Doctors are taking aim at excess fat with lasers, ultrasound, and hypodermics. Will getting slim soon be as simple as writing a check?
Let’s skip the sanctimonious lecture about diet and exercise and cut right to the problem: exercise isn’t much fun and food tastes good. Unless you live on salmon filets and spend more time on the treadmill than you do with your family, chances are you’ve got a few trouble spots—or heck, you’re one big trouble spot from chin to toe. But what’s a woman who happens to like both French pastries and French couture to do?
Science is on the case. Sweat-free, sacrifice-free weight-loss is this generation’s moon shot and a legion of plastic surgeons, dermatologists, and white-coat experts are giving the effort their all. With so many Americans overweight and over-funded, there’s a lot of money to be made in the fat-reduction business. That’s why the search for new treatments is attracting the kind of feverish, deep-pocket research that would make NASA green with envy.
As of this writing, nothing’s been developed that can totally relieve you of the drudgery of diet and exercise. Still, if you’re willing to do your part (more cardio, fewer cookies) and get close to your ideal weight, there are new aesthetic procedures that can turn a pretty-good body into a really great one. Of course, these procedures come at a price—both metaphorically and literally. While science can help you trim those stubborn spots, smooth out the lumps and bumps of cellulite, and tighten up some of the floppy stuff, these procedures aren’t without risk, pain, and cost. Here’s a look at what science has wrought.
Liposuction has always been the procedure of choice for removing localized deposits of fat on the body. It’s a fairly simple surgery: with the patient typically under local anesthesia or IV sedation, the plastic surgeon (or dermatologist, in some cases) makes a tiny incision, inserts a long tube, and switches on a medical version of an Electrolux. Out comes the fat (a maximum of five liters—or approximately 10 pounds—for procedures done in a plastic surgeon’s office. And, after a few days of moderate pain and a few weeks of bondage in an elastic compression garment, you’ve got a sleeker set of thighs or flatter abs or a thinner waist. The fat cells that are suctioned out are gone for good (those that remain, however, can grow—if you gain weight). And although there are risks (it’s surgery, after all), the procedure has got a good safety record. Little wonder, then, that, according to the American Society of Plastic Surgeons, more than 323,605 lipo procedures were performed last year, making it the most common cosmetic surgery.
“Five liters is a large volume of fat,” says Douglas Senderoff, MD, FACS, a plastic surgeon with a practice in
But liposuction has its limitations and problems. For one thing, it’s not an obesity treatment or an end-run around poor habits. If you suction out the fat cells in one location but continue to overeat, the fat has got to go somewhere. Hello, new trouble spot! And then there are the safety issues. Though very rare, if a chunk of fat that is suctioned off breaks off and lodges in an artery, you could risk stroke or even death. And there are other potential negatives: discoloration, nerve damage, numbness, rippling, dimpling, sagging, and uneven contours. “You usually see rippling in cases where the surgeon has over-suctioned the area,” Dr. Senderoff says. The American Society of Plastic Surgeons estimates that some 20 percent of all liposuction patients will return for secondary procedures to improve unsatisfactory results.
Surgeons are always looking for refinements of the technique. The latest is Vaser Liposuction (aka LipoSelection), a three-year-old technique that uses ultrasound energy to selectively liquefy the fat before it’s suctioned, leaving blood vessels, nerves, and connective tissue relatively untouched. “We can remove fat with less trauma,” Dr. Senderoff says. Less trauma means less bruising and swelling, and, in theory at least, a quicker recovery time. “Because healing rates depend on the individual patient, there’s no true way to prove that healing is faster, but we think it is,” explains Peter Fodor, MD, a principal researcher on ultrasound-assisted liposuction. Dr. Fodor also believes that the procedure produces “smoother” results. And, according to Dr. Senderoff, “the real advantage is that Vaser can be used where traditional liposuction wouldn’t get great results—in fibrous areas, like the back or, on men, the chest area.” Vaser liposuction costs “a few hundred more” than traditional liposuction. (Dr. Senderoff charges $6,200 for “typical” inner and outer thigh liposuction with Vaser.)
With all its advantages, Dr. Fodor cautions, Vaser isn’t necessarily a better choice for every patient. “Rather than the technique that is being used, what is important is the surgeon’s ability and talent.”
