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#REDIRECT [[Fat removal procedures]]
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'''Non-surgical liposuction''' techniques use laser energy, radiofrequency, ultrasound or cold ([[cryolipolysis]]) to reduce fat.<ref>{{Cite journal
| doi = 10.1016/j.cps.2011.05.002
| issn = 1558-0504
| volume = 38
| issue = 3
| pages = 503–520, vii-iii
| last = Mulholland
| first = R. Stephen
|author2=Malcolm D. Paul |author3=Charbel Chalfoun
| title = Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level laser therapy
| journal = Clinics in Plastic Surgery
| date = 2011
| pmid = 21824546
}}</ref> Devices are applied directly to the skin of the treatment area and do not employ injections (as in [[injection lipolysis]]) or incisions (as in [[Liposuction#Laser Assisted|laser assisted liposuction]]). Although fat loss is more subtle with non-surgical lipolysis techniques compared to surgical liposuction, non-surgical lipolysis techniques have several advantages including reduced risk, reduced cost, and reduced healing time.<ref>{{Cite journal
| doi = 10.1097/PRS.0b013e3182a806b3
| issn = 1529-4242
| volume = 132
| issue = 6
| pages = 1411–1420
| last = Fischer
| first = John P.
|author2=Ari M. Wes |author3=Joseph M. Serletti |author4=Stephen J. Kovach
| title = Complications in body contouring procedures: an analysis of 1797 patients from the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program databases
| journal = Plastic and Reconstructive Surgery
| date = 2013
| pmid = 24005367
}}</ref> Laser,<ref>{{Cite journal
| doi = 10.1002/lsm.22119
| issn = 1096-9101
| volume = 45
| issue = 3
| pages = 141–147
| last = Jackson
| first = Robert F.
|author2=Gregory C. Roche |author3=Steven C. Shanks
| title = A double-blind, placebo-controlled randomized trial evaluating the ability of low-level laser therapy to improve the appearance of cellulite
| journal = Lasers in Surgery and Medicine
| date = 2013
| pmid = 23508376
}}</ref> radiofrequency,<ref>{{Cite journal
| doi = 10.1016/j.clindermatol.2007.05.005
| issn = 0738-081X
| volume = 25
| issue = 5
| pages = 487–491
| last = Alster
| first = Tina S.
|author2=Jason R. Lupton
| title = Nonablative cutaneous remodeling using radiofrequency devices
| journal = Clinics in Dermatology
| accessdate = 2014-06-16
| date = 2007
| url = http://yadda.icm.edu.pl/yadda/element/bwmeta1.element.elsevier-32407175-550c-3553-a700-4ee82da57f56
}}</ref> and ultrasound<ref>{{Cite journal
| doi = 10.1016/j.det.2013.09.001
| issn = 1558-0520
| volume = 32
| issue = 1
| pages = 71–77
| last = Minkis
| first = Kira
|author2=Murad Alam
| title = Ultrasound skin tightening
| journal = Dermatologic Clinics
| date = 2014
| pmid = 24267423
}}</ref> techniques provide additional advantages of tissue tightening.<ref>{{Cite book
| publisher = CRC Press
| isbn = 9781841849331
| last = Goldman
| first = Mitchel P.
|author2=Richard E. Fitzpatrick |author3=E. Victor Ross |author4=Suzanne L. Kilmer |author5=Robert A. Weiss
| title = Lasers and Energy Devices for the Skin
| date = 2013
}}</ref> Because there is no suction involved, terms such as laser lipolysis, cryolipolysis or body contouring are preferred to non-surgical liposuction.

