liposuction Archives | The Aesthetic Clinique

Coolsculpting Update 2017 – Faster, More Comfortable, Better Results

Coolsculpting’s original FDA approval was in 2009 and it was initially cleared to cool skin prior to dermal procedures. It was later in 2010 that the FDA approved Coolsculpting for fat reduction in the flanks (love handles). Over the next several years, the procedure has been approved for abdomen, thighs – both inner and outer with various sized handpieces to treat every body type.

What’s new is that there are 2 new indications for Coolsculpting treatment. The submental fat (double chin) can now be treated with the Cool Mini handpiece. Depending on the needs of the patient, one or two applications are needed. Treatment times are 45 minutes. There is no downtime as is customary with all Coolsculpting procedures. A 2nd treatment is needed in some patients who need larger corrections. Another exciting area of recently approved treatment is the underarm area. This is where the new Cool Petite handpiece is used. Loose skin is not going to improve but that annoying “bat wing” can be reduced with these treatments.

In 2016, there was a significant change to the handpieces used for treatment called the CoolAdvantage Handpieces. (Not all practices have upgraded to these, so patients must inquire). The difference is that these handpieces are more shallow – the amount of suction witl therefore be less. The cooling plate is continuous rather than just the sides. The area treated is now more uniformly cooled than with the prior handpieces. These changes result in:

More comfortable treatments
Treatment times of 35 minutes vs the usual 60 minutes
Faster onset of results – as little as 3 weeks
Less bruising and post procedure pain

Soon after Coolsculpting’s approval it had been noted that manual massage post treatment led to improved results. About a couple years ago it was found that using the Zimmer Z Wave in place of the massage yielded even better results. It was found that adding the Z Wave increased the treatment efficacy by 68-100%. The Z Wave uses Acoustic Pulsed Technology, which sends shock waves through the skin and fat. It is a painless 5-10 minute procedure. These shock waves further injure the fat cells leading to a better result. After the Coolsculpting treatment, there are fat cells which are killed, some unaffected, and some which are “on the fence” as to whether they will survive or die. The Z Wave pushes some of these “undecided” cells over the brink. Z Wave has also been shown to lead to less post procedure discomfort.

“If one is good, two is better”. In some practices, a second Coolsculpting machine has been purchased. This allows for “DualSculpting”, treating 2 areas simultaneously. Treatment times are then cut in half using this technique.

Comparing the DualSculpting to treatments 1 year ago, two areas can now be treated in about one quarter of the time when adding the benefits of the CoolAdvantage Handpieces.

The Aesthetic Clinique has been one of the pioneers in Coolsculpting treatments. Its first machine was obtained in 2009, being one of the first 25 in the country, even before the formal FDA approval for fat reduction. All the latest handpieces are available including the CoolAdvantage, Cool Mini, and Cool Petite. The Zimmer Z Wave is a complementary service added to all Coolsculpting treatments. A second machine has just been purchased, so DualSculpting is now available at The Aesthetic Clinique.

Recent advances have made Coolsculpting significantly faster, more comfortable, and more effective. It is a great noninvasive procedure for reducing unwanted fat without downtime.

Treating the Double Chin and Jawline Fat Has Become Easy

Until recently, the dreaded double chin has been fairly difficult to treat. Liposuction was the mainstay of treatment. This can be performed under local anesthetic, but there is downtime, bruising, need to wear a chin strap, and some risks. Now, there are 3 non surgical options to treat this area and along the jawline (with 2 of them) which have no or minimal downtime.

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Kybella is a bile salt (deoxycholic acid) that is found in the gallbladder. It is natural secreted to assist the body in digesting consumed fat. It is now available in an injection form and can be used in the submental area to permanently reduce fat. It typically requires 1-2 vials per session, and about 2-4 session. This is all dependent on the amount of fat in this area. 1 month to 6 weeks in the recommended period between treatments. The procedure takes about 15 minutes. There is very minimal pain at first. It then starts burning and this lasts for up t0 30 minutes. Swelling occurs for the first 3 days that is significant. Most of the swelling is gone by a week. All swelling is gone by about 3-4 weeks and results are seen at this time. Areas other than the submental area are being investigated

Pros: short procedure, effective for submental area, long lasting results

Cons: swelling, can’t be used along lateral neck – only central portion, multiple treatments

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CoolMini from Coolsculpting is a new handpiece that is designed to treat the upper neck area. At this point, most people have heard of Coolsculpting. This technology cools fat down to a certain temperature to where it will partial die, but leave the other structures intact. The CoolMini is a newer technology from Coolsculpting that uses more uniform cooling, and doesn’t require the full one hour to get treated. It’s suction grabs onto the fatty area and stays attached for the 45 minute cycle. It can be used to the central and lateral portions of the neck. If there are large areas needing treatment, more than one session is needed and more than one attachment is needed per session.

