INTRODUCTION
Body sculpting, or body conturing, is among the fastest growing areas in cosmetic dermatology. In 2015, dermatologic surgeons performed over 230,000 body sculpting treatments.1 One survey reported 89% of consumers, are concerned with excess weight and 35% of consumers are considering body sculpting treatments.2 In addition to the common indication of body sculpting for removal of excess lower abdominal fat for men and women, men are also concerned with pseudogynecomastia (enlarged male breast due to excess fat) and procedures for male breast reduction rose 26% from 2014 to 2015.2 Pseudogynecomastia and excess lower abdominal fat may affect patients' quality-of-life, resulting in self-consciousness and psychological distress.3 Liposuction is the most popular and the most effective surgical treatment for focal fat reduction.4 However, liposuction is associated with possible adverse effects and downtime. Concerns associated with invasive procedures, such as liposuction, include risks for infection, nerve damage, hematoma, complications with anesthesia, and the high cost associated with surgical treatment. Physicians and consumers alike are seeking minimally invasive, low risk, and cost-effective techniques for focal fat reduction with fast recovery time.Recently, non-invasive fat reducation techniques have become more widely available and may be associated with fewer adverse effects compared to invasive procedures. Non-invasive fat reduction techniques include using temperature, sound and light modulation to selectively target adipocytes for fat removal while minimizing the effects on the epidermis and dermis.5 Examples include cryolipolysis, high intensity focused ultrasound, and low level and infrared lasers using wavelengths specifically targeted for adipocytes.5,6 A landmark manuscript published in 2008 reported that pro- longed, controlled local skin cooling can induce selective damage and removal of fat deposits without injuring local tissue.7 This reported phenomenon is based upon historical observations that lipid-rich tissue is more susceptible to cold injury than surrounding water-rich tissue.8 Cryolipolysis, or "fat freezing," was FDA-cleared (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA) for fat removal of the anks or "love handles" (K080521) in 2010, abdomen (K120023) in 2012, thighs (K133212) in 2014, submental region (K151179) in 2015, and arms (K162050), bra bulge, back, and underneath the buttock or "banana roll" (K160259) in 2016.
