Noninvasive body contouring - why multiple devices is a MUST for the best results.


Noninvasive body contouring has seen an increased popularity in Australia over the past few years.  The trend is increasing with an increasing number of procedures together with devices that are seen in the Australian market.   In my opinion, it is not one device that will give the best results, but finding the correct device for the patient's body type will give optimal outcomes.

As a dermatologist who only concentrates on procedural dermatology, I visit the United States annually to see the growing trends as well as devices which usually preclude the Australian aesthetic market. I was one early pioneers who adopted cryolipolysis when High Tech Laser had the distribution rights to CoolSculpting.  Over the past seven years, the noninvasive body contouring scene has expanded vastly to involve other cryolipolysis devices, radiofrequency energy devices as well as even lasers to help decrease unwanted fat and contour body areas.

 I have been fortunate enough to use over seven different devices to compare and contrast results together with return of investment upon the devices tested.

 The majority of my work is procedural medical dermatology, I do however oversee a separate entity for body contouring known as the Fiori Institute of Skin and Body.  To date, we have two clinics in Brisbane Australia and we will be expanding in different Westfield shopping centre locations and into Sydney NSW by the end of 2017.  The Fiori Institute offers a wide range of body contouring and skin tightening including CoolSculpting, CoolTech, Thermage, Ultherapy and the EndyMed multi platform devices. This article will discuss my opinion on the various technologies incorporated within this clinic in the context of body contouring and fat reduction.

Announcing conflict of interest, I am regarded as the key opinion leader with Cynosure, the maker of SculpSure.  My strength, however, lies in laser dermatology, namely in the use of picosecond lasers and not with SculpSure which I do own as well.  I do not have any other conflict of interest when naming other companies nor devices. I am not paid by any company to write this review.

In the context of body contouring, I do believe that cryolipolysis provides a far more reliable outcome compared to thermogenic apoptosis of fat.   Namely, I do believe that freezing fat provides a far more reliable outcome and much higher satisfaction rate than heating fat.To date I have performed over 2500 procedures including a mix of both radiofrequency, diode-based laser energy delivery (SculpSure) as well as cryolipolysis using both the generation one and generation two CoolSculpting machines together with several CoolTech devices.


What is the reasoning behind the different devices and applications?

One size does not fit all.   Our lifestyle, downtime, pain tolerances, body types, as well as specific goals all come into play in regards to body contouring and fat reduction.  This is why I firmly believe that multiple devices need to be considered when it comes to gold standard noninvasive body contouring.

 When SculpSure first came into the scene, it was heavily marketed and had a real self satisfaction rate of 98%.  However, as I predicted, this would drop to below 80%.  As of April 2017, the self rated patient satisfaction rate hovers at around 75%, which is 10% below that of cryolipolysis devices.  I foresee that this percentage satisfaction rate for SculpSure would decrease to around 70% within the next six to eight months.


Why is thermogenic apoptosis of fat more variable in the results compared to cryolipolysis?

Unlike cryolipolysis methods, devices like SculpSure does not preselect the candidate.  With thermogenic devices any individual in theory is a suitable candidate as ‘applicator fit’ does not matter. Having said this, I myself have had SculpSure treatments with excellent success, however, my goals were to achieve a global reduction in subcutaneous fat and not to contour any aspect of my body. Cryolipolysis devices such as CoolSculpting and CoolTech have the advantage that if technicians are well trained, then the applicator preselects area.  This is why I run several cryolipolysis devices within the practice.  CoolTech has numerous advantages over CoolSculpting apart from its return of investment.  The base device itself is cheaper that CoolSculpting, as are the consumables.  Additionally, the device comes with dual applicators as standard, this cuts down treatment time in half.  I understand CoolSculpting does have dual sculpting, however, once again, the return of investment can be questionable. Today's topic, however, will be the clinical aspects of cryolipolysis versus other methods of permanent fat reduction.


What is the pros and cons of SculpSure?

