Commentary on: The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature

Extract

I commend the authors on their thorough review of cryotherapy for noninvasive localized subcutaneous fat reduction. ¹ Data from almost 1500 subjects across multiple body sites demonstrate that, due to its intrinsic cold-sensitivity, lipid-rich subcutaneous tissue can be preferentially targeted without damage to surrounding water-rich structures.

Yet, despite all of the evidence regarding the safety and efficacy of this modality, the underlying mechanisms by which its clinical effects occur have yet to be completely elucidated. Manstein et al ² evaluated previously treated (frozen, then thawed) pig lard, providing the first evidence that intra-adipocyte (cytoplasmic) triglycerides crystallize around 10°C, a temperature significantly greater than the freezing point of tissue water (0°C), which can now be reliably achieved in superficial subcutaneous fat with a commercially available device with a vacuum applicator. ³ Histologic samples of pig fat showed no gross evidence of adipocyte damage immediately post-exposure, suggesting that the primary mechanism of action within selectively treated adipose tissue is apoptotic and directly stimulated by cold-induced lipid crystallization.