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Background: Noninvasive body contouring is becoming more popular in the United States as an alternative to liposuction. The most popular of these methods, cryolipolysis, uses precisely controlled cooling to reduce focal adiposities. The number of cryolipolysis procedures performed annually has experienced rampant growth in United States markets, and the indications have likewise diversified. In light of this change, it is imperative to perform an updated review of available US safety and efficacy data on cryolipolysis., Aims: To examine the safety and efficacy of cryolipolysis treatments in the United States using data extracted from research performed exclusively at US-based sites., Methods: In order to identify relevant studies, a literature search was conducted on PubMed using the terms "CoolSculpting" OR "cryolipolysis" OR "lipocryolysis." Articles were manually reviewed to exclude literature reviews, research not performed on humans, studies on experimental combinations of techniques, and any studies not performed in the United States., Results: The initial literature search returned 246 results. Following manual review, a total of 18 studies were selected for data extraction. Mean reduction in fat thickness by ultrasound was 2.0-5.1 mm or 19.6%-32.3%; mean reduction by body caliper was 2.3-7 mm or 14.9%-21.5%. Side effects were mild and transient. Four instances of PAH were documented in 3453 treatment cycles., Conclusions: Cryolipolysis is a safe, modestly effective method for reducing focal adiposity. Complications are rare and treatable. However, US-based studies are few in number and often of low power and/or quality. More high-quality research is needed for all aspects of cryolipolysis., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Cervicomental contour represents an important aesthetic problem., Aims: This research evaluates the safety and the efficacy of a new non-invasive system delivering microwave energy for the treatment of submental skin laxity and fat., Methods: Forty-eight subjects underwent submental treatment with the device at hand at Poliambulatorio San Michele, Reggio Emilia, Italy. The treatment was performed on the submental area starting from 1.5 cm below the lower border of the mandible up to the hyoid bone. Treatment consisted of 6 sessions of 10 min, with a 2-week interval between each session. At the baseline and upon follow-up 12 weeks from the last treatment, the following evaluations were performed: Photographic evaluation, Clinician-Reported Submental Fat Rating Scale (CR-SMFRS), Submental Skin Laxity Grade (SMSLG), Five-Point Likert Scale Questionnaire (LSQ) for Skin Laxity, Patient-Reported Submental Fat Rating Scale (PR-SMFRS) and Numeric Rating Scale (NRS) for pain evaluation., Results: Mean submental fat and laxity scores evaluation significantly decrease respectively from 3.4 ± 0.5 and 3.7 ± 0.5 at baseline to 1.7 ± 0.6 and 2.4 ± 0.6 (p < 0.01) at 12-week follow-up after the last treatment. The treatment was well-tolerated according to the NRS results. Out of the 47 participants (70.2%), 33 were very satisfied or satisfied. Most patients denied experiencing any discomfort during and after the treatment with the non-invasive device delivering microwaves. The submental subcutaneous fat reduction, the improvement of submental skin tightening, and aesthetic results are confirmed also by photographic evaluation. No side effects were observed., Conclusions: Our results showed the potential microwaves role in the treatment of localized submental subcutaneous adiposities and skin laxity., (© 2022 Wiley Periodicals LLC.)

Background: Cryolipolysis is a noninvasive method that allows selective reduction of adipose tissue. The aim of the present study was to evaluate the efficacy of cryothermogenesis, the repetitive applications of cryotherapy, in body contouring of the abdomen and saddlebag areas., Methods: Thirty participants were included in the study. Premenopausal women with an overload of subcutaneous abdominal and saddlebag adipose tissue were enrolled. For each participant, five cryothermogenesis sessions were carried out using a medical device equipped with two cooling probes. The primary endpoint was metric measurement. The secondary endpoints were the measurement of subcutaneous fat mass using a Lunar iDXA whole-body scanner (GE Healthcare, Madison, Wis.) and a metabolic assessment conducted before treatment and 15 days after treatment., Results: The mean age of participants was 36.72 ± 7 years. Participants had different phototypes and an average body mass index of 23.0 ± 1.41 kg/m2. A decrease in body mass index was observed 3 months after the last session; the body mass index dropped to 20.5 ± 2.1 kg/m2 (p = 0.004 compared to baseline). Waist measurements showed a significant decrease, with an average loss of 4.1 cm after 15 days and 4.62 cm after 3 months. Concerning the circumference of saddlebags, a decrease was observed 3 months after treatment. These results were confirmed by iDXA computed tomographic measurements, showing a significant fat mass reduction in the treated areas., Conclusion: The results indicate that subcutaneous fat in the abdomen and saddlebags was reduced after five successive cryothermogenesis sessions, without any complications, in a cohort of participants with different phototypes., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Background: Paradoxical adipose hyperplasia (PAH) is a rare, moderate-to-severe adverse event associated with cryolipolysis (CoolSculpting, CS)., Objectives: The aim of this study was to describe the incidence, diagnosis, and treatment of PAH occurring after CS for nonsurgical fat reduction., Methods: A multicenter evaluation of all patients who underwent CS treatment between January 2015 and December 2019 at 8 Canadian medical centers was conducted. Data abstracted included symptoms, management strategy, outcome, operator characteristics, device characteristics, patient characteristics, body region, and CS treatment details. Incidence of PAH was calculated based on the number of treatment cycles., Results: Our findings revealed incidence rates between 0.05% and 0.39%, which are slightly higher than the manufacturer's quoted rate of 0.025% (1 per 4000 cycles). Incidence rates at all sites were dramatically reduced by over 75% with the implementation of newer models of CS units. Of patients who developed PAH, 55% were male and 77.8% were of European ethnic origin. The majority of cases (76.9%) were associated with older models of CS units., Conclusions: Development of PAH may be related to a combination of factors, including older models of CS units and applicators, as well as individual characteristics that predispose certain patients., (© 2020 The Aesthetic Society.)

