New Cosmetic Surgery Techniques: Help or Hype?

There ere are always lots of articles in women's magazines that are very optimistic and enthusiastic about "new" technology or devices. We do understand that this is the product of very intensive lobbying by the device and equipment manufacturers to get the publicity for their inventions.

However, it is the duty of physicians, whose interest stands with the patient and not with the commercial success or failure of device makers, to help sort out the hype and fluff from reality.

The following is a review of some of the subjects that were recently discussed in the June 2009 Vogue magazine.

CAN LIPOSUCTION ALSO DISSOLVE FAT?

Recently there have been introduced a variety of devices that claim to "melt the fat cells”. Liposuction cannula, when inserted under the skin, heat the fat layer.

Here are the names of some of these devices: SmartLipo, SlimLipo, CoolLipo, Lipotherme and AccuShape. The contention is that heat supplied through the suction cannula will melt the fat and besides allowing this now liquid fat to be evacuated by the cannula.

Then, the heat emitted by the cannula will alledgedly tighten the overlying skin.

Another product entitled BodyTipe is currently awaiting FDA approval since its technology uses radiofrequency to liquify the fat cells. The claim there is that the speed is greater than that of the previously mentioned laser devices.

If these machines worked very well it would be both amazing and surprising. Whether or not this can "zap" one to three inches of fat from the abdomen and lower the waist measurement . . . is going to be very interesting.

One of the issues will be, as always, that the first people who pony up to have it done will be part of the test group and therefore less likely to have satisfaction. All surgical procedures in the hands of physicians require testing, evaluation, modification and further evaluation. And, as I teach in my book, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON, unlike other technology development, these tools are generally not tested first on laboratory animals. So, my advice has always been "Don't be the first kid on the block to have something done: wait in line because, later, the kinks will be worked out and you have a better chance of success."

CAN YOU TIGHTEN THE SKIN WITHOUT REMOVAL?

New machinery claims to perform "circumferential reduction" of the thighs, for example, using either radiofrequency or infrared light. These massage heads, when applied to the skin, claim to tighten flabby inelastic skin and hence allow one to more easily slide into their favorite pair of jeans.

Today's versions, marketed under the name SkinTyte or Titan, claim to be improvements over the original external radiofrequency device known as Thermage. Thermage, which began its career over six years ago, was not very impressive. We saw many people who came to see us who bemoaned the money spent and results not achieved.

Whether or not, by whatever technology, tightening of the skin can convert to permanent narrower waist and thinner thighs engenders a lot of skepticism on my part. One thing we have learned is that when various technologies are applied to the skin while there appears to be an immediate contraction and tightening, within a short period of time, as the skin regains some hydration or water retention it re-expands to its former dimension. Stay tuned.

THE BATTLE AGAINST CELLULITE CONTINUES

There has been a lot of description of what I consider an ill-defined layer of the skin called "cellulite". Not all doctors even agree on what it is. In any event, it is a buzz word for the skin that seems to have dips, moguls and depressions. Are these irregularities due to this specific cellulite—fat layer underneath the skin? A new FDA- approved technology called Smooth-Shapes seeks to liquify this cellulite under the skin using a laser beam. Then, the liquid fat is literally rolled away using a device similar to a pastry roller, such that it is directed to the lymphatics which presumably will pick-up this extra liquid non-cooking fat and carry it away. The original "roller technique" only was called Endermologie. Its popularity waned in the face of unhappy patients.

Whether or not this evacuation of fat from fat cells will be permanent really depends on the fats cell ability to produce more fat. Remember, this process does not remove fat cells as liposuction does, but rather claims to evacuate the contents from individual fat cells. Fat cells, through normal metabolic processes, become "fatter" depending on dietary intake and other factors. Let’s watch this one carefully.

DO FAT DISSOLVING INJECTIONS WORK?

There is a company that produces a solution or cocktail known as ATX-101 which claims to contain a bio-salt derived from cows that "breaks down dietary fat". And while this apparently aids in cow's digestion, the contention is that there is a similar dissolution of fat when the material is injected into the fat layer of humans. If indeed targeted fat cells are destroyed and eliminated from the body, there would be a net loss of fat cells and presumably a thinner being. Whether or not this drug will be successful remains to be seen. It would be nice if it were, but I would suggest not being in the first wave of volunteers until we know more.

-- Robert Kotler, MD, FACS