Pros: minimal or no downtime, can treat lateral as well as submental fat, proven technology that is permanent

Cons: treatment times are 45 min per application, might need more than one application and more than one session

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Infini uses high intensity radiofrequency to treat excessive fat in the neck. It gets to the fat by use of the microneedling delivery system. It can go up to 3.5 mm which is into the superficial layer of fat. By adjusting the power and pulse duration, fat along the jawline, jowls, and submental areat can be treated. It is usually a series of 3 treatments, spaced about 4-6 weeks apart.

Pros: can treat all areas of fat in the neck and jowls, tightens skin as well and improves wrinkles

Cons: requires topical anesthetic (more painful than others), requires 3 treatments usually, mild redness and swelling afterwards for a couple days

There are now a few ways to treat the neck and double chin area. Which one is best for you is based on your desires, lifestyle, and anatomy. All are effective with minimal or non invasive techniques.

Maximizing Coolsculpting Results with CoolAdvantage and Zimmer Z Wave

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Coolsculpting has established itself as the worlds #1 noninvasive fat reduction treatment. It has over 3 million treatments worldwide and has been found to be a safe, well tolerated, and reliable procedure. It was FDA approved to cool skin to allow for anesthesia in 2009 and later in 2010, it was given the permanent fat reduction approval.

Coolsculpting treatments involve attaching a handpiece to the area of desired fat removal. There are various sizes of handpieces to assist in reaching all the different areas of the body where there is excessive fat. Most of these handpieces use a suction to pull/draw the tissue and fat into the handpiece, so a requirement (except for the outer thigh where a flat handpiece is used) is that there is “pinchable” fat. These handpieces gradually cool the area treated to the optimal temperature where the fat is killed but the surrounding tissues (skin, blood vessels, nerves) are kept safe. The attachment duration has been 1 hour until recently. It has been proven that about 25% of the fat treated will be removed during this process. It has also been shown that massaging the area treated immediately after handpiece removal improved the outcomes too. There was more fat loss and less post procedure discomfort.

There was a study last year that showed the Zimmer Z Wave treatment, done in place of the massage, lead to a 65-100% improvement in outcomes. In large volume practices, including Dr. Weiner’s office, this is now routinely performed on all Coolsculpting patients immediately when the handpieces are removed. The Z Wave uses radio pulsed technology that send shock waves through the tissues. When these waves bump against newly frozen fat cells, the already compromised cell is further damaged. This increases the amount of fat cell death from the Coolsculpting treatment. Another way to explain how it works is that with Coolsculpting, there are cells that are killed, cells that aren’t, and cells that are undecided. The Z Wave pushes some of these undecided cells to the point that they will die.

A recent advancement in the handpiece technology has been developed. This is the found in the CoolAdvantage and CoolMini handpiece. The changes consist of a more uniform cooling of the area treated. Older handpieces had cooling elements only on the sides of the handpiece cup but the newer has cooling throughout. What does this do to change the treatments? It lowers the treatment time from 1 hour to 35 minutes (45 min with the CoolMini). The newer handpieces have less depth, so more fibrous, less flexible skin areas can now be treated. This also translate into a much more comfortable treatment because there is less pulling in of the tissues. It has been found that post treatment discomfort is also less. There are reports that these handpieces are more effective because there are no longer fat pockets that might not get to the critical temperature need for death.

With the addition of CoolAdvantage technology and the Zimmer Z Wave, Coolsculpting treatment times are almost cut in half, treatments are more comfortable (during and after), and most importantly, the procedure is significantly more efficacious. When researching providers, make sure they use these new technologies.

