- Dec 05, 2023
Non-Surgical Fat Removal and Cellulite Reduction: A Comprehensive Guide
AUTHOR - DR. DAVID JACK
In the ever-evolving world of aesthetic medicine, non-surgical body contouring has risen as a popular alternative to traditional surgical techniques for stubborn body areas such as liposuction and other more invasive procedures. These treatments offer solutions to reduce unwanted fat and cellulite, catering to patients who are either apprehensive about surgery or who are not at the point of needing more invasive treatments. In this article, I delve into the best non-surgical fat reduction and body contouring treatments available, and discuss the pros and cons of each.
Fat Dissolving Injections: Aqualyx, Belkyra/Kybella)
Key Indications: Aqualyx or Belkyra are indicated for localised fat deposits such as under-chin fat, small pockets of fat on the body, such as the lower abdomen, inner or outer thighs
Mechanism of Action of fat dissolving injections: Treatments like Aqualyx and Belkyra/Kybella have gained popularity as non-surgical treatments for addressing localised pockets of fat. These are injectable treatments that usually use a chemical called deoxycholic acid, which is naturally produced in the liver to emulsify fat. When this chemical is injected it causes permanent breakdown of fat cells (adipocytes), which the body then naturally eliminates via the lymphatic system. They are particularly effective for small areas of fat like under the chin, offering a quick procedure with minimal downtime.
Suitability: Ideal for those with specific, stubborn small fat pockets under the chin or on the body but generally not for larger fat deposits, particularly patients with darker skin types or those who wish to avoid laser or energy-based treatments.
Risks and Side effects of fat dissolving injections: Possible side effects include localised swelling, pain, or bruising at the injection site. Usually swelling or bruising may last for about a week or so. However, the procedure is quick, usually taking 15-30 minutes with no downtime. With Aqualyx, there is a small risk of lump formation, which usually resolves with time.
Endolift for Fat Reduction
Key Indications: Endolift is indicated for skin tightening and body contouring, due to its dual effects of reducing fat and tightening skin. It is ideal for the reduction of localised fat deposits under the chin, jowl reduction, treatment of malar (under eye bags), reduction of pockets of body fat such as the abdomen and arms as well as general body contouring.
Mode of Action of Endolift: Endolift is a semi-surgical treatment that uses a laser fibre that is inserted under the skin, under local anaesthetic. The laser operates at a wavelength that can directly stimulate skin tightening, through induction of collagen production, as well as breaking down fat cells. This allows it to both reduce pockets of fat and tighten skin at the same time - fairly unique for a minimally invasive treatment. Endolift is especially suitable for mild to moderate skin laxity, as well as small-medium pockets of stubborn fat, and offers the advantage of minimal discomfort and quick recovery. Usually, results will show progressively but they usually take up to 9 months to be fully evident.
Risks and Benefits: Discomfort is minimal due to injections of local anaesthetic, but there is often some swelling and mild bruising in the treated area for a week or so. Normally lymphatic drainage massage can help reduce swelling at 1 week post treatment.
Key Indications: Skin tightening, cellulite reduction and fat reduction.
Mode of Action: Radiofrequency or RF treatments use radiofrequency energy to heat the skin and deeper layers of the body, promoting collagen production and inducing fat cell reduction.
Radiofrequency treatments can be either non-ablative, i.e. they don’t involve breaking the skin surface and just heat from the surface of the skin, or ablative, i.e. they deliver radiofrequency energy through the skin surface via microneedles. Non-ablative radiofrequency treatments include treatments such as Forma and thermage. Ablative radiofrequency treatments are also known as radiofrequency microneedling, and include treatments such as Morpheus8. Morpheus8 is fairly unique in the field of Radiofrequency Microneedling, particularly for body treatments, as it can penetrate up to 7mm depth into the fat tissue, not only tightening lax skin but causing contracture, tightening and reduction of the subcutaneous fat layer in a particularly safe and controlled way.
Suitability: Radiofrequency treatments are ideal for individuals with mild to moderate skin laxity and cellulite, ablative radiofrequency microneedling treatments can help significantly with crepey skin around the eyes and neck, and deeper RF treatments can help with jowl laxity or small pockets of fat with skin laxity on body areas.
Risks of radiofrequency treatments: With non-ablative radiofrequency treatments there should be no discomfort (treatments can actually be quite relaxing) and no downtime. Ablative RF treatments/radiofrequency microneedling downtime is minimal but will often result in redness on the day of treatment. Benefits include smoother, tighter skin and reduced cellulite. Possible temporary redness post-treatment.
Cryolipolysis (Fat Freezing) (e.g., CoolSculpting) - for body fat pockets
Key Indications: Fat reduction in specific larger body areas such as the abdomen, thighs, and flanks.
Mode of Action: Cryolipolysis operates on the principle of selectively targeting and destroying fat cells without damaging the surrounding tissue. This non-surgical fat reduction technique works based on the specific sensitivity of fat cells, and not other cells, to cold temperatures. During the procedure, a device is applied to the targeted area, delivering controlled cooling to the fat cells beneath the skin. This cooling is carefully calibrated to reach a temperature that crystallises fat cells (adipocytes) but does not harm the overlying skin or surrounding tissues. The exposure to cold temperatures triggers a process called apoptosis, a natural cell death, in the fat cells. Unlike other cells in the body, fat cells are particularly susceptible to cold-induced stress. When these cells are cooled, their cellular structure becomes irreversibly damaged, leading them to gradually break down and die.
Once the targeted fat cells have been crystallised and undergone apoptosis, the body's natural metabolic processes take over. Over several weeks following the treatment, these damaged fat cells are processed and eliminated by the body’s lymphatic system, similar to how it disposes of other cellular debris. As this occurs the thickness of the fat layer in the treated area is reduced. This results in a visible reduction of fat and contouring of the targeted area. The complete process can take several weeks to months, and often more than one session is needed for optimal results.
Suitability: Cryolipolysis is particularly effective for reducing localised fat deposits that are resistant to diet and exercise, such as those in the abdomen, thighs, or under the chin. Its non-invasive nature, minimal downtime, and ability to provide noticeable fat reduction without surgery make it an attractive option for those with slightly larger fat pockets than those who might undergo fat-dissolving injections. It's important to note that while effective in reducing fat pockets, cryolipolysis is not a treatment for obesity or a substitute for traditional weight loss methods.
Risks of cryolipolysis: Non-invasive with very little downtime. Potential side effects include temporary redness, swelling, or numbness in the treated areas. A very small risk of a side effect called Paradoxical Adipose Hypertrophy (PAH) is associated with cryolipolysis - - it is estimated that this risk is about 1 in 4000 (0.025% risk). This side effect results in a paradoxical expansion of the treated area, and requires treatment with other fat removal methods such as liposuction.
Key Indications: Type 2 diabetes, Blood sugar regulation. While primarily used for diabetes management, the weight loss effects of semaglutide have interest for non-diabetic people seeking to reduce body fat. Clinical trials have shown significant weight loss in participants using semaglutide (15-20% in some cases), compared to other weight loss medications or lifestyle changes alone.
Mode of Action: Ozempic (Semaglutide) has a multifaceted mode of action. Originally developed for the treatment of type 2 diabetes through it’s action as a GLP-1 receptor agonist, which causes increased insulin secretion and decreased glucagon secretion by the pancreas in response to glucose (sugar) exposure (i.e. when food is consumed). In this way, Semaglutide improves glycemic control in patients with type 2 diabetes, indirectly causing weight loss by reduction of fat stores. Secondary effects of Ozempic are that it modulates appetite and calorie intake by acting on the areas of the brain that regulate hunger and fullness, leading to a decrease in overall food intake. It also can slow gastric emptying, which causes a feeling of fullness, also reducing food cravings,
Suitability: Ozempic may be suitable for individuals who are overweight or obese, particularly those struggling with weight-related health issues. However, its use for weight management needs to be carefully evaluated and monitored by doctors, given the risk profile of the medication and original uses as a diabetes treatment.
Risks of Ozempic: Common side effects include gastrointestinal issues such as nausea, vomiting, and diarrhoea. It’s important to note that long-term effects and safety profiles in the context of weight management are still being studied.
The use of GLP-1 receptor agonists like Ozempic has been linked in some studies to an increased risk of pancreatitis, i.e. inflammation of the pancreas. This condition can be serious and, in chronic forms, may potentially lead to pancreatic cancer over the longer term. Although the direct causality between drugs like Ozempic and pancreatic cancer is still debated and requires more extensive research, the potential association demands cautious use, especially in individuals with a history of pancreatitis or other pancreatic disorders.
There is also concern about an increased risk of a rare type of thyroid cancer known as medullary thyroid carcinoma (MTC) associated with GLP-1 receptor agonists. Animal studies have shown that these drugs can lead to the development of C-cell tumours in the thyroid, although it’s unclear if this risk is directly translatable to humans. Nevertheless, Ozempic carries a warning about this potential risk, and its use is generally contraindicated in individuals with a personal or family history of MTC or in those with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Other long-term risks associated with Ozempic include potential renal impairment or worsening of renal function, particularly in patients with pre-existing kidney disease.
The realm of non-surgical fat and cellulite reduction includes a diverse range of treatments catering to varied aesthetic needs, indications and patient desires. It's crucial to consult with a trained aesthetic professional who can provide guidance on selecting the most appropriate treatment for you, considering your specific requirements and discussing the risks and benefits of each option.