Firstly, with thermogenic lipolysis devices. SculpSure has adjustable treatment levels.  This means that if the heat cooling cycle cannot be tolerated at its maximum, then the technician has the ability to reduce the energy levels and hence heat to the adipocytes. The reduction of energy levels will decrease pain, however according to the company this has no bearing on the outcome of the procedure. What this really means in context of the eventual treatment outcome is not known.  To date, there are no studies that compare maximum levels on one side compared to minimal treatment parameters on the other side. Though the company says it has no difference in outcomes, I would be interested to see some data.  Though the treatment itself may be considered overall more painful compared to cryolipolysis, the after effects are minimal.  Essentially patients have no downtime following controlled thermolipolysis either with radiofrequency or diode-based energy systems.  In contrast, cryolipolysis patients may have a downtime ranging from a few hours through to several weeks or months with paraesthesia.  Additionally, the massage or the use of an ultrasound device post-treatment often causes some discomfort following cryolipolysis treatments.


Why is the applicator size for cryolipolysis vitally important?

Comparing devices such as Coolsculpting and CoolTech, in some cases CoolSculpting will have an advantage, for example treating the abdomen with its large applicator.  For the CoolTech device, two applicators are needed with a gap in the middle.  This often entails a second treatment for the patient as compared with the Coolsculpting applicator which can treat the abdominal girth with only one treatment.  The flip side, however, is that with the CoolTech applicator for the flanks, the pockets are deeper.  For love handles, muffin tops and flanks, my technicians seem to prefer the CoolTech device over Coolsculpting.  The same can be said for treatment under the chin area with the mini applicator. This especially applies to the dual applicators for larger chins. Comparing these two devices, even a subtle change in applicator fit will yield a better result for the client.  In some cases we do choose CoolTech over CoolSculpting purely based upon the application fit.


Why do some people respond better than others? 

Results, refund and nonresponders-  my next statement will raise some controversy and I am sure to receive some phone calls from companies.  Cryolipolysis is much more predictable in its outcomes compared to  thermolipolysis. Running both CoolSculpting and CoolTech technology we have a much higher patient satisfaction rate approaching 97% compared to SculpSure and other thermogenic devices.  We have recently implemented the EndyMed PRO shaper to our clinic.  I cannot comment on this device as it is too early in my assessment.  Having performed nearly a thousand SculpSure patients, our patient satisfaction rate is 76% which remarkably is within 1% of the real self patient satisfaction rate.  There is, however, a marked discrepancy between the satisfaction rate for cryolipolysis devices with both CoolTech and CoolSculpting running at around 97% to 98% satisfaction rate.


Why do I run both cryolipolysis together with thermogenic lipolysis in my clinics?

Once again it bares down to patient perception together with there lifestyle, downtime and body types.  I do believe that for patients who can tolerate maximum levels of diode-based energy delivery with the SculpSure device, in select patients we can get a modest to good outcome.  I do believe that this does reduce and debulk subcutaneous fat in individuals who want an overall decrease in girth.  For more finesse, I do believe that cryolipolysis will give the better result.   With the EndyMed RF PRO shaper, this is more time consuming compared to other devices and several treatments are needed for optimal outcomes.  The advantage of using this system is that pain levels compared with diode-based laser energy is markedly reduced.  I have yet to make a firm conclusion in regard to the efficacy of this device.


Why do I implement synergistic cryolipolysis devices within the practice- namely Cooltech and Coolsculpting? 

I do believe that this method of running both Coolsculpting and CoolTech is, in my opinion, the better method to achieve the end outcome.   This is based upon the fact that with more applicator sizes, patients have a better chance of the best fit and hence will achieve the best possible results.  In some situations, CoolTech out performs Coolsculpting whilst in other cases, it is vice versa.  In my unbias conclusion, both systems offer very similar clinical results and patient satisfaction rates. 

The Fiori Institute of Skin and Body offers 'FREE Fitment guide' and consultations for patients interested in body contouring. Our staff are trained to ensure you have the best possible outcomes, we use a METHOD and not just a device to achieve your desired goals. Own You.

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Brisbane Dermatologist