Vanquish ME Vs Coolsculpting for Fat Reduction

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Coolsculpting ushered in the era of non invasive fat reduction in 2009. Who would ever have believed that a one hour procedure could remove fat permanently, without incisions? Coolsculpting can produce reliable fat loss of approximately 20-25% with no downtime and minimal risk. It is clearly the market leader with over 2 million treatments. For a long time, Coolsculpting stood without competition, but over the past couple years, formidable competition has been developed. The differences between Coolsculpting and Vanquish ME will be elaborated below. (Dr. Weiner has experience with both technologies, adopting the Coolsculpting in 2009 and the Vanquish in 2014.)

Research has found that a fat cell’s survival is sensitive to both heat and cold. Coolsculpting takes advantage of cooling the fat tissue to a temperature that is safe for all other structures such as nerves, muscles, and skin. After the Coolsculpting treatment, the fat cells gradually die in a process called apoptosis over the next 6-8 weeks. Subsequent treatments in the same areas yield even better results.

Vanquish ME uses radiofrequency technology to heat up the fat tissue to a point where the fat cells undergo apoptosis as well. The more treatments an individual has, the better the outcomes will be.

From a cursory perspective, it appears that these technologies are interchangeable, but that is definitely not the case. These are where they differ:

One of the major differences between these 2 technologies is that Coolsculpting requires pinchable fat that can be suctioned into the handpiece. This is a major downside to this technology because patients that have fat that can’t be drawn into the handpiece, can’t be treated. On the other hand, Vanquish ME can treat all patients. This includes the moderate to severe obese patient, who is not a candidate for the Coolsculpting. It can also treat the very fit patient who has just a small bit of fat that doesn’t go away with exercise but is not enough to place in a Coolsculpting handpiece.

The treatment area of Vanquish ME is significantly larger than with a Coolsculpting application. This is important because there have been cases of Coolsculpting treatments leading to demarcations between the treated areas. Correction of this problem is difficult, and might require liposuction. This has not been found to occur with Vanquish ME due to the large treatment areas, multiple sessions, and feathering that occurs on the edges of the area treated.

Coolsculpting has been advocated for patients with BMI’s (body mass index) below 30. This limits the procedure to those patients which are mildly overweight. On the other hand, Vanquish ME can be performed on all body types. The problem with treating the higher BMI patient’s with Coolsculpting is that they are at higher risk to have the indentations and demarcations then the lower BMI patients.

Radiofrequency has long been used to help tighten skin. The heat causes collagen stimulation and remodeling. An advantage of the Vanquish ME over Coolsculpting is it’s ability to cause some skin contraction.

Potential side effects of Coolsculpting have been shown to be numbness, bruising, prolonged pain, and paradoxical fat enlargement. The potential side effects from Vanquish has only been superficial skin burns, but that risk has been minimized with changes in the administration of the treatments.

The areas treatable with the technologies are:

Abdomen and Flanks: Coolsculpting needs at least 4 different applications to treat abdomen and flanks (4 hours). This can be performed in one treatment with the Vanquish ME, but will require 4-6 visits (about 4-5 hours).
Inner and Outer Thighs: Coolsculpting 2 different applications each leg vs Vanquish ME’s one each leg but 4-6 treatments
Chin, Gynecomastia, Bra Fat: Only treatable with Coolsculpting
Arms (“batwings”): Treatable with both technologies

Zimmer’s Z Wave has been shown to increase the fat destruction after use of both the Vanquish ME and Coolsculpting. Studies have shown an average increase of about 68% fat loss (up to 100%) when the Z Wave is used. The Z Wave is a painless 5 minute procedure that is performed at the conclusion of the treatment. Technically, the Z Wave is described as “Radial Pulse Therapy (RPT)”, which causes a shock wave to go thru the fat. It pushes fat cells that are “undecided” as to whether they are going to survive the fat destroying treatment over the edge, leading to a more effective treatment.

Both Vanquish ME and Coolsculpting have proven technologies that treat unwanted fat permanently using noninvasive techniques. Coolsculpting can be used to treat some areas that Vanquish can not. Coolsculpting has more side effects, albeit usually minor. The clear winner for the larger patient is the Vanquish ME for its ability to treat larger surface areas without the risk of lines of demarcation or indentations. Patients with loose skin will be better served with the Vanquish ME.

