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  • By Lois W. Stern Editor-at-Large

    Ruler around stomach

    Plastic surgery welcomes Zeltiq™, the newest kid on the block for fat reduction. In an earlier MMH article I wrote about Smart Lipo™ http://news.makemeheal.com/smartlipo/734/, the first of the laser lipolysis treatments to emerge on the market. In this ever expanding world of plastic surgery, a number of other companies have developed innovative variations to this original, under different brand names. With all these fat be gone technologies on the forefront, I was particularly interested to learn about Zeltiq™. Would it add something new to the plastic surgeon’s arsenal of treatments poised to wage the battle against unwanted body fat deposits? I turned to two highly respected, board certified plastic surgeons for my information: Dr. Lawrence Bass, Director of the Department of Minimally Invasive Plastic Surgery at NYU Medical, with private practices in Great Neck, NY and Manhattan, and Dr. Scott Sattler of Naficy Surgery and Rejuvenation Center in Seattle, Washington, SeattleFace.com. Both of these plastic surgeons are in the forefront of providing Zeltiq™ to their patients, in addition to more traditional forms of Liposuction.

    Zeltiq™, laser lipolysis, and liposuction all offer varied treatment options for the permanent removal of fat cells. Although the underlying technique used by each of these methods is unique, all of these plastic surgery options distinguish themselves by permanently eliminating fat cells from the body – a feat that diet and exercise can not accomplish. It is important to note that  although one can trim down through diet and exercise, these measures do not reduce the total number of fat cells, but only reduce the amount of fat within each cell.

    What intrigues me about Zeltiq is its totally non-invasive form of body contouring, inspired by a most curious observation: that children who habitually sucked on ice Popsicles developed cheek dimples, presumably due to loss of fatty tissue from their cheeks. The Zeltiq technology takes advantage of this greater sensitivity of fat cells to cold (as compared to muscle or skin cells.)

    What is Zeltiq™ ?

    Dr. Lawrence Bass:

    “Zeltiq™ (pronounced Zel ′teek) Aesthetics, founded in 2005, is a science-based medical device company dedicated to the development of non-invasive procedures for the reduction of unwanted fat tissue. The Zeltiq™ approach utilizes a patented method called Cryolipolysis™  (the use of precisely controlled cooling to remove fat) that is designed to target only fat cells and not harm the skin or other tissue.”

    A Zeltiq Treatment

    During treatment, gentle suction draws a roll of skin and fat into an applicator. The fat is then chilled under careful temperature  control, until it becomes so cold that it is firm and doughy but does not freeze. Typically 3 or 4 applications are made in a single treatment, which takes approximately one hour per treatment area. Some patients elect to have one or two areas treated at a time. No anesthesia is administered and the patient feels no pain during treatment, but does experience a strong pulling sensation. No incisions are made and no anesthesia is required. While this chilling process is taking place, patients are free to watch TV, read  books, take naps or speak on their cell phones. It is not uncommon for patients to undergo other treatments or spa services while Zeltiqis in progress. Sounds almost too good to be true.

    Zeltiq, Plastic Surgery

    Recovery after a Zeltiq™ treatment

    After a treatment, the skin will be flushed and is often mildly bruised, with some numbness for a week or two, however patients should not experience discomfort or recovery downtime, but can immediately resume their normal activities – going directly back to work or even to the gym. Since no sedation or anesthesia is required for the Zeltiq procedure, patients can drive themselves home following treatment. No compression garments are required.

    Several days after the procedure, the cooled fat cells begin a process called “apoptosis” and begin to shrink. These damaged fat cells are slowly digested over several months by our bodies and removed through the liver. Body contours will reduce slowly over the next 2-3 months. Once fat cells have been cold shocked, they fail to renew themselves and are eliminated slowly over several months.

    Results after a Zeltiq treatment take a few weeks to evolve. In most patients, a noticeable and measurable result is observed 2-4 months after treatment. A moderate degree of fat reduction should be expected.

    Love Handles Before cryolipolysis, Plastic Surgery

    Love handles before cryolipolysis

    Love Handles After cryolipolysis, Plastic Surgery

    4 months after a single cryolipolysis treatment

    Who are the best candidates for Zeltiq ?

