Non-invasive body contouring

The global body contouring devices market was valued at US$1.2 billion in 2021 and is expected to expand at an annual growth rate of 14.3% from 2022 to 2030. Body contouring devices can be invasive (surgical) and non-invasive, aiming to reshape an area of the body, remove unwanted fat, achieve firmness in a treatment area, and improve muscle tone.

The expansion of this market is directly proportional to the worldwide increase in obesity and premature ageing, with skin sagging showing in a much younger generation.

This desire to attain a perfect body has grown alongside the prevalence of social media, with swathes of beautiful models and heavily edited images all around us. The global trend to click, upload and share selfies and videos that are photoshopped have enhanced the pressure to look good. It is, therefore, essential to inform the public and potential seekers of the ‘perfect body’ about non-invasive body contouring, its effects and limitations.

Various approved modalities for non-invasive body contouring are on offer, including: radiofrequency, high-intensity focused ultrasound, laser therapy, cryolipolysis, high-intensity focused electromagnetic field, and functional magnetic stimulation.

Radiofrequency

Radiofrequency (RF) is safe and tolerable non-ablative technology that has attained wide popularity for non-surgical body contouring. In RF, electrical energy generates heat by forcing collisions between certain molecules. Various tissues have different impedance due to differences in their water content.

Fat tissue has high impedance, and thermal energy can easily cause fat cells’ destruction (apoptosis) in the fat tissue. This process happens without any significant risk of causing damage to the different skin layers or underlying muscles, making it very safe. RF also denatures collagen fibres, which induces skin tightening.

One recent study assessed fat tissue reduction and skin tightening with 3D volumetric studies, taken before each session and at two months post treatment. In 90% of patients, fat reduction was documented, with 60% being satisfied with the cosmetic effects. Bipolar and tripolar RF variants have minimal downtime after the procedure; however, the bipolar version requires more frequent sessions than monopolar RF.

RF has demonstrated no adverse effect profile, making it the most popular non-invasive body contouring procedure.

High-intensity focused ultrasound

High-intensity focused ultrasound (HIFU) is a non-invasive body contouring tool, which has gained popularity for not only fat removal but also skin tightening. HIFU, too, relies on the generation of heat energy, which induces fat cell destruction (adipocyte apoptosis), similar to RF. However, while RF is based on electric energy, HIFU uses ultrasound energy.

HIFU devices can focus energy at precisely targeted microzones (less than 1 mm in size) in the deeper portion of the fat layer, sparing any other tissue. In addition, HIFU tends to disrupt the fat cell membranes mechanically, thereby enhancing fat removal.

Furthermore, micro-coagulation leads to collagen denaturation, contraction and remodeling, while new collagen synthesis gradually enhances skin tightening. HIFU has been found suitable for correcting mild to moderate skin laxity in young patients. However, elderly patients with severe skin laxity or photoageing are not qualified candidates for tightening (only for fat reduction). Although the lipids are released during this procedure, there have been no reports of an increase in serum lipid levels, making it very safe.

Laser therapy

Laser technology (not to be confused with various laser therapies for skin rejuvenation) has recently emerged as a non-invasive tool for body contouring. The FDA has approved a 1 060 nm diode laser that uses heat to selectively destroy the adipocytes (fat cells) selectively and cause a reduction in stubborn fat. The device has an in-built cooling system that helps prevent skin damage during the process. No serious adverse events are encountered.

The results are only temporary, and the probability of recurrence of fatty deposition is high, causing it to be a modality for patients who may prefer immediate short-term cosmetic improvement.

High-intensity focused electromagnetic field

A high-intensity focused electromagnetic field (HIFEM) is a novel modality introduced recently to reduce fat and strengthen the muscles. This tool uses magnetic induction and relies upon creating electrical currents in the tissues by changing the magnetic fields, leading to muscle contraction. During this process, muscle relaxation time is decreased, making ‘spasms’ that lead to adaptive changes such as increased muscle mass and decreased fat tissue.

The advisory board of doctors unanimously agreed on several factors related to HIFEM, including the observation that using HIFEM and RF should be preferred over HIFEM alone. It achieves better results in overall body contouring (fat removal, tightening and muscle firming).

Similarly, functional magnetic stimulation (FMS) treatment can provide an alternative or additional therapy to standard physical exercise or electrical stimulation due to its ability to induce muscle contraction efficiently and painlessly. The increased muscle activity during magnetic stimulation (FMS) increases catabolic processes and it can, therefore, along with diet and exercise, also increase the fat burning rate.

Cryolipolysis

Cryolipolysis (fat freezing) is performed by a device based on the principle that fat cells, due to the higher lipids, are more liable to freezing and damage than the cells from the surrounding tissues that have more water.

During this process, selective fat cell damage occurs while the rest of the structures stay preserved. The ‘frozen fat’ is then digested by macrophages, which translates clinically into reduced fat tissue over the subsequent 2-3 months.

The adverse effects of cryolipolysis include redness, oedema, bruises, numbness, skin hyperpigmentation, motor neuropathy and pain. Further, over the past several years, reports regarding paradoxical adipose hyperplasia (fat regrowth) after cryolipolysis have increased, and patients are less inclined to do this procedure.

Additionally, before the procedure, a proper patient selection must be applied, and men with visceral abdominal fat and firm, non-distensible, fibrous fat tissue are contraindicated for cryolipolysis.

How successful are these procedures?

All the non-surgical body contouring devices mentioned have been subject to extensive research before their use in patients, with scientific data concluding a statistically significant success rate. So why do we still have patients that don’t achieve the results they want?

Part of the answer to this question is laid at the doorstep of the physician, who needs to ensure effective communication with their patient and consider a functional medicine approach in delivering effective results. In attaining a desirable outcome, there are certain aspects that need to be addressed, three of which are detailed below.

1. Educate patients about underlying medical conditions

Many ongoing body imperfections often result from underlying medical conditions and internal contributing factors. Patients with insulin resistance would have stubborn belly fat ‘driven’ by visceral fat, extensive fat deposition in the upper torso, and excessive skin laxity that is difficult to tone. This kind of patient will have limited results if we don’t apply the functional medicine approach to reverse the medical condition – insulin resistance.

Menopausal women, due to multiple hormonal depletion, would have: prominently sagging arms and low muscle tone (low growth hormone); increased skin laxity on the tummy area, inner thighs, inner arms and knees (low oestrogen depleting collagen); as well as increased abdominal obesity and love handles (testosterone/oestrogen mismatch and higher insulin). The success of contouring procedures in such a patient will be limited. Menopausal hormone depletion is an ongoing process, and these patients should go on bio-identical hormone replacement to prevent further deterioration.  

2. Educate the patient about the duration of the results

This process is again tightly bound to understating underlying intrinsic and extrinsic factors that create a body concern. These are examples of patients that can create severe skin sagging with their lifestyles:

• Patients with extensive photoageing who spend too much time in the sun
• Marathon runners with severe oxidative stress
• Individuals eating processed and ‘junk’ food, which makes advanced glycation end products (AGEs)
• Patients who overeat but are genetically unable to clear free radicals.

Although such patients would love to have long-term results after body tightening procedures, their results will not be lasting should they persist with these unfavourable lifestyles. 

3. Discuss with patients how realistic their expectations are

This is a vital step that needs to be addressed in all cases, particularly where expectations seem unlikely to be met. Seeing celebrities who have undergone multiple surgical interventions, and are often photoshopped, can create unrealistic expectations. Referring to the scientific data and identifying underlying medical conditions will help patients to gain a more realistic perspective of how successful their non-invasive contouring procedure will be.

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