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April 21, 2006 -- Diet and exercise are probably the best way to slim down and tone for beach season, but there may be a new option on the block.
Fat-dissolving and skin-tightening procedures for body contouring that are less invasive can seem oh-so-appealing when weighed against other options, such as liposuction. Some of the latest innovations include mesotherapy (lipodissolve), which involves the injection of various cocktails into the skin to dissolve fat, Thermage (also known as Thermacool or Thermalift), which uses radiofrequency to tighten facial skin for a "nonsurgical" face-lift, and LipoSonix, which uses high-intensity ultrasound to target and destroy fat cells.
No Such Thing as a Magic Wand
But buyer beware, say plastic surgeons at the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Orlando, Fla.
"Be aware that we live in a very competitive environment whereby youth is king and people are looking for less-invasive procedures, and these procedures are now for the first time being directly marketed by the manufacturer in consumer magazines," points out session moderator Franklin L. DiSpaltro, MD, a plastic surgeon in West Orange, N.J., and a past president of ASAPS.
No one has discovered a magic wand, he says. "It's still the technician behind the wand that gets the result and if you look at the advertising you would think we discovered the magic wand.""
Take Thermage, for example. "We have seen questionable results and some good results, but we still don't know if it is the surgeon or the machine," he says.
And mesotherapy may be particularly problematic due to the influx of programs being hawked in the popular press and on the Internet. "It seems to work in certain practitioners' hands, but we don't know their formulation, skill set, and how they control their environment," he says.
"A lot of people use a lot of substances [for mesotherapy]," adds Peter B. Fodor, MD, a plastic surgeon in Los Angeles and an associate clinical professor of plastic surgery at UCLA.
"I have not seen a patient saying, 'I had it done and it worked,' but I have seen many patients who had mesotherapy and now have complications," he tells WebMD. Such complications may include skin indentations, changes in skin color, and infections.
"Based on what I see from my patients complaining about it, I would not be recommending mesotherapy ," he says.
ASAPS formed an ad hoc committee to further investigate the pros and cons of mesotherapy, he says. "We don't know whether it works or not because it is used by a lot of people who inject all kinds of chemicals into the skin," Fodor explains. "Our committee looked at the literature and we found no uniformity to what is being used, how much is being injected, and where it is being injected, so we could not draw any conclusions," he says. That's why ASAPS is conducting a clinical trial at five centers to definitively answer questions about mesotherapy. "We will do some studies with an exact and rigid protocol so we can compare apples to apples, not apples to oranges," he says.
Beaming Fat Away
Fodor is more enthusiastic about the LipoSonix technology. "I am very optimistic," he says." I love the results," he says citing as much as a 7-centimeter reduction in waist circumference seen in clinical trials conducted in Mexico. This technology, which uses high-intensity ultrasound waves, beamed about an inch under the skin to break up fatty tissue, has been studied in both pig models and in 33 people in Mexico, he says. The company has applied for FDA status to begin preclinical studies in the U.S. and expects such trials to begin in 2007.
So far there have been no signs of safety problems, he says. Studies have shown that the treatment did not burn or seriously irritate the skin, and it reduced fat on the abdomen without causing serious complications by sending too much loose fat into the bloodstream.
"I would like to say it is ready to replace liposuction, but it's not -- yet," he says. Still it does have certain benefits over liposuction namely that a person can have the treatment and go to lunch afterward, Fodor says. Unlike liposuction, the new technology does not involve pain, scars, anesthesia, or a long recovery time. Only some topical anesthesia is used, he says.
Slow and Steady Wins the Race
"If we would right from the beginning, go for broke and take the chance of doing several treatment layers at a time, the results would be very dramatic, but we want to walk before we run," he says. Fodor serves as chair of the LipoSonix Scientific Advisory Board.
"Safety and precision matters come first," he says. "It's one thing to reduce fat and another to do so in a precise body sculpting manner."
DiSpaltro isn't totally sold in Liposonix just yet, he tells WebMD.
"I am not pessimistic, but show me the proof," he says. "The world is not made up of magic wands."
SOURCES: Franklin L. DiSpaltro, MD, plastic surgeon, West Orange, N.J.; past president, American Society for Aesthetic Plastic Surgery. Peter B. Fodor, MD, plastic surgeon, Los Angeles; associate clinical professor of plastic surgery, UCLA.