DANA POINT, CALIF. – The market for nonsurgical body contouring has "settled into a rhythm," and increasing numbers of patients accept the fact that these technologies work, in the opinion of Dr. Michael S. Kaminer.
However, the evolution of technology in the realm of nonsurgical body contouring has slowed. "The absence of technology evolution will allow low-cost providers to gain market share," Dr. Kaminer said at a meeting sponsored by SkinCare Physicians and Northwestern University.
Dr. Michael S. Kaminer
"It’s essential for us to brand these procedures as requiring skillful assessment and contouring expertise. In the short term, it may be more important for us to focus on superior results with current technology rather than trying to win the technology arms race. Advances in technology will help, but are they coming? Maybe it’s time to focus on getting better results with what we already own."
According to the results of a 2011 survey of American Society for Dermatologic Surgery members, noninvasive treatment of fat and cellulite was the most common body sculpting procedure, with 74,000 procedures noted. Cryolipolysis accounted for 12% of body sculpting treatments with a total of 55,500 procedures, followed by tumescent liposuction with 18,500 procedures.
"The bottom line is that our noninvasive procedures are far outstripping liposuction," said Dr. Kaminer, a managing partner at SkinCare Physicians, Chestnut Hill, Mass. "Because of this, patients and physicians are shifting their focus to noninvasive methods for fat removal. But they are also starting to expect more. I think that’s where our opportunity is. If we don’t advance the technology, it has the potential to go the route of laser hair removal, with competition based on price and convenience rather than on science and outcomes."
He went on to discuss ways to optimize outcomes with the existing technology cleared for body contouring. With cryolipolysis (CoolSculpting), for example, combining massage with the procedure has been shown to improve outcomes by as much as 60%, compared with patients who did not undergo concomitant massage.
Dr. Kaminer’s additional tips for cryolipolysis included performing multiple cycles over time for more complete fat removal and shape change, and learning how to use and optimize different applicators. "There are many of them, which is frustrating, but if you learn how to use the different applicators effectively you will get better body sculpting results," said Dr. Kaminer, who also serves as an associate clinical professor of dermatology at Yale University, New Haven, Conn. To that end, consider treating the inner and outer thighs with different applicators. Vertical placement of the flat applicator works well on inner thighs, he said, while the curved applicator works well on outer thighs.
When using ultrasound (Liposonix) for body sculpting, stacked pulses at lower fluences yield results similar to those of nonstacked pulses at high fluences, "but improve comfort for the patient," he said.
In Dr. Kaminer’s clinical experience, patients are satisfied with 40%-50% fat removal after 1-2 treatments with CoolSculpting and Liposonix. Workflow, staffing, patient pain, and time per treatment differ for each device. "Multiple procedures have the potential to give liposuction-like results," he noted. "To me, that’s where we should focus as a specialty. Also, should we focus more on the final shape rather than on how much fat we’re removing? This will differentiate us from spalike providers."
Dr. Kaminer disclosed that he is a consultant for and has received research funding from Zeltiq and Solta Medical.