The issue seems relatively simple, can a device reliably melt fat and reshape the body. Surgical approaches are still the gold standard for most of these procedures, but noninvasive body procedures have skyrocketed in popularity. Some reasons for this is that surgical procedures are expensive, may require extensive scarring, may be painful (i.e. tummy tucks requiring pain pumps), and the complication profile may be more extensive than noninvasive procedures.
Noninvasive body procedures have the advantage of little to no downtime, contracture of the areas over a period of 6 months, little to no external scarring and much lower complication profile. In addition, noninvasive body procedures are much more affordable than the traditional knife and suture approach. The goal of noninvasive body contouring is not to replace surgical procedures, but provide a real alternative option for patients seeking changes without the risks, downtime as surgery.
Noninvasive body contouring involves the use of non-surgical means to reshape the body, abdomen, legs, arms, and neck. Early systems relied on trying to heat fat through the skin. These systems were inconsistent in fat melting because the fat needs to be heated to at least 42 degrees centigrade for the fat to begin to melt. Newer techniques rely on alternate modalities to heat fat. These innovative approaches to body fat have led to more reliable results and happier patients.
BodyFx
One such technique is the use of vacuum technology with electroporation as seen on BodyFX. BodyFx has been shown in several studies to reduce fat. In 1 study patients were found to have lost an equivalent of 30% fat loss at 2.5 cm depth. The benefit of BodyFx is that the technology allows for patients to have controlled heat at the set temperature and uses the technique of bipolar radiofrequency with electroporation. Here the temperature is raised to 42 degrees centigrade and then over span of 10 minutes, radio pulses are used to disrupt the fat membranes when this temperature has been achieved. The advantage of this device is since heat is applied, contracture is to be expected allowing for patients to see both reduction of fat and contracture of the underlying tissues. With standard liposuction, especially in an older patient or one with lax skin, you can expect to see some laxity after treatment. With BodyFX, the need to trim excess skin has been obviated due to skin contracture through heat.
In addition, BodyFX has the advantage of being able to treat cellulite. Cellulite is created by dermal attachments to the skin in vertical manner in female patients. Male skin, which often does not have cellulite, has a criss crossed manner to attach to skin. BodyFx heats these dermal attachments and contracts the fat allowing for improvement in the appearance of cellulite.
Forma
Another modality used primarily for rejuvenation in both the body and the face is Forma. Forma has a temperatures sensor built in and allow for skin temperature monitoring in real time. The software algorithm allows for unprecedented safety and support. Since Forma is a top down approach (meaning through the skin down to the subcutaneous tissues), results will rely on bulk heating to contract the tissues. This can be helpful in creating collagen and improving elasticity, important components of maintenance, however patients should not expect liposuction type results as the temperature will be directed towards collagen formation and tightening. This is a great option for trying to improve slightly lax tissues where surgical alternatives are not ideal.
Radio-frequency assisted liposuction or RFAL (Bodytite or Facetite)
RFAL or radio-frequency assisted liposuction (aka Facetite or Bodytite) is another option for patient. The Facetite and Bodytite procedures work by placing a cannula underneath the skin to specifically tighten the areas of interest and then using a controlled thermal field to contract the skin. Fat will actually coagulate and contract. The benefit of this procedure is limited downtime and as close to surgical result as is possible in the market. Another benefit to radiofrequency liposuction is in patients with excess fat and some skin laxity. Previously the only option available was surgery. The reason for this was that liposuction in a patient with some skin laxity can actually worsen the appearance of the skin. The only true option were removal skin as well as fat in procedures such as tummy tucks, mini tummy tucks, and mommy lifts or mommy makeovers. With RFAL, since there is tightening of the tissues with contracture, the patient’s do not need to have surgery. These are great alternatives to surgery as patients avoid an incision, receive tightening and contracture of the tissues, and fat is removed from the area. In addition, recovery is much faster than traditional surgical approaches and patients can avoid such modalities as pain pumps afterwards. Although RFAL (Facetite and Bodytite) can not achieve the same magnitude of results as surgery, it has bridged the gap for many patients to avoid surgical procedures and tighten areas without largely invasive procedures with significant downtime and risk.
Read more on Facetite, Necktite, and Bodytite here.
What are some of the downsides of liposuction?
Liposuction is invasive, painful, expensive. For this reason, non-invasive treatments have increased in popularity dramatically over the last several years including Coolsculpt, RFAL (facetite and bodytite worldwide), Thermage, Exilis. Noninvasive body contouring represents techniques which minimize downtime.
How does BodyFX work?
