treat more than four to six areas of the body during one session, so the patient does not become uncomfortable.
Side effects
The patient will feel sore afterwards, and there is some swelling and discomfort. Oil, moisturiser or body lotion can be used to soothe a sore area but this is not always necessary. Typically there is minimal downtime and I always give my patients my private number so they can contact me any time after treatment. Although there is no reason to stop patients resuming normal activities immediately, a prudent practitioner will recommend that they listen to their bodies first.
Results
As the inflammatory response on which cryolipolysis depends is slow, the results are gradual, starting to show at four weeks, with best results developing by four to six months.6
I see a clear and visible reduction of fat in patients that I treat, but they all react individually and in some cases, subsequent treatments may be necessary
I see a clear and visible reduction of fat in patients that I treat, but they all react individually and in some cases, subsequent treatments may be necessary. In my clinical experience, the majority of patients also enjoy psychological benefits from treatment once they see unwanted fat gone. I have noted that most are subsequently motivated to eat healthier, exercise more, lose weight and even change their wardrobe.
Research
In a clinical study on CoolSculpting, Pietrzak et al reported that only six of 528 patients who were treated with the cryolipolysis device were dissatisfied with the outcome, and four of those were then satisfied when treated a second time. It was observed that well managed treatments using the cryolipolysis device could yield results comparable to those of liposuction.5 Research by Coleman et al on 10 human subjects treated with a prototype device, indicated that cryolipolysis resulted in a normalised fat layer reduction of 20.4% at two months and 25.5% six months after treatment.2 Literature reviews from this period also underlined the method’s efficacy. Recent studies concentrating on the effectiveness of this technique when applied to specific body areas, reported mean normalised fat reduction of between 2.6mm and 2.8mm to the thighs. Munavalli and Panchaprateep also recently demonstrated the feasibility of cryolipolysis for treating pseudogynecomastia.8 Moreover, the benefits of cryolipolysis can be long-term, with results visible up to five years later.9
Safety and side effects
Recent research has indicated that cryolipolysis does not produce any significant adverse side effects such as scarring, ulceration, or disfigurement, and where effects have been noted, they have been minor, temporary and well tolerated.3,6 Research on porcine models demonstrated that prolonged, controlled local skin cooling reduced subcutaneous fat without damaging skin.10 Other studies discount the potential for changes in lipid levels or liver function after cryolipolysis.11
Known side effects of this procedure are:
Redness and bruising: erythema of the skin, bruising and temporary numbness at the targeted site are commonly observed following treatment, but resolve quickly.7
Late-onset pain: late-onset pain may occur several weeks after treatment, but is rare and usually resolves without intervention.3,6 Keaney, Gudas and Alster suggest that late-onset pain is not uncommon, and recommend suitable counselling and intervention.
Sensory alteration:short-term changes in the function of peripheral sensory nerves may occur, but these return to normal within several weeks with no long-term damage to nerve fibres or skin.2
Paradoxical adipocyte hyperplasia (PAH):in rare cases additional fat can grow at a treatment site, the incidence of which has been indicated as 1 in 20,000 patients.13
Conclusion
I have noticed an increase in popularity for cryolipolysis treatment and believe this is a result of its efficacy. In my opinion, cryolipolysis can offer practitioners significant business growth opportunities, as well as providing patients with noticeable results. I have attended reputable workshops in Miami, US, with the leaders in the field to learn about the procedure, so that I can endeavour to give my patients a much better, natural-looking shape using cryolipolysis. I would recommend fellow practitioners do the same. One of the best pieces of advice I can offer colleagues wishing to adopt or perfect this treatment is to accrue as much hands-on experience as possible and, above all, to choose your patients well. With the right patient, this treatment can achieve excellent results.
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