As people look for ways to tighten skin and remove unwanted body fat and cellulite, non-invasive body contouring procedures are increasingly in demand in med spas and esthetic medical practices across the country (Alizadeh et al, 2016).

These procedures include (Alizadeh et al., 2016): 

• Cryolipolysis (Coolsculpting) 
• Radiofrequency (RF),
• Low-level laser therapy (LLLT),
• High-intensity focused ultrasound (HIFU)
• Low-frequency high powered ultrasound (body cavitation)

Non-invasive procedures are appealing as they avoid the pitfalls of surgical procedures, such as down time, costs, scarring, pain, infection risk, among other complications (Alizadeh et al., 2016).  

How do the body contouring procedures work?  

Body contouring treatment options differ in types of energy used (cold, heat, light, soundwaves) to achieve specific outcome goals.  

Low-level laser therapy

Low-level laser therapy is a non-invasive therapy performed for 30 minutes over 6-8 sessions (Alizadeh et al., 2016).  The laser therapy disrupts the cell membranes of fat cells leading to leakage of fat content and subsequent shrinkage of fat cells.

It is noted that the low-level laser treatment poses no harm to surrounding tissues (Alizadeh et al., 2016).  

A double-blinded, placebo controlled trial evaluated the use of low-level laser therapy on 67 participants with a BMI ranging from 25-30 (Jackson et al., 2009).   Patients were randomized into 2 groups, with one group receiving low-level laser therapy, and the other group receiving sham therapy. 

These sessions were provided 3 times a week for 2 weeks in both groups (Jackson et al., 2009). Treatment sites included the waist, hips, and each thigh.

Compared to the control group, those receiving the laser therapy experienced the following results: 

• Waist circumference: average reduction of approximately 1 inch (0.98”)
• Hip circumference reduction of approximately 1 inch (0.85”)
• Just over half an inch from each thigh (0.65”)

Total inches lost on average from all treatment areas combined was 3.51 inches.  In a period of 2 weeks following completion of treatment, a small fraction (0.31 inches combined from all sites) was regained.

This shows that contouring treatments need to be combined with lifestyle interventions to maintain fat loss following treatments.  

A follow up study in 2012 conducted on 689 patients noted after just 1 week of laser treatment involving 3 treatment sessions, circumference in hips, waist, and thighs combined led to a reduction of 3.27 inches (Jackson et al., 2012).  

Satisfaction rate with laser therapy sessions in another study was rated at 80% (Alizadeh et al., 2016).   

Radiofrequency (RF)

Radiofrequency uses electromagnetic waves to heat the dermal layer, break down disorganized collagen structures, and promote new collagen production (Araujo et al., 2015).  It is used to treat the following conditions (Alizadeh et al., 2016):

• Fine lines and wrinkles, including around the eyes
• Skin tightening
• Fat reduction

In one trial of nearly 40 female patients, weekly treatments of RF were applied over an 8-week period (Manuskiatti et al., 2009).  After the last treatment, 4 weeks were allowed to pass before obtaining final measurements for results.

Average abdominal circumference reduction was 3.5 cm, and thigh circumference reduction was 1.7 cm (Manuskiatti et al., 2009).  Buttocks and arms were also treated but did not show changes in circumference.  

Cellulite appearance graded before and after treatments averaged improvements of 50% (Manuskiatti et al., 2009).  

Another small study of 26 females demonstrated a 20% reduction in cellulite for nearly 70% of treated subjects after just 2 treatments using 3 passes lasting 30 seconds for each treated area (Emilia del Pino et al, 2006).  

In a review of studies, more than 90% of the studies reported significant improvements in skin laxity following treatments with RF with outcomes measured using before and after photos, biopsies, and patient satisfaction questionnaires (Alizadeh et al., 2016).   

However, it must be noted that the study methodologies used were limited, such as not blinding the researchers to who had treatment and did not have treatment, as well as factors such as small sample sizes among other limitations (Araujo et al., 2015). 

For cellulite and subcutaneous fat reduction, studies consistently show reductions of approximately 2 cm circumference in treated areas, with treatments commonly involving 6-12 sessions (Alizabeth et al., 2016). 

Ultrasound cavitation

Ultrasound cavitation uses a low frequency ultrasound wave pattern to create micro-bubbles in fat cell membranes leading to leakage of fat content from fat cells, with subsequent clearance from the body (Mohammadzadeh et al., 2016).  

In a randomized-controlled trial of 50 women split into two groups of 25, half the group received a calorie restricted diet plan which reduced calories by 500 from their calculated baseline needs. 

The intervention group also received the calorie restriction paired with one 40 minute session of RF and one session of ultrasound cavitation each week (Mohammadzadeh et al., 2016).  

The study ran 5 weeks, and the women had BMI’s at the start of the intervention between 25 and 30.  

Comparisons of waist circumference, abdominal circumference, fat mass, and BMI were made between groups at the start of the study, at 3-weeks, and at 5-weeks.  

Findings at the end of the 5 weeks were as follows (Mohammadzadeh et al., 2016): 

• 9% abdominal circumference reduction compared to 5% in the control group
• 3.76 cm waist circumference reduction compared to 2.4cm in the control group
• Total combined reduction from waist and abdomen of 9.51 cm compared to 3.12 cm in the control group

Researchers note in another study of 30 individuals, ultrasound cavitation was useful in reducing abdominal circumference by 3.95 cm in a 3 month period.