    Dr. Lawrence Bass

    “Zeltiq is ideal for men and women who have isolated fatty regions of the abdomen (tummy), flank (love handles) and back roll (muffin top) as the Zeltiq procedure targets folds of fat that can be grabbed hold of. Patients who are close to their ideal body weight, but have problem areas of excess fat in these areas are excellent candidates for the Zeltiq procedure.”

    Will Zeltiq be able to expand spot treatments to other areas of the body?

    Dr. Scott Sattler:

    In our discussion with the manufacturer rep from Zeltiq, there are several new applicators under development which aim to address some of the limitations with the current Zeltiq applicator. These limitations include size of the applicator and the need for multiple treatment cycles to treat large areas of the abdomen and flanks. A belt-type applicator is planned for pan-treatment of the abdomen. Applicators are also in the works for other regions, such as thighs, that the current applicator does not work for.”

    Further observations:

    I questioned both of my experts about further observations they would like to make based on  their experiences in using fat reduction treatments in their private practices.

    Dr. Scott Sattler:

    “The best candidates for Zeltiq™ are those who are in relatively good shape, but have modest areas of fat bulges that they’d like removed. Neither Smart Lipo™ nor Zeltiq™ is an alternative to a healthy diet and lifestyle. What Zeltiq™ excels at is non-invasive fat reduction of focal fatty deposits located in the abdomen, flank and dorsal back rolls. There is no other non-invasive technology out there that can compare to it. It’s very unique. But it’s not for everyone. I tell patients that it’s ideal for fit, healthy patients close to their ideal body weight that have a focal region of stubborn ‘grabbable’ fat. Any fit, gym toned male will tell you that his stubborn love handles drive him crazy. This is the type of patient that Zeltiq is perfect for.”

    Dr. Lawrence Bass

    “In my experience, when laser lipolysis is done  with small liposuctions, and only under a local anesthesia, fat reduction results are probably similar to those of a single Zeltiq™ treatment. Although Zeltiq™ is relatively painless, HIFU (High Intensity Focused Ultrasound) treatments typically cause some pain and possible skin burns. Cryolipolysis with Zeltiq will not tighten loose folds of skin. Regions of excess skin along the abdomen and flank are best treated with techniques that allow for the surgical removal of skin.”

    Ever fearful that fat reduction treatments will leave us with loose, lax skin as a trade off for skinnier bodies, I ask: “What about skin tightening? Will treatments with one device provide better skin tightening than the other?” The jury is still out on this answer, even amongst highly qualified plastic surgeons.

    Some support the idea that the skin will shrink a given amount no matter which fat reduction treatment the patient undergoes [Dr. Sattler], citing skin tightening as dependant on a patient’s own skin elasticity, not on anything a device does to the skin. Others, especially those within the laser community, [Dr. Bass] cite increased skin shrinkage with laser lipo compared to straight tumescent lipo. (e.g. DiBernardo 27% vs. 7 %), while emphasizing that the distinction is subtle and not based on formal medical science.

    If you are considering any type of fat reduction treatment, a good pre-surgery discussion point might be the anticipated amount of skin tightening you are likely to experience.

    Zeltiq, Plastic Surgery

    Although Zeltiq is FDA approved for cooling associated with a variety of dermatologic treatments (e.g. as anesthesia for skin excisions), FDA clearance for non-invasive, fat reduction (lipolysis) is still pending in the United States. The Zeltiq™ device is approved in Europe for aesthetic fat reduction and has been used off-label for several years by American plastic surgeons and dermatologists who have found it to be safe and effective for body contouring. It’s probably just a matter of time before the FDA approves its use for cryolipolysis.

    Lois  Stern, Plastic Surgery

    Lois W. Stern, Editor-At-Large at Makemeheal.com, is the published author of two books: Sex, Lies and Cosmetic Surgery www.sexliesandcosmeticsurgery.com and Tick Tock, Stop the Clock www.ticktockstoptheclock.com/ as well as a number of magazine articles. Her Professional Edition DVD is a popular aid to office staff while interacting with their patients. She and Patty Kovacs are the co-founders of http://coast2coastbeauty.com/CURRENT_NEWS.html. Check it out!

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