Cryolipolysis: The Importance of Scientific Evaluation of a New Technique

Extract

As of October 8, 2014, the second most viewed publication on the Aesthetic Surgery Journal's website¹ is an article on cryolipolysis that was published over 14 months ago.² To my knowledge, this communication represents the first original article in the Aesthetic Surgery Journal to focus on “commercial experience.” It may be the first article in the Journal to quantitate cross-selling. No measurement data or patient-reported outcome data are provided. The authors report no adverse events and, after 4 initially dissatisfied patients were re-treated, no unhappy patients. No plastic surgery procedure can claim a 100% patient satisfaction rate. This reality is especially true of liposuction, because some patients inevitably have unrealistic expectations and cellulite is usually not eliminated by liposuction.³ Even after liposuction, reported patient satisfaction is ∼80%:^3,4 respectable but certainly not 100%. A claim of skin tightening⁵ based on two patients who also lost weight is tenuous.

The new verb of “coolsculpting” serves the interests of the manufacturer because both coolsculpting and cryolipolysis (a name that seems generic) are registered trademarks (Zeltiq Aesthetics, Pleasanton, CA).⁶ Today, cryolipolysis is one of the most discussed treatments on Realself.com.⁷ Experienced plastic surgeons, however, have witnessed these bubbles of interest before (eg, LipoDissolve) and will take a measured view. First, one needs to consider the standard to which the new treatment is compared (Figure 1). Magnetic resonance imaging (Figure 2), the most reliable method for imaging the fat layer,⁸ reveals that liposuction reduces the subcutaneous fat thickness by ∼45%.⁹ Liposuction removes, on average, 2420 cc of fat from multiple sites in one treatment.³ Liposuction permits 3-dimensional fat removal from confluent areas (Figure 1) with subtle, controlled differences in aspirate volumes. The fat does not return or redistribute,^10,11 and there are favorable changes in circulating triglyceride and leukocyte levels.¹² Outcome studies are supportive.³ These findings hold up to scientific scrutiny and are powerful selling points to patients, no doubt explaining the enduring popularity of liposuction. Importantly, supportive studies are free of commercial bias.^3,4,9-12