==History and development==
In 2010, Zerona became the first non-invasive lipolysis device approved by the FDA following a randomized controlled trial demonstrating circumference reduction of the waist, hip, and thighs.<ref>{{Cite journal
| doi = 10.1002/lsm.20855
| issn = 1096-9101
| volume = 41
| issue = 10
| pages = 799–809
| last = Jackson
| first = Robert F.
|author2=Doug D. Dedo |author3=Greg C. Roche |author4=David I. Turok |author5=Ryan J. Maloney
| title = Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study
| journal = Lasers in Surgery and Medicine
| date = Dec 2009
| pmid = 20014253
}}</ref> Zeltiq obtained FDA approval in 2010 for cryolipolysis of the flanks and additional approval in 2012 for cryolipolysis of the abdomen.<ref>{{cite web |url= http://www.accessdata.fda.gov/cdrh_docs/pdf12/K120023.pdf |title=510(k) filing for Zelitq CoolSculpting |date=2012 |website=FDA.gov }}</ref> Strawberry was approved by the FDA in 2013<ref>{{cite web |url= http://www.accessdata.fda.gov/cdrh_docs/pdf13/K130341.pdf |title=510(k) filing for Laser Lipo Ltd Strawberry |date=2013 |website=FDA.gov }}</ref> SculpSure, the world's first hyperthermic laser for non-invasive fat destruction, obtained FDA approval in 2015<ref>{{cite web |url= https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K150230 |title=510(k) Premarket filing for SculpSure |date=2015 |website=FDA.gov }}</ref>

On January 21, 2005, Meridian Medical received FDA approval for the Lapex 2000.<ref>{{citation |url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K034009 | title= 510(k) Premarket Notification |last= K034009 |first= FDA | date=2005 |website= www.accessdata.fda.gov }}
</ref>
On December 29, 2008, Meridian received FDA approval for the Lapex BCS.<ref>{{citation |url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K081962 | title= 510(k) Premarket Notification |last= K081962 |first= FDA | date=2008 |website= www.accessdata.fda.gov }}
</ref> In 2013, the lipo laser division of Meridian Co. Ltd. separated from the parent company to become YOLO Medical Inc., retaining the patents. During this transition, the Lapex line was rebranded as the YOLO Curve.<ref>{{citation |url=http://www.yolomedical.com/newsroom_press.php?i=51 | title= YOLO Medical Now Manufacturing In Canada |last= YOLO Medical |first= PR | date=2013 |website= www.yolomedical.com/ }}
</ref>
On April 24, 2015, YOLO Medical received FDA approval for the successor to the Curve, known as the Lipofina Laser System.<ref>{{citation |url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K143741 | title= 510(k) Premarket Notification |last= K143741 |first= FDA | date=2015 |website= www.accessdata.fda.gov }}
</ref>

==Techniques==

===Low level laser light===
Low level laser light reduces the stability of [[adipocyte]] cell membranes, allowing cells to release their stores of fat without damaging the cell.<ref>{{Cite journal| issn = 1085-5629| volume = 32| issue = 1| pages = 35–40| last1 = Nestor| first1 = Mark S.| last2 = Newburger| first2 = Jessica| last3 = Zarraga| first3 = Matthew B.| title = Body contouring using 635-nm low level laser therapy| journal = Seminars in Cutaneous Medicine and Surgery| date = March 2013 | pmid = 24049928}}</ref><ref>{{Cite journal| issn = 0032-1052| volume = 110| issue = 3| pages = 912–922; discussion 923–925| last1 = Neira| first1 = Rodrigo| last2 = Arroyave| first2 = José| last3 = Ramirez| first3 = Hugo| last4 = Ortiz| first4 = Clara Lucía| last5 = Solarte| first5 = Efrain| last6 = Sequeda| first6 = Federico| last7 = Gutierrez| first7 = Maria Isabel| title = Fat liquefaction: effect of low-level laser energy on adipose tissue| journal = Plastic and Reconstructive Surgery| date = 2002-09-01| pmid = 12172159| doi=10.1097/00006534-200209010-00030}}</ref> Because the fat is released into the extracellular space, cardio based exercise is usually promoted after the procedure. Exercise increases lymph flow and is thought to also promote the use of the lipids as an energy source. This is also why adequate hydration is encouraged. The laser technologies are differentiated mainly by the wavelength of light used.