What Everyone Is Missing About Neothetics (NEOT) Lipo 102 Drug Candidate…Potential Blockbuster Status

Lipo 202 for abdomenal fat reduction with injections.

Lipo 202 for abdominal fat reduction with injections.

Removing and reducing fat in Americans is a huge industry in the Aesthetics market. There are multiple ways to do this:

Suction (traditional) Liposuction
Laser Liposuction
“Tickle” (vibration) Liposuction
Water Liposuction
Freezing the Fat (Coolsculpting)
Heating the Fat (Vanquish, TruSculpt, Sculpsure, Ultrashape, Liposonix)
Chemically with Injections (Kythera’s Kybella, Neothetics 102, 202)

There are positives and negatives to all the above methods. Some are more aggressive but have more downtime and risk. Pain is a limiting factor for wide acceptance with others. Devices tend to cost the physician $80,000 and up, which keeps costs high to patients. The public demands little to no downtime with reasonable costs.

Kybella’s FDA approval recently has opened up a new way to remove fat…using just injections. Kybella drug, deoxycholic acid, is a bile salt. It is normally excreted by the liver to aid in the breakdown of fat that is ingested. It has been shown to be effective in reducing the double chin fat through a series of injections. Most people will require between 2-4 treatments. The fat cell that is affected is permanently killed. That doesn’t mean your chin will stay the same after you are done with treatment. Residual fat cells will enlarge, if there is an overall weight gain due to eating habits, exercise change, or other systemic disease. There are already trials going on to use Kybella for other areas and it is just a matter of time that it will be approved for the excessive abdominal fat. It seems like a great way to remove fat…but there is one catch. There is swelling and discomfort for a few days at least. Most will overlook this minor point, but it is just this issue that makes room for Neothetic’s Lipo 102 to become a blockbuster. Neothetics doesn’t cause the fat cell to lyse (burst open) and therefore leads to significantly less inflammation and swelling.

Neothetics is researching Lipo 202 for abdominal fat reduction and Lipo 102 for fat reduction in the eye area for Graves disease patients (off label use for treating cosmetic unsightly fat bulges around the eye is obviously their intention). Neothetic’s Lipo 102 and 202 are both made with salmeterol xinafoate. Salmeterol is an asthma drug, a beta adrenergic agonist. In layman’s term, this drug acts like adrenaline (epinephrine). Fluticasone is a strong steroid and helps reduce swelling and is added to Lipo 102. The way Lipo 102 and 202 work on fat is that the salmeterol mimics exercise of the fat cell, by increasing the metabolism of the cell. Glycerol and fatty acids are expelled from the fat cell because it percieves (it is tricked into believing) that the body needs these energy sources. This will result in shrinkage of the fat cell. Just as with Kybella, multiple treatments are needed.

NEOT, Neothetics, Lipo 202 causes fat cell shrinkage

Neothetics NEOT Lipo 202 causes reduction of abdominal circumference

One of the big questions is: “How long do results last with Lipo 102 or 202?”. This question is being researched in a follow up study to the phase II study on abdominal fat using Lipo 202. Although a concern to investors, whether or not the results are long standing or not is almost irrelevant in the authors opinion. For a procedure that is 5 minutes from start to finish, with very little downtime, it’s perfectly acceptable to require touch ups months after treatment. This is the norm for Botox, dermal fillers, laser procedures, and skin tightening procedures.

The hidden gem with Neothetics is Lipo 102. There is currently no easy way to treat fat around the eye without surgery. Lasers have been tried and were abandoned because of numerous complications. If there were a way to reduce bulging fat around the eye with injections, it would be a HUGE drug. Kybella has too much swelling to be considered for this area. The eye cannot tolerate post septal swelling (within the orbit) without risk to visual loss. It is conceivable that the procedure would be similar to getting Botox around the eye, but in a slightly different area, with little to no downtime. Again, the need for touch ups would be perfectly acceptable to most patients as long as pain, risk, and downtime are minimal.