The buried or hidden penis in adults is troublesome in males, whereas the length of the penile shaft is buried under the skin surface of the suprapubic fat to a degree that reveals the concept of a little penis. We aimed to assess a new modality of treatment to increase the apparent penile length by using the cryolipolysis in the reduction of male suprapubic fat as a noninvasive procedure. This prospective study was performed on 46 male patients complaining of buried short apparent small size penis. All patients were subjected to full medical history, body mass index and examination of penile (length, size and abnormalities). The measures of the apparent penile length from the skin to the tip of the glans penis and suprapubic skin fold thickness using (adipometer) were recorded before the three consecutive suprapubic cryolipolysis sessions. The mean apparent stretched penile length at session 1, 2 and 3 were 12.1 ± 0.5 cm, 12.66 ± 0.48 and 12.88 ± 0.72, respectively, with a statistically significant increase between three sessions (p < .001), whereas the mean skin fold suprapubic fat at session 1, 2 and 3 was 2.99 ± 0.49 cm, 2.37 ± 0.48 and 2 ± 0.37, respectively, with a statistically significant decrease (p < .001). The cryolipolysis of suprapubic fat is a safe, effective, noninvasive and applicable procedure that successfully decreases the suprapubic fat in males and increases the apparent length of the buried penises., (© 2021 Wiley-VCH GmbH.)

Cryolipolysis is a nonsurgical body sculpting technique that uses controlled cooling for localized fat reduction. The aim of the present study was to assess whether an intensive regimen of CoolSculpting based on multiple cycles/sessions on the same body area(s) could yield greater (more clinically significant) improvements in body contour. This was a prospective analysis of consecutive, healthy, adult patients undergoing CoolSculpting in routine practice across a variety of treatment areas. Patients underwent ≤4 cycles of CoolSculpting per body area during an initial treatment session, and ≤4 further cycles 4 weeks later (if required). They were followed up for ≥12 weeks. Twenty-eight patients were enrolled (n = 26 female; mean age: 51.6 ± 9.0 years; mean body weight: 69.4 ± 13.7 kg). They were treated across 58 body areas: 48 in a single session; 10 across two sessions. The mean number of cycles per area was 2.8 ± 1.5. Twenty-seven patients (54 body areas) were considered as treatment "responders." In these individuals, mean skinfold thickness decreased from 35.4 ± 9.9 mm pretreatment to 22.2 ± 7.6 mm at 12 weeks (mean change: -40%; P < .001). Mean change in skinfold thickness was greater with ≥3 vs 1 to 2 cycles of CoolSculpting (P = .01). Patient satisfaction was high (n = 51/58; 88%). No adverse events were recorded. The study shows that multiple cycles/sessions of CoolSculpting can safely improve overall treatment benefit in body contouring, with greater decreases in skinfold thickness than have typically been previously observed., (© 2021 The Authors. Dermatologic Therapy published by Wiley Periodicals LLC.)

Background: Cryolipolysis is a noninvasive method for removal of subcutaneous fat for body contouring. Conventional cryolipolysis with topical cooling requires extracting heat from subcutaneous fat by conduction across the skin, thus limiting the amount and the location of the fat removed. The authors hypothesized that local injection of a physiological ice slurry directly into target adipose tissue would lead to more efficient and effective cryolipolysis., Methods: Injectable slurries containing 20 percent and 40 percent ice content were made using common parenteral agents (normal saline and glycerol), then locally injected into the subcutaneous fat of swine. Ultrasound imaging, photography, histological, and gross tissue responses were monitored before and periodically up to 8 weeks after injection., Results: Fat loss occurred gradually over several weeks following a single ice slurry injection. There was an obvious and significant 55 ± 6 percent reduction in adipose tissue thickness compared with control sites injected with the same volume of melted slurry (p < 0.001, t test). The amount of fat loss correlated with the total volume of ice injected. There was no scarring or damage to surrounding tissue., Conclusion: Physiological ice slurry injection is a promising new strategy for selective and nonsurgical fat removal.

Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is to provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications will be reviewed along with measures to optimize patient safety and outcomes.

In recent years, interest in body sculpting has increased and various technologies have been used and developed. In the present study, we assessed the efficacy and safety of combination treatment using high-intensity focused ultrasound (HIFU) and cryolipolysis. The findings show that not only HIFU but also combination treatments are safe and well-tolerated options for the treatment of central abdominal subcutaneous adipose tissue (SAT). Interestingly, the pain associated with HIFU when it was performed after cryolipolysis was significantly reduced., (© 2018 Wiley Periodicals, Inc.)

Background: Cryolipolysis is a minimally invasive technique used to decrease local adipose tissue by thermal cooling. Paradoxical adipose hypertrophy (PAH) is a rare complication of cryolipolysis with important aesthetic consequences., Objectives: The objective of this study was to describe four cases of PAH after a cryolipolysis treatment., Methods: Between January 2014 and January 2017, all patients who had undergone a cryolipolysis treatment in a single center were reviewed. The device used was a CoolSculpting device and the same operator performed all the cryolipolysis treatments. We retrospectively included all patients who had a suspicion of PAH., Results: In our study, 398 patients underwent a session of cryolipolysis. Four patients presented with a voluminous painless swelling in the treated area, between 2 and 4 months after the cryolipolysis session. One patient was treated with liposuction. Histological analysis of the adipose tissue in this patient revealed a nonspecific panniculitis. The other three patients did not receive any additional treatment, and their symptoms stabilized after several months., Conclusions: Although cryolipolysis generally yields good results, it can be complicated with PAH, which tends to occur a few months after the cryolipolysis treatment. Patients should be informed of the possibility of developing this complication and encouraged to attend regular follow up for at least 6 months, so that this condition can be readily detected. Surgical treatment should be offered if there is no spontaneous improvement of the symptoms.

Background: Cryolipolysis is a noninvasive method for the selective reduction of fat, especially proven to be safe and effective in body contouring. There is a demand for reduction in submental fat, which is related not only with a favorable appearance but also with signs of aging., Objective: This study evaluated the efficacy and safety of cryolipolysis for subcutaneous fat reduction in the submental area in Asians., Materials and Methods: Ten healthy Koreans were treated using a cryolipolysis contact device (CoolMini applicator, Zeltiq Aesthetics). The device was applied on the participant's neck twice via two lateral approaches. Patient's body weight was measured, and photographs were taken at baseline and during the follow-up visit after 8 weeks. Participants were examined with ultrasound and the depth of the subcutaneous fat layer was measured., Results: The subjective reduction of submental fat was noted in most of the participants. Reduction of the subcutaneous fat layer depth was confirmed by ultrasound after 8 weeks of treatment., Conclusion: The results of this study indicate that submental fat can be safely and effectively reduced with use of a cryolipolysis applicator. The present study shows that cryolipolysis can be an option for nonsurgical facial contouring.

Introduction: Liposuction and mesotherapy are popular treatments for fat reduction of lower face, but because these treatments are invasive, a novel non-invasive treatment with similar or better efficacy has been sought. There are various devices such as CoolSculpt, laser, RF, and HIFU that are used as non-invasive treatments for fat reduction and body contouring, but these applications have not been applied to facial fat reduction. In this study, we selected Monopolar 1-MHz RF for body contouring to be applied for fat reduction and tightening of the lower face., Material and Methods: From March through August of 2016, we treated fourteen Asian women (average age: 44.6 years old) for fat reduction and tightening of the lower face using 1-MHz Monopolar RF (truSculpt™, Cutera, Inc., Brisbane, CA). We performed the treatment primarily in the nasolabial fold and buccal area weekly for five consecutive weeks, and evaluated the effects for fat reduction and tightening before each treatment and for 2 months after the treatment using handy VECTRA 3D® (Canfield Scientific, Inc.) for imaging. Three-dimensional (3D) volumetric assessments were performed at pre- and post-two-months after treatment. Patients rated their satisfaction for tightening using a 5-points scale., Results: During the study, more than ninety percent of patients showed volumetric change by fat reduction at the treated area, with an average of 2.7 ml. Sixty percent of patients were either "satisfied" or "very satisfied" with the tightening effects. The treatments were accompanied only by very mild heat pain. Efficacy was maintained for 2 months after the treatments, and three patients showed a higher fat reduction effect at 2 months after the final treatment compared with the final treatment. A mild redness was observed just for few hours after the treatment, but complications such as, swelling, induration, burn, sensory disturbance or facial paralysis, were not observed., Conclusion: In this study, we found that Monopolar 1-MHz RF applied with a stationary applicator was effective especially for lower face fat reduction and with a tightening effect in facial contouring. A highly efficacious treatment with satisfactory comfort and safety can be achieved with no downtime, and the device has the potential for becoming one of the standard non-invasive treatments for fat reduction of facial contouring. Lasers Surg. Med.49:750-755, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)