===Ultrasound===
Focused thermal ultrasound techniques work by raising the tissue temperature above 56&nbsp;°C, resulting in coagulative necrosis of adipocytes, with sparing of vessels and nerves. Passive heating of the skin may also induce collagen remodeling.<ref>{{Cite journal| doi = 10.2147/CCID.S69118| issn = 1178-7015| volume = 8| pages = 47–52| last = Fabi| first = Sabrina Guillen| title = Noninvasive skin tightening: focus on new ultrasound techniques| journal = Clinical, Cosmetic and Investigational Dermatology| date = 2015| pmid = 25709486| pmc=4327394 }}</ref><ref>{{Cite journal| doi = 10.1007/s00266-011-9700-5| issn = 1432-5241| volume = 35| issue = 5| pages = 901–912| last1 = Jewell| first1 = Mark L.| last2 = Solish| first2 = Nowell J.| last3 = Desilets| first3 = Charles S.| title = Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound| journal = Aesthetic Plastic Surgery| date = October 2011 | pmid = 21461627}}</ref><ref>{{Cite journal|url = |title = Effect of low-intensity, low-frequency ultrasound treatment on anthropometry, subcutaneous adipose tissue, and body composition of young normal weight females.|last = |first = |date = Sep 2014|journal = J Cosmet Dermatol.|accessdate = |doi = 10.1111/jocd.12101|pmid = 25196687 |volume=13 |pages=202–7}}</ref><ref>{{Cite journal|url = |title = Use of transcutaneous ultrasound for lipolysis and skin tightening: a review.|last = |first = |date = Apr 2014|journal = Aesthetic Plast Surg.|accessdate = |doi = 10.1007/s00266-014-0286-6|pmid = 24567045 |volume=38 |pages=429–41}}</ref>

===Radiofrequency===
[[Radiofrequency]] devices work by producing an alternating flow, which creates an electric field over the skin. The electric field shifts polarity millions of times per second, that causes a change in orientation of charged particles.<ref>{{Cite journal| isbn = 978-0-323-32197-6| pages = 21|last1 = Orringer| first1 = Jeffrey| last2 = S Dover| first2 = Jeffrey|last3 = Alam| first3 = Murad|title = Body Shaping, Skin, Fat, Cellulite}}</ref>

===Cryolipolysis===
[[Cryolipolysis]] is the term for using cryogenics to induce lipolysis. Adipose tissue is cooled above freezing causing localized cell death and inflammation.<ref>{{Cite journal| doi = 10.1111/j.1524-4725.2009.01259.x| issn = 1524-4725| volume = 35| issue = 10| pages = 1462–1470| last1 = Zelickson| first1 = Brian| last2 = Egbert| first2 = Barbara M.| last3 = Preciado| first3 = Jessica| last4 = Allison| first4 = John| last5 = Springer| first5 = Kevin| last6 = Rhoades| first6 = Robert W.| last7 = Manstein| first7 = Dieter| title = Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model| journal = Dermatologic Surgery | date = October 2009 | pmid = 19614940}}</ref>

== Devices ==
There are several devices on the market.