Neothetics’ Lipo 202 for treating abdominal fat in less than 5 minutes with injections seems like a great story. However, Lipo 102 has an even greater potential and without competitors for treating the bulging eye fat. With the recent acquisition of Kythera by Allergan, the other 2 large players in the aesthetics industry, Galderma and Merz, may want to have a competitor to Kybella. A fat busting injectable seems to fit in well with the offerings of either company, but it’s the authors opinion that Merz will eventually be the buyer of Neothetics later this year. With Kythera being bought by Allergan for $2 Billion, and Neothetics $146 Million Market Cap, with $70 Million in cash, it makes the buy out all more likely. In addition, there were several insider buys at the IPO price of 14 when NEOT went public late last year. There have been no insiders selling after the IPO despite the stock’s dip to just under 6 a few weeks ago. Since the purchase of KYTH by Allergan, the stock has moved up to 10.73 on large volume.

Disclosure: Dr. Weiner is a share holder of Neothetics (NEOT) and was a shareholder of Allergan (AGN) and Kythera (KYTH). At the time of posting this blog, NEOT had closed at 10.73.

New Handpieces From Coolsculpting Help Create an “INNER THIGH GAP”

Coolsculpting of Inner and Outer Thighs showing the Thigh Gap. 5 weeks after treatment.

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It seems that women are going to great lengths to try to achieve the elusive “inner thigh gap”. According to Nik Richie, the founder of the website “The Dirty” who claims to be the first to coin the phrase “inner thigh gap”, the space between the thighs needs to ideally be 5 finger breadths. Many people, including physicians, argue that women are genetically predisposed as to whether they have the ability to obtain an ITG. If one’s hips are narrow, the argument is that the legs are too close together and having a gap is not possible. Nik’s reply is that it is possible in all women with harsh dieting and exercise, with particular attention to the thigh abductor weight machine (I think he meant adductor machine). Most women would probably be satisfied with an ITG of any dimension, and feel that Nik’s definition is at the far end of the spectrum.

Coolsculpting has just made it easier for women to improve their inner thighs. Whether or not one achieves the perfect “5 finger breadth” gap is really dependent upon what status the thighs are before starting the procedure, their anatomy (genetics) and how much is related to excessive fat deposits. Each Coolsculpting treatment is able to decrease fat in the treated area by about 25%. Results can be visible at only 5 weeks but take about 3 months to fully appreciate the change. The procedure can be repeated if more fat reduction is desired.

Although Coolsculpting was initially FDA approved in 2009 (2010 approval to treat flanks), the handpieces to treat the thigh area were only recently developed and approved. Both the Coolsmooth and Coolfit handpieces are able to treat the thigh area. Treatments are nearly painless and take approximately 1-2 hours per thigh. There is no downtime and no restrictions on activity after the procedure. Risks are minimal and include bruising, numbness, and need for more treatments. Dr. Weiner feels that Coolsculpting offers a healthy method for reducing thigh fat and does not endorse the alternative, that being extreme dieting. In addition, Dr. Weiner stresses that patients must have realistic expectations as to what the Coolsculpting procedure can achieve, and have an appropriate body image before commencing treatment.

Certainly the “inner thigh gap” is a controversial subject. Dr. Weiner’s stance is that many people will not be able to achieve the gap with the Coolsculpting procedure, but they should expect improvement. There are some people who have an actual physical need to reduce their inner thighs – those who have thighs that rub during exercise or walking – who are particularly good candidates for this treatment. The bottom line is that Coolsculpting is a noninvasive, no downtime, permanent way to improve one’s inner thighs with it’s newly approved handpieces, gap or no gap.

Website

Recent Advances in Coolsculpting – 2014

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Coolsculpting is a noninvasive technique to permanently reduce unwanted fat. It was FDA approved in 2009 for treatment of the flanks. It has subsequently been FDA approved for abdominal fat and, as of April, 2014, has the indication for treating thighs.

Up until this point, all the handpieces required a suction to adhere to the area that was going to be treated. There needed to be a roll of fat that could be “grabbed” by the suction or the area couldn’t be treated. The development of the newest handpiece, the Coolsmooth, allowed for areas to be treated without the use of the suction, such as the thigh area. It also enabled the person with smaller amounts of fat or tighter skin to be treated. At the present time, each application of the Coolsmooth handpiece requires 2 hours but this will most likely be reduced to 1 hour in the future.