No adverse effects in either of the studies (Mohammadzadeh et al., 2016).  

High-intensity focused ultrasound (HIFU)

Ultrasound modalities have been in use since the 1940’s to treat kidney stones, uterine fibroids, tumors, and more recently, unwanted fatty tissue (Alizadeh et al., 2016). 

HIFU focuses ultrasound waves on a particular area, causing molecules to vibrate and generate heat.  HIFU is an FDA approved procedure for the removal of unwanted subcutaneous fat cells.

In the case of targeting unwanted body fat, these waves cause destruction and death of fat cells by achieving destruction of their blood supplying vessels (Alizadeh et al., 2016).  Simultaneously, FDA approved devices spare surrounding tissues.

In a randomized-controlled clinical trial with 180 subjects using treatment for 15 minutes to treat the flanks and anterior abdomen, average waist size reduction was 2 cm in circumference. 

In a separate retrospective study of just over 80 subjects, treatment sessions lasting 60 to 90 minutes resulted in a waist size reduction on average of 4.6 cm in circumference (Alizadeh et al., 2016). 

Side effects of treatment in the studies included:

• Bruising
• Pain
• Tenderness
• Swelling
• Firmness of tissue (common in treated tissue until it can be broken down and absorbed by the body

These studies noted no significant changes in body weight or BMI.  This is expected with body contouring as the goal is to reduce subcutaneous (under the skin) fat tissue rather than to produce substantial weight loss.

Recovery time was minimal, and no major adverse effects were noted in these trials in terms of blood lipid levels, or burns or scars or bodily harm of any kind (Alizadeh et al., 2016).

Cryotherapy (Cool Sculpting)

Cool sculpting or cryotherapy is a safe and effective method for permanent destruction of fat tissue.  More can be learned in the following article:  Cool Sculpting:  how does it work, and how effective are treatments?

Wrap-up 

Body contouring is shown repeatedly to be safe and effective at reducing superficial fat, and enhances reduction of waist, thigh, buttocks, and abdominal circumferences with or without weight loss interventions.

For those losing weight, superior reductions in the waist and hip circumferences are seen in those who also undergo body contouring.  

Treatments are non-invasive and are well tolerated with minimal adverse effects.

While body contouring does appear to take around 0.5 to 1” or so off of treated areas, it is noted that body contouring does not contribute to meaningful weight loss.  

Rather, the goal of body contouring is to sculpt and shape areas by reducing the fat content under the skin–such as cellulite or unwanted belly fat outside the muscle wall. 

For this reason, studies on body contouring focused on normal weight or overweight but not obese individuals.   

Further, the application of RF energy can support tightening of loose skin.  

How we can help

Lancaster Wellness staff are trained in the application of body contouring.

We currently offer the following procedures for body contouring:

• RF
• Ultrasound cavitation
• Low level laser therapy
• Cryotherapy

Schedule a consultation for free online here, or call us at 717-297-7900, and lets get rid of that annoying little bit of unwanted fat!

Article by Donovan Carper MSN RN CPT CHC

References

Alizadeh, Z., Halabchi, F., Mazaheri, R., Abolhasani, M., & Tabesh, M. (2016). Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat. International journal of endocrinology and metabolism, 14(4), e36727. https://doi.org/10.5812/ijem.36727 

Araujo AR, Soares VP, Silva FS, Moreira Tda S. Radiofrequency for the treatment of skin laxity: mith or truth. An Bras Dermatol. 2015;90(5):707-21. [PubMed ID: 26560216]. https://doi.org/10.1590/abd1806-4841.20153605 

Bani, D., Quattrini Li, A., Freschi, G., & Russo, G. L. (2013). Histological and Ultrastructural Effects of Ultrasound-induced Cavitation on Human Skin Adipose Tissue. Plastic and reconstructive surgery. Global open, 1(6), e41. https://doi.org/10.1097/GOX.0b013e3182a7f222v 

Emilia del Pino, M., Rosado, R. H., Azuela, A., Graciela Guzmán, M., Argüelles, D., Rodríguez, C., & Rosado, G. M. (2006). Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs. Journal of drugs in dermatology : JDD, 5(8), 714–722

Jackson, R. F., Dedo, D. D., Roche, G. C., Turok, D. I., & Maloney, R. J. (2009). Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study. Lasers in surgery and medicine, 41(10), 799–809. https://doi.org/10.1002/lsm.20855 . 

Jackson, R. F., Stern, F. A., Neira, R., Ortiz-Neira, C. L., & Maloney, J. (2012). Application of low-level laser therapy for noninvasive body contouring. Lasers in surgery and medicine, 44(3), 211–217. https://doi.org/10.1002/lsm.22007 

Kołodziejczak, A., & Rotsztejn, H. (2022). Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region. Lasers in medical science, 37(2), 895–903. https://doi.org/10.1007/s10103-021-03329-7 

Manuskiatti, W., Wachirakaphan, C., Lektrakul, N., & Varothai, S. (2009). Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study. Journal of the European Academy of Dermatology and Venereology : JEADV, 23(7), 820–827. https://doi.org/10.1111/j.1468-3083.2009.03254.x 

Mohammadzadeh, M., Nasrfard, S., Nezafati, P., Dahoue, M. A., Hasanpour, N., Safarian, M., … & Norouzy, A. (2016). Reduction in measures of adiposity using a combination of radio frequency and ultrasound cavitation methods. European Journal of Integrative Medicine, 8(3), 313-316.