Mild dermal heating can cause adipocyte apoptosis. A subsequent pulse will destroy the fat cells. Body FX is FDA approved for reduction of cellulite and causes direct apoptosis of adipocytes. BodyFX has been shown to have reductions in subcutaneous fat thickness and treatment area circumference
Science of BodyFX
Dermal heating to 42 degrees centigrade can cause adipocyte apoptosis. Body FX is FDA approved for reduction of cellulite and works by both heating to kill adipocytes as well as breaking up the dermal attachments of cellulite. BodyFX has shown reductions in subcutaenous fat thickness and treatment area circumference in a study. Since dermal heating is applied skin is tightened in treatment area to compact collagen treatment area. There are 2 main reasons for BodyFx’s effectiveness in cellulite:
- Radiofrequency heating of dermis will cause neocollagenous (new collagen formation) and reduction of fat (heating of adiopocyte triglyceraide droplet). By heating collagen the bonds which are crosslinked breakdown. This results in new collagen being formed causing collagen to become tighter. The heat of the adipose tissue is thought to activate the hormone lipase as well when the skin is heated to 42 degrees centigrade.
- Radiofrequency specifically target fat and targets adipocyte death or apoptosis. Many patients will have a combination of treatments to maximize efficacy. Once the area is heated, an extra bolt of radiofrequency is generated causing fat to electroporate.
One study examined 3 patients on only 1 side versus non-treated skin with the use of BodyfX.
This study found a significant clinical improvements were seen in abdominal circumference and reduction of subcutaneous tissue thickness on ultrasound. On electron microscopy, decreased size adipocytes and withered shape were noted. In addition, a reduction in dermal thickness was found which was more compact (making it more difficult for cellulite to reform) as well as an overall reduction in fat (nearly 3 cm) with some tightening of skin.
Are there any studies examining BodyFx and its effectiveness?
A study examined 3 patients on only 1 side versus non-treated skin. Significant clinical improvements were seen in abdominal circumference and reduction of subcutaneous tissue thickeness on ultrasound. Also noted were decreased size adipocytes and withered shape. Finally, a reduction in dermal thickness more compact was seen. Reduction in fat (nearly 3 cm) was observed as well as tightening of skin.
How is fat different from cellulite?
Fat is not the same as cellulite. Fat is overabundance of adipose tissue. Cellulite has a structural component. Cellulite occurs for the following reasons:
- skin architecture theory- subcutaneous tissue fat lobules and connective tissue septae cause fat to bulge between the septae
- hormonal component- Since cellulite is mostly seen in women there must be a hormonal contribution.
So cellulite has thin fibrous strands and facilitates herniation into dermis (cottage dermis). Male fat has criss-crossing which is more resistant than female to herniation).
Is there a grading system for cellulite?
Stages of cellulite
- positive for dimpling only- no spontaneous cellulite
- spontaneous dimpling when standing
- spontaneous dimpling and furrows when standing and lying down
How can you reduce the appearance of cellulite?
Since the dermis plays a role in appearance of cellulite, it requires treatment as well as fat. Reducing cellulite involves the following:
- Goal is to thicken dermis- stronger more dense collagen→ may prevent fat herniation
- Reduce volume of fat
- Helps collagen in dermis + reduction of fat
What is BodyFX’s effects on cellulite?
Triple effect on cellulite
- suction- remodels vertical septae and decrease pits
- rf adipocygte death and decrase size of fat noduels
- rf skin creates thicker dermis and decrease herniation of fat cells
What are the side effects of BodyFX?
- pinching or discomfort
- prickle sensation
- transient bruising
Normal cell membrane
What is electroporation?
Electroporation effect (rapid pulses to selectively target adipocytes)-creates pores in adipocytes which disables membranes with increase flow of ions and changing pH causing apoptotic cell death
Do tissues change after BodyFx?
Remodeling of tissue following body fx treatment
- heated dermis and attenuated vertical fibrous septae and electroporation damage to adipocytes
- apoptosis of adipose cells with adipocyte death
- tissue remodeling following bodyfx use with thickened more organized dermis and remodeled fibrous septae
BodyFX Safety Mechanisms
- Has a high and low impedance sensors
- Contact sensor
- Epidermal thermal sensor
- Measures 10x per second
- Device immediately terminates when cutoff temperature is reached
- Only non-invasive body contouring device in peer-reviewed human studies to both permanently kill adipose and tighten skin
BodyFX actually deliquesces fat by electroporation.
Noninvasive body contouring in Chicago can use a variety of devices including Coolsculpt, BodyFx, Forma, Thermage, and Ultherapy.