{| class="wikitable"
|-
! Device !! Manufacturer !! Mechanism !! Wavelength
|-
| [[SculpSure]] || Cynosure || [[Laser lipolysis with sapphire cooling|Laser]] ||
|-
| Curve || YOLO Medical || [[Low level laser therapy|Low level laser]] || 658&nbsp;nm
|-
| Lapex 2000 || Meridian Medical || [[Low level laser therapy|Low level laser]] || 658&nbsp;nm
|-
| Zerona || Erchonia Corp || [[Low level laser therapy|Low level laser]] || 635&nbsp;nm divergent beams
|-
| Strawberry || Laser Lipo Ltd || [[Low level laser therapy|Low level laser]] || 660&nbsp;nm
|-
| I-Lipo || Chromogenex || [[Low level laser therapy|Low level laser]] || 650-660&nbsp;nm
|-
| Smoothshapes || Cynosure || [[Low level laser therapy|Low level laser]] || 650&nbsp;nm and 915&nbsp;nm
|-
| Lumislim Titan || Medisico Plc || [[Low level laser therapy|Low level laser]] || 650&nbsp;nm and 940&nbsp;nm
|-
| BTL Exilis Elite || BTL Aesthetics|| [[Radio frequency#In medicine|Radiofrequency]] ||
|-
| BTL Vanquish ME || BTL Aesthetics|| [[Radio frequency#In medicine|Radiofrequency]] ||
|-
| Thermage || Solta Medical || [[Radio frequency#In medicine|Radiofrequency]] ||
|-
| Endymed || Caesarea || [[Radio frequency#In medicine|Radiofrequency]] ||
|-
| Infini || Lutronic || [[Radio frequency#In medicine|Radiofrequency]] ||
|-
| Tri-pollar || Pollogen || [[Radio frequency#In medicine|Radiofrequency]] ||
|-
| Liposonix || Solta Medical || [[High-intensity focused ultrasound|Thermal Focused Ultrasound]] ||
|-
| UltraShape || Syneron/Candela Inc || [[Nonthermal Focused Ultrasound]] ||
|-
| CoolSculpting || [[Zeltiq Aesthetics]] || [[Cryolipolysis]] ||
|-
| Lipo Angel Plus || Lipo Angel || [[Ultrasonic Cavitation, Radio Frequency, Low Level Laser therapy ]] ||
|}

== Comparison to surgery ==
Costs vary, depending on treatment area and clinic prices. Total cost, rather than cost per treatment, is the relevant indicator. There may be one or two days of discomfort after each treatment, but no prolonged recovery time and no discontinuation of daily activities.{{cn|date=October 2017}}

==Legal status==
On August 19, 2014, YOLO Medical filed a lawsuit alleging patent infringement against the following: Chromogenex Technologies Ltd., Chromogenex US, Inc., Strawberry – Laser Lipo Ltd., Lilia Enterprises, LLC., Lipolaser Centers of America, One Source Media, Brandon Robinson, Jon Perlman, M.D., David Halpern, M.D., Leonard Grossman, M.D., Stephen Ronan, M.D., F.A.C.S. and VB Laser Trim Clinic.<ref>{{citation |url=http://www.prnewswire.com/news-releases/yolo-medical-sues-chromogenex-technologies-strawberry---laser-lipo-for-patent-infringement-272546341.html | title= YOLO Medical sues Chromogenex Technologies Strawberry - Laser Lipo for patent infringement |last= PR Newswire |first= UBM | date=2014 |website= www.prnewswire.com/ }}
</ref>

Various lipolysis techniques ("actes de lyse adipocytaire à visée esthétique") including [[injection lipolysis]], RF, laser, ultrasound, and [[cryolipolysis]] were forbidden in France by a decree of the French Public Health Authority on 11 April 2011. The decree was revised on 17 February 2012, distinguishing invasive techniques, which remain forbidden, from permitted non-invasive techniques; laser, RF, ultrasound and cryolipolysis that did not penetrate the skin became legal, and injection lipolysis and [[mesotherapy]] remained illegal. Laser devices that involve inserting the probe through the skin transcutaneously but do not suck out the liquefied material are also prohibited. Surgeons are permitted to perform surgical liposuction techniques using laser-assisted lipolysis so long as suction is performed.<ref>{{Citation
| title = Décret n° 2011-382 du 11 avril 2011 relatif à l'interdiction de la pratique d'actes de lyse adipocytaire à visée esthétique
| url =http://legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000023845272#LEGIARTI000023846926
| accessdate = 2015-01-08
| date = 2011
| website = legifrance.gouv.fr
}}</ref>
<ref>{{citation |url=http://www.sante.gouv.fr/questions-reponses-sur-le-decret-d-interdiction-des-lipolyses.html | title= Questions / answers on the prohibition order of lipolyses |last= Touraine |first= Marisol | date=2012 |website= www.sante.gouv.fr }}
</ref>

==References==
{{reflist|30em}}

[[Category:Medical ultrasonography]]
[[Category:Management of obesity]]
[[Category:Plastic surgery]]

Latest revision as of 20:52, 2 December 2018

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