“Treatment to transformation” is a technique whereby multiple applications of the Coolsculpting machine are applied in either one or several sittings. By overlapping areas treated or by treating some areas 2 or 3 times, results are now approaching what liposuction can achieve – without the downtime or risk associated. The technique has been pioneered by Dr. Grant Stevens, from Marina del Ray, California.

Massaging immediately after removal of the handpiece has been shown to increase the fat loss in a recent study. This has been done in our office for at least 4 years.

Although loose skin is a theoretical risk after losing fat underneath it, Dr. Stevens has shown that this is absolutely not the case. He has seen skin contraction with his patients and has not seen cases of excess skin.

A recent study presented at ASLMS 2014 showed effectiveness in patients with gynecomastia. Two treatments were required and most patients were satisfied with their results.

Future handpieces are being developed to work on the neck/chin area, ankles, and one specifically for breast tissue. Cellulite reduction is also being studied and it looks promising. Treatment for uneven results after liposuction seems to be greatly improved with Coolsculpting as well, and the new Coolsmooth handpiece will be a huge advance in this treatment.

Coolsculpting questions answered by Dr. Steve Weiner

All these questions were answered before the CoolSmooth handpiece was available. Some areas will be treatable with this handpiece that couldn’t be previously treated.

Q: Why not ice packs to kill fat? Do you really expect us to believe it’s dangerous?

A: Can’t compare ice to Coolsculpting

Coolsculpting protects skin, muscle, and nerves by precisely controlling the temperature at which the fat is cooled to. Through feedback mechanism, the temperature is maintained over the hour of the cycle to a certain level. Ice applied would give a variable temperature and can cause skin injury. From personal experience, my daughter fell asleep with an ice pack and that resulted in hyperpigmentation on her leg.

Q: Can Insulin Dependent Diabetics Get CoolSculpting?

A: Coolsculpting for Diabetic is FINE

There is no problem getting Coolsculpting as a Diabetic. You might have slightly more numbness in the area because diabetics are predisposed to nerve issues, but this is only congecture. I have treated numerous patients with diabetes without any issues.

Q: Stomach Pain After Zeltiq (CoolSculpting)

A: Discomfort after Zeltiq will resolve

Having some discomfort after Zeltiq does occur. I goes away without treatment in 2-3 weeks or less. No special diet is needed after the treatment. If it gets severe, you should be evaluated by your physician.

Q: Does Coolsculpting Work on Inner Thighs?

A: Coolsculpting can be used for inner thighs on some people

The limiting factor is the handpiece attachment. If it can attach, then Coolsculpting can be used for this area. Another alternative for helping inner thighs without a lot of downtime is the Body-Jet, Water Assisted Liposuction. The Body-Jet will remove the fat faster and more aggressively than Coolsculpting. I’ve heard thru the grapevine that there is a Coolsculpting handpiece in the works specifically to be used for the thighs, but I don’t know if this is true or when it should be coming.

Q: Will Zeltiq Work for Buffalo Hump?

A: Zeltiq will work on Buffalo Hump if it can attach

Zeltiq will work on fat where it can attach. I’m not optimistic it can work there for you. My suggestion is to do an attachment with the handpiece without turning on the cooling to see if it will be effective. There have been no cases of embolism after the Zeltiq. There are more handpieces coming in the future which might work if the current ones don’t.

Q: How Does Zeltiq Coolsculpting Affect Cholesterol Levels in the Bloodstream?

A: Coolsculpting results in no change in cholesterol levels

After extensive testing by Zeltiq, there has been no elevation in the levels of cholesterol found in pateints undergoing Coolsculpting. This was a concern which the FDA wanted data and would have prevented approval had this not been true. I assume because the breakdown of the fat cells is slow and gradual, that the levels aren’t significantly elevated.

Q: Why is Zeltiq Used for Fat Removal?

A: FDA has approved Zeltiq / Coolsculpting for Fat Reduction

When a device is FDA cleared for an indication, it can be used off label for other purposes. It had been used in other countries for Fat Reduction and so it was appropriate to be used in the US for that. A doctor can’t use a drug or device for anything if it is cleared, only what is considered by peers or experts in the field to be appropriate and customary. Having said that, the Coolsculpting device is now cleared for the flanks for fat reduction, but it will be used anywhere where it can be attached.

Q: Is Cool Sculpting Appropriate for Women over 65?