Surgery-Free Tummy Tucks
Want a tighter, toned midriff but without the expense, scarring, or extensive recovery of a surgical tummy tuck? Well Thermage isn’t the answer. However, if your expectations are modest, Thermage might have something to offer. “Basically, it’s radio frequency waves which penetrate down through the top layer of skin into the deeper layers of collagen and superficial fat,” explains David Bank, MD, FAAD, a dermatologist whose nurse, Lisa Yozzo, does the in-office treatment at The Center for Dermatology, Cosmetic and Laser Surgery in Mount Kisco. “The waves cause the collagen to tighten and contract so you’ll see tightening and toning immediately and, since it stimulates the skin to produce more collagen, you’ll see even better results six months later.” Dr. Bank also maintains that Thermage breaks down some of the superficial fat, so “especially in the abdomen and belly-button region, where there’s a pocket of fat and some wrinkly, lax skin, you can both dissolve the fat and tighten the skin.”
Thermage isn’t new—it’s been used to tighten sagging facial contours for 10 years now—but the FDA granted clearance for its use on non-facial sites only within the last year. Plastic surgeons and dermatologists are starting to use the pro cedure on abdomens, legs, and even arms. “In the hands of someone experienced, it’s very safe,” Dr. Bank assures.
Thermage might be safe—and quick (about an hour for the abdomen)—but it’s not particularly comfortable. “We sedate the patient with Valium because spots can feel uncomfortably hot when the tip is applied,” Dr. Bank admits. “What’s nice about it is that it’s a one-time treatment. And you can go back to work immediately.”
Critics of the procedure say it’s not worth the cost (about $3,500 for abdominal treatment). “The result is unpredictable,” Dr. Fodor says, “and we don’t understand why it works on some patients but not on others.” Assuming you’re lucky enough to get results, they only last two to four years. “It’s not that the procedure wears off,” Dr. Bank says. “It’s just that the aging process continues.”
Cellulite-Zapping Devices that Work (Sort of)
Dimples on your cheeks are cute. Dimples on your other cheeks? Not so much. If you’re troubled by cellulite, that lumpy, bumpy stuff on the thighs and buttocks, you’re not alone. Most women (by some estimates, as many as 85 percent of all post-pubescent females) have it. Cellulite is caused by excess fat cells bulging through the septae (the mesh-like fibrous tissue in the layer just beneath the outer skin). Because aging makes a woman’s septae more fibrous and decreasing collagen production thins out her skin, cellulite tends to worsen with the years. Hormones, poor circulation, and excess body fat all contribute to the condition.
Until recently, the most effective treatment on the market was Endermologie, a kind of deep-massaging device that works mostly by mechanically breaking down the fibrous septae. An aesthetician wields the hand-held vacuum/roller device as it sucks up fat and skin and squishes it in a safe and painless (if somewhat undignified) massage session. Some 15 years ago, it became the first cellulite treatment to receive FDA approval for “temporarily reducing the appearance of cellulite.” (The key words—“temporary” and “appearance”—mean it doesn’t make the problem go away.)
A newer treatment, VelaSmooth, seems to produce more noticeable, albeit still temporary, results. “VelaSmooth combines radio frequency with infrared heat and suction,” explains Anca Tchelebi, MD, the physician director of Park Avenue Medical Spa in Armonk. “Besides providing mechanical action, the heating stimulates lipolysis [the breakdown of fat stored in fat cells].” According to VelaSmooth’s manufacturer, Syneron Inc., the device works to “reduce the appearance of cellulite and facilitate new collagen deposition.” And for those of us who’d like to see thighs that are thinner as well as smoother, Dr. Tchelebi reports that VelaSmooth treatment can provide “a circumference difference of half an inch to one or two inches.”
How well does it work? A 2005 study published in the Journal of Cosmetic and Laser Therapy followed 20 adult women who received eight biweekly VelaSmooth buttocks and thigh treatments on one side. Eighteen patients noticed a difference and 17 of the 18 patients were impressed enough to want to treat their other side. After the series of treatments, circumferential thigh measurements were reduced by 0.8 cm on the treated side (yeah, I know, but it’s something). Side effects were limited to temporary swelling in most patients, and bruising was observed in two patients.
Dr. Tchelebi believes that the treatment produces better results than this study indicates—especially when administered by a trained physician. “More studies are required with good quality control,” she says. Still, even in the best hands, VelaSmooth doesn’t produce uniform results for everybody. “All our clients are seeing an improvement in skin texture, but not all will have the same degree of response—particularly in loss of inches,” Dr. Tchelebi says. Of course, some women get lucky. Dr. Tchelebi reports that one of her patients lost two-and-a-half inches with VelaSmooth. “We recommend a series of sixteen weekly treatments,” she says. “Generally, you start seeing results after the eighth treatment.” Each session costs $200 (packages are also available).
