Monday, June 27, 2016

Coolsculpting or Sculpsure

Many of you have heard of Coolsculpting by now.  The company has done a phenomenal job marketing their procedure for noninvasive body sculpting.  The idea comes from world renowned laser guru, Dr. Rox Anderson, of the Massachusetts General Hospital and Harvard Medical School.  By using cold temperatures to freeze the fat cells, the fat cells undergo apoptosis and die off.  It takes about 3 months for the body to slowly eliminate all the dead fat cells from your body.  About 24% of the fat cells are killed in one 40-60 minute session.  The fat must be pinchable and must fit into a predesigned applicator for the procedure to work.  If you are having upper and lower stomach and love handles treated, you are looking at 4 hours of treatment time.  Three sessions are recommended for best results, spaced from 6-12 weeks apart.  After a coolsculpting procedure, the skin has to initially thaw out.  Gentle massaging can be helpful here. Many patients feel uncomfortable after the procedure and describe pins and needles types of sensations.  The pain can continue or worsen over the next few weeks to months as the nerves are often affected.  There have also been cases of the fat deposits actually growing rather than shrinking, now well documented as Paradoxical Adipose Hyperplasia.  Finally, cryolipolysis does not offer any direct skin tightening benefits, though some clinicians are reporting seeing tightening of the skin.  I feel it is definitely a procedure that works and the aggressive marketing has made it a household name.  Is it the best procedure available for noninvasive body sculpting?  While it's a good option, we feel there are even better options.

One procedure we absolutely love is Vanquish.  Vanquish is completely painless.  It uses focused radiofrequency currents that are driven through the fat cells, causing them to heat up to 45 degrees celsius.  At this temperature, the fat cells undergo apoptosis or controlled cell death and die off.  They are slowly eliminated from the body over 12 weeks time. The fat does not need to be pinchable.  The procedure can be performed on slim to very heavy patients and BMI is not as critical in evaluating candidacy as it is with Coolsculpting.  A large area is treated over 30-45 minutes from the stomach to love handles.  It is recommended that the patient return weekly for 4-6 sessions.  Besides the stomach and love handles, other areas that can be treated include back fat, arms, and thighs.  For dramatic reductions of fat cells of up to 60-80% after 4-6 sessions, Vanquish is by far the most effective.  It also has no associated post treatment pain.  All normal activities can be resumed immediately.  No special diets are required.  We do, however, request that patients consume 8 glasses of water with any noninvasive body sculpting procedure to help flush the fat out.  There is also no danger of Paradoxical Adipose Hyperplasia as there is with Coolsculpting.  In our practice, we have seen some very dramatic results with Vanquish.  The skin usually also heats up to 42 degrees celsius during the procedure providing the added benefit of well documented collagen stimulation and hence true body contouring and skin tightening.

New to the market is a procedure called Sculpsure.  Although we love Vanquish, we feel Sculpsure has a good position for treating specific pockets of fat.  It can also treat larger areas.  The advantage is that it does not require weekly visits and can be accomplished in a single 25 minute session per area.  An area consists of 4 applicators that can be placed anywhere for that 25 minute session.  To treat an upper and lower abdomen and love handles takes 1-1.5 hours (compared to the 4 hours it would take with Coolsculpting).  One can expect to see at least a 25% reduction in fat cells after a single session.  Patients may need an additional 1-2 sessions spaced 6-12 weeks apart.  Unlike Coolsculpting, Sculpsure does not require the fat to be pinchable.  It can be administered on any part of the body except the chin (for now).   There is absolutely no recovery time or post treatment nerve pain.  One does not have to wait for the skin to thaw out as with Coolsculpting and there is no risk of Paradoxical Adipose Hyperplasia.  Also, heating is great for stimulating new collagen growth in the skin.  For all these reasons, most practices on the east and west coasts are switching to Sculpsure for localized areas of fat.  Below are some results from Sculpsure and from Vanquish.