A: Coolsculpting can be used for any age group

There is no age which is ideal for the Coolsculpting. Over 65 is not a contraindication. Results should be similar. The chances of skin laxity are probably increased becaue of decreased skin elasticity but clinically that hasn’t been seen.

Q: How Long Does the Coolsculpting Procedure Last and How Many Treatments Are Needed?

A: Coolsculpting permanently reduces fat

You can expect on average about 22% reduction in the area treated. You might need more than one treatment to get your desired results. The cryolipolysis kills the fat cells, but if you gain weight, the remaining fat will get larger and lessen the results.

Q: Will Cool Sculpting (Zeltiq) Address Skin Laxity?

A: Zeltiq will not address lax skin but…………

We have done hundreds of these precedures and haven’t seen lax skin get worse. It might be that the reduction is so slow that the skin gradually contracts on its own. In general, healthier, younger people should have more elastic skin that should contract better after Zeltiq or lipo than an older person. Also keep in mind the amount of fat reduction per treatment is generally about 22%.

Q: Zeltiq (CoolSculpting) to Treat Fat On Upper Outer Thighs?

A: Zeltiq will work on thighs

I have treated several patients with Zeltiq on their thighs. However, there needs to be an area which can be pinched that measures about 2 inches. Also keep in mind that Zeltiq removes about 25% of the fat that is treated. If this area is small, the results will be small, because 25% of a small area is even smaller.

Q: Can Zeltiq Cool Sculpting Be Used for Upper Arm Fat?

A: Yes, Zeltiq can be used on upper arm fat

With the newest handpiece, we are treating the upper arm fat. Previously, the handpiece was too big to get a good grip on that area. We haven’t used it long enough to see the results, but I will post pictures as soon as I have those clients come back.

Q: CoolSculpting Vs Laser Lipolysis

A: Zeltiq results will take longer to see than laser lipolysis but can be as good

Zeltiq is going to get a consistent result (about 25% fat loss) per treatment. Laser lipolysis is a form of liposuction which uses a laser to destroy the fat. There is much more user variability with the laser. Total amount of fat removal is potentially the same, if you do several treatments with the Zeltiq. The end results are all dependent on the person performing the treatment not necessarily the technology.

Q: CoolSculpting (Zeltiq) for Cellulite Reduction

A: Zeltiq experience is limited with cellulite

With this new technology, the primary focus is fat reduction. Right now it is not promoted for cellulite reduction. It may improve it, but that’s not it’s intention. My guess is that in the future, Zeltiq in combo with Thermage or other radiofrequency device will be the answer for cellulite.

Q: Does Zeltiq (CoolSculpting) Really Work for Fat Reduction?

A: Zeltiq works for Fat Reduction, about 22% loss with one treatment

I have an article posted here on Realself regarding Zeltiq which is quite comprehensive. The short answer is that is very consistantly works for a 20-25% fat reduction in the treated areas. Currently due to constraints by the hand piece, only the love handles, belly, and back fat can be treated. In the future, other hand pieces will allow for thighs and gluteal reduction. This is a NO DOWNTIME procedure and almost everyone considers it painless. For no downtime, no pain, no incisions, and no anesthesia, it will be a very popular procedure in the near future.

The New Coolsmooth Handpiece for Coolscupting is a “Game Changer”

Coolsmooth Handpiece for Coolsculpting

Coolsmooth Handpiece cooling plates

Coolsmooth will be available April 2014

Dr. Weiner answers questions about Coolsculpting

Coolcurve Handpiece

Coolsculpting is a noninvasive way to treat undesired fat deposits using cryolipolysis. It
permanently removes the fat with no downtime, minimal side effects, and little to no pain. It’s
been available at The Aesthetic Clinique since December 2009, with Dr. Weiner being one of
the first 25 users in the Country.

Coolsculpting is the world’s leading technology for noninvasive fat removal. It was developed by physicians at Harvard University, Dr. Rox Anderson and Dr. Dieter Manstein. They coined the term “cryolipolysis” for the process of cooling fat cells to the point that they will gradually die through apoptosis. The fat reduction, around 25% of the treated area, becomes fully appreciated at about 3-4 months, and the results will be long lasting if diet, exercise, and weight are stable.

