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COSMETIC MEDICINE

leased. The lipids are released into
the interstitial space and removed
by the lymphatic system. There-
fore, there is volume reduction in
fat without inducing cell death.
On average, patients undergo six
to 12 treatments every 48 hours
for a period of two weeks8.
Emerging technologies are on the
horizon that promise greater
agility with a smaller “footprint.”
The eonFR is a cart-based system
using a 1064 nm laser. It is a plat-
form meant to be used for multi-
ple aesthetic indications including
body contouring among others. It
uses a powered articulated arm to
deliver the laser energy and cool
the skin simultaneously without
any skin contact. The surface area
fat. Although the mechanism of action is not fully understood, the is significantly larger due to this capability and the set-up time is
cold exposure is thought to create an inflammatory reaction within minimal with has no post-treatment required. The physician deter-
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the adipocytes leading to apoptosis . CoolSculpting is FDA-ap- mines the treatment zone, selects it, reviews it with the visualized
proved for reduction of fat in the abdomen, flank, thighs, back, light and implements treatment with the push of a button. It is cur-
arms, upper buttock, and submental region. During the procedure, rently pending FDA clearance.
a vacuum applicator is attached to the targeted area which draws Another technique for noninvasive fat reduction is high frequency
tissue into an applicator cup, and this is gently held between two ultrasound (UltraShape ) which emits acoustic waves of focused
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cooling panels. The procedure usually takes between one to three ultrasonic energy to target only subcutaneous fat at a controlled
hours depending on the number of areas addressed. Studies have depth. The energy is transmitted through pulsed ultrasound to me-
demonstrated that average reductions in the subcutaneous fat layer chanically target the adipocytes without increasing the temperature
range from 14%-25.5%, 3,4,5. The most common side effects include in the surrounding tissues. Only areas with at least 1.5cm of fat
localized erythema, bruising or swelling, and decreased sensation thickness should be treated, and it is recommended that patients
that can last one to eight weeks. After therapy, cryolipolysis has not undergo a series of three treatments spaced two weeks apart to see
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found to increase serum lipid levels or liver function tests . optimal results. The maximum fat thickness reduction is usually seen
Laser fat reduction (SculpSure , Zerona ) is another technology between 15 and 30 days after the final treatment .
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that use laser therapy to target subcutaneous adipose tissue without Radiofrequency energy devices (Thermage , Velashape ) use ei-
affecting the dermis. SculpSure uses a laser at 1060nm to increase ther monopolar or bipolar radiofrequency energy to deep-heat fat
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the temperature of the adipose cells between 42 and 47 to damage cells, connective tissue, and dermal fibers. The mechanism is dual
the adipocytes and disrupt their structure. Over the next three action by causing immediate collagen contraction and remodeling,
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months, the lymphatic system eliminates them . Sculpsure is FDA- as well as increasing the adipocyte’s metabolism and accelerating the
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cleared for the abdomen, flanks, bank, thighs, and submental area. triglyceride egress from the cell. Thermage is a monopolar ra-
Treatment takes approximately 25 minutes per area and requires diofrequency device that is mostly used for skin tightening and cel-
multiple sessions, and it can take up to 12 weeks to see optimal re- lulite but also has a modest reduction in fat. It is FDA-approved
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sults. In contrast, Zerona uses low-level laser technology at a wave- only for the periorbital rhytids but can also be used in different areas
length of 635nm to penetrate fat and create a temporary pore in of the body. VelaShape combines 700nm-2000nm infrared light
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the cell membrane of the adipocyte through which lipids are re- and suction coupled bipolar radiofrequency to mechanically manip-
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