Dominick Artuso, MD, a bariatric surgeon who offers non-invasive cosmetic procedures in his
“Two D-Actor treatments a week for three weeks is enough to make a significant difference,” he claims. “The maintenance program is just once or twice a year at most.” And the results? “Of my patients, twenty-five percent see wonderful results, twenty-five percent see nothing, and fifty percent see something but wish it could be more.” According to Dr. Artuso, the treatment is completely safe (“there’s no laser, so there’s no potential for burning”) and comfortable (“it’s very relaxing—like a vibrating massage”). Price, however, might make you squirm: $1,500 per area for six treatments and 50 percent off a second area. If you wanted the backs of your thighs and butt done, for example, it would cost $2,250. “We’re offering twenty percent off because it’s a new treatment,” says Dr. Artuso. No promises, however, that the treatment will take 20 percent off of you.
The newest high-tech weapon in the battle of the bulge is a non-invasive treatment that uses ultrasonic waves, and/or heat in the form of ultrasound energy to permanently melt subcutaneous fat. Currently in clinical trials, similar devices from two different manufacturers, LipoSonix and UltraShape, work by directing a relatively low intensity of energy to specific depths beneath the skin. While you’re mildly sedated, a technician wields the device over your skin and, in one short session, your abdomen is as much as five centimeters thinner. There’s no downtime or recovery and, one month later, if you wish, you can repeat the treatment and remove more fat. Says Dr. Fodor, the chairman of the medical advisory committee for LipoSonix, “It gives us the ability to remove fat without surgery.”
The big question is, what happens when you dissolve a whole lot of fat all at once? “We’ve been doing full blood analysis and thus far, we haven’t had a single patient with results outside normal parameters,” reports Cam Pollock, director of marketing for LipoSonix Inc. “When fat cells are destroyed by this process, the cells die,” and, according to Pollock, are slowly reabsorbed by the body. The way high-intensity focused ultrasound (HIFU) destroys fat also seems to eliminate one of the serious risks associated with liposuction: embolisms. “That’s not possible with this technique,” Pollock assures.
How well does it work? Will the future be filled with leisurely days of baguettes, Brie, and bikinis? “The truth is, there isn’t a magic bullet,” Pollock
admits, adding that, “the ideal candidate for HIFU would have a body mass index under 30”—in other words,
The near-term expectations for HIFU are that it will cost “about two or three thousand dollars per treatment,” Pollock says, and be made available sometime soon. So, you could start saving your penniesâ€¦or you could embark on a program of diet and exercise. I know, I know. Never mind.
Shots in the Dark?
Think French women know safety and efficacy better than the FDA? Willing to put up with lots of tiny injections if it means a happier bathing-suit shopping experience? Well, consider mesotherapy, an injectable, controversial therapy for cellulite and fat reduction.
With mesotherapy as its practiced in France, combinations of different medications are injected into the mesoderm, the layer of fat and connective tissue under the skin. The medications are in minute quantities but the injections are many—sometimes dozens over a single area in a single session. Generally, mesotherapy formulas consist of vitamins, homeopathic medicines, herbal extracts, and off-label pharmaceuticals (drugs approved by the FDA for other, unrelated conditions like asthma or high blood pressure).
Here in the U.S., instead of a cocktail of substances, mesotherapy often relies on injections of just one very specific substance: Lipostabil, a drug used in other countries to produce a localized, fat-burning effect but not approved for use in the U.S. However, it’s legally sold as a nutritional supplement.
“There’s no proof that mesotherapy works,” Dr. Peter Fodor says, “and, to put it mildly, we have concerns about both mesotherapy and Lipostabil. I wouldn’t let either be used on me.”
Westchester mesotherapists Drs. Artuso and Tchelebi claim it’s safe—and that it works. “It dissolves the contents of the fat cell slowly, so the body eventually absorbs it and excretes it,” Dr. Artuso says. “You can lose three-quarters of an inch wherever you accumulate fat.”
The injections are said to feel like mosquito bites and there might be temporary itching, swelling, and bruising at the injection sites. Treatment regimens and cost vary according to the practitioner. Dr. Artuso prefers three to six mesotherapy sessions and charges $1,200 per body part treated with 50 percent off a second area. (Thighs would cost $1,200 and, if you add in your butt, $1,800.) Dr. Tchelebi prefers to follow a schedule of two sessions per week with a minimum of eight sessions, each costing between $200 to $500, depending on the amount of medication required. “Some fifty percent of patients are non-responders,” Dr. Tchelebi admits. And Dr. Artuso cautions, “If you don’t watch it, you can regain the weight.”