Until the Coolsmooth handpiece was developed, the Coolsculpting procedure involved placing a suction device to the area of excessive fatty deposits. This required that there was some tissue redundancy which could be drawn into the handpiece. A subset of patients were not treatable because the tissue was too taut despite there being excessive fat deposits.

The Coolsmooth handpiece doesn’t rely on suction to be able to treat. It can conform to any body type without the need for tissue redundancy. Instead of the cooling plates being located in the sides of a suction apparatus, the plates can be laid directly on the areas of the excessive fat. The Coolsmooth handpiece has opened up the treatment candidates to virtually everyone, even those with only very small fat reductions needed.

While the FDA has only approved Coolsculpting for use on flanks (love handles) and abdomen, physicians have been treating other areas off label including: inner thighs, arms, gynecomastia, bra fat, and back fat. In addition to treating previous untreatable patients, the Coolsmooth offers a treatment for the outer thighs.

Coolsculpting just announced that there have been 1 million treatments performed using its technology worldwide. This is a testament to its effectiveness and safety record and substantiates why it is the world leader in the field of noninvasive fat reduction.

Dr. Weiner is a Facial Plastic Surgeon who “laid down his scalpel” in 2005 and now concentrates solely and injectables and lasers for cosmetic enhancements. Santa Rosa is located between Destin and Panama City Beach, Florida.

To stay abreast with Dr. Weiner:
Blog: http://stevenfweinermd.wordpress.com
Website: http://www.theclinique.net
YouTube: http://www.youtube.com/user/StevenFWeinerFacial
FaceBook: https://www.facebook.com/TheAestheticClinique

Kybella or Kythera (KYTH) ATX-101, for Double Chin Fat Removal…This is big! Dr. Steve Weiner explains it’s implications.

UPDATE: FDA APPROVED 4/29/2015, Now known as “Kybella”

UPDATE: KYTH Bought out by Allergan. Price of stock at time of original blog: 41.95, buyout price over 75

Kythera announced yesterday (9/16/2013) that they had 2 phase 3 studies for fat reduction in the submental area (underneath the chin) or “double chin” with just injections with their product ATX-101. The results were very positive, with 70% having one grade of change and 13.4% having 2 grades or more change. No serious side effects were noted. Minor side effects were discomfort and swelling which resolved. Another interesting positive outcome were the patient’s subjective scores on “happiness, self consciousness, feeling old, overweight, embarrassment, and being bothered” were all improved to the positive, several fold over the placebo. The results were sustainable as well with 90% still improved at 2 years and 80% sustaining benefits after 3 and 4 years.

Why is this a big deal? We can now destroy fat noninvasively with just injections. Granted, ATX-101 will probably only be useful for small areas of fat but it opens the door for off label use in areas other than the chin. Mesotherapy, multiple small injections to dissolve fat deposits, which has been done with non FDA approved products in the past, can now be somewhat legitimized with using FDA approved ATX-101, when and if it is approved. I suspect that ATX-101 will be approved in 2014 and late 2014 it will be in the hands of all the cosmetic physicians in the country. Soon there will be courses and experts, using the product all over the body for contouring. Heck, to have injections instead of liposuction, its a no brainer.

Another possible off label use for ATX-101 is for lipomas, benign fatty tumors, usually fairly superficial and slow growing. For those not wanting to have surgery and the scar that would follow, lipomas could be controlled with injections of ATX-101. Some people have multiple lipomas and the thought of having scars all over their body is not as attractive as getting injections to keep them “at bay” or make smaller.

There will still be a place for liposuction and Coolsculpting because the larger areas of fatty deposits won’t be treatable with ATX-101.

Looking for a good investment, buy KYTH. I suspect that this is quickly bought up by either Allergan (AGN) or Valeant (VRX) who both have cosmetic injectables (Botox, Restylane, Juvederm, Sculptra, Dysport) that would love to add this to their product lines.

The Aesthetic Clinique, and Dr. Steve Weiner, MD, Facial Plastic Surgeon, will be one of the first to have Kythera’s ATX-101 when it is FDA approved in 2014. For more information about Dr. Weiner and The Aesthetic Clinique, see http://www.theclinique.net

Improvement vs time for ATX-101

The patient’s subjective changes

KYTH study results: http://www.kytherabiopharma.com/newsroom/

LA Times article about ATX-101

Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial