“Hands-Free” Noninvasive Body Contouring Devices: Review of Effectiveness and Patient Satisfaction

Since both the demand for body contouring and interest in non-invasive approaches is growing so rapidly, this paper will review the literary evidence behind the devices currently available in addition to going over the methods for non-surgical body contouring. Liposuction continues to be one of the leading cosmetic surgical procedures worldwide. The International Society for Aesthetic Plastic Surgery reported that in 2014, more than 1.37 million liposuction procedures had been performed globally, making it the second most common cosmetic procedure after eyelid surgery.¹According to the American Society for Aesthetic Plastic Surgery, 10.9 million non-surgical procedures were performed in 2015, compared with only 1.9 million surgical procedures: almost 396,000 surgical fat reduction procedures and 2.6 million non-surgical skin-tightening procedures were performed in the United States.² While there are numerous noninvasive body-contouring devices currently available on the market, all of these devices deliver some form of energy that creates changes in the adipocytes.All non-surgical procedures for body sculpting induce fat cell shrinkage, apoptosis, or necrosis. A variety of energy sources can accomplish this, including: laser light, radiofrequency, acoustic and shock waves, or cold. They differ from each other not only by their mechanism of action, but also in the response rate, side effects, level of discomfort/pain, and the number of treatments required. Although no procedure has yet been accepted as the gold standard, cryolipolysis, high-intensity ultrasound, and non-contact radiofrequency are all competing for the role of being the safest and most effective procedure.This review will concentrate on three popular “hands-free” devices (Table 1): Coolsculpting System by Zeltiq, Vanquish by BTL Industries, and SculpSure by Cynosure – each of which employ different energy types. They have one thing in common: when positioned for treatment at a designated area, they do not require active “hands-on” participation by the operator; ie, set-up, turn-on, and monitor. The Vanquish radiofrequency device is the only one of the three that operates in non-contact mode, while the other two devices – Coolsculpting System and SculpSure – require direct contact with the skin during treatment.The Coolsculpting System generates “destructive” energy (cold) in the handpiece and transfers it to the subcutaneous fat via direct contact with the skin. The non-contact radiofrequency, and contact laser devices, have their respective energy selectively absorbed and converted to heat within the tissues designated for destruction.

CoolSculpting treatment (Zeltiq Aesthetics, Pleasanton, CA) is indicated for reduction of fat in the abdomen, brassiere rolls, lumbar rolls, hip rolls/flanks, inner thigh, medial knee, peritrochanteric areas (saddlebags), arms, and ankles. This device has an applicator, which is applied to the treatment area, allowing tissue to be vacuumed up between 2 cooling panels measuring 4.5x7 cm (31.5 cm²) each, for 30 to 60 minutes. The amount of cooling is determined by thermistors that monitor the skin temperature.³The aim of cryolipolysis is to cause selective damage to the adipocytes without producing any dermal damage. The exact mechanism of the selective destruction of adipocytes by cooling is still not fully understood.In an early animal study by Manstein et al,⁴ cold exposed subcutaneous fat had a nearly 80% reduction of the superficial fat layer at varying temperatures at 3.5 months. They observed that lower temperatures (−5°- −7°C) had a higher possibility of