Fat, Zapped (And is it All That?)

Clean eating and regular exercise absolutely work better than any other strategy for getting rid of extra fat in the body, whether you’re talking about major weight loss or a few extra pounds. But when those few extra pounds are lodged stubbornly in an especially unwanted spot and refuse to respond to diet or even a serious workout schedule, the world of dermatology has been hard at work at some pretty effective, non-invasive—if also not jaw-droppingly dramatic—solutions.

The new fat-melting devices have little to no downtime, but they also do less in the way of fat removal than traditional surgery or liposuction. Less, though, is what many people are looking for—a flatter stomach, a smoother thigh. “It’s not major surgery like a tummy tuck, or even liposuction, and that’s a serious advantage for a lot of people,” says New York dermatologist Robert Anolik of the Laser and Skin Surgery Center, a clinical assistant professor of dermatology at NYU and frequent goop contributor. “They have an area on their body that bugs them, rather than needing a major overhaul.”

“I tell patients to think of it for problem areas that just won’t budge despite a healthy lifestyle,” says dermatologist Dendy Engelman of Manhattan Dermatology and Cosmetic Surgery and director of dermatologic surgery and laser medicine and Metropolitan Hospital.

Dermatologists disagree about which device works the best: Unlike drugs, devices don’t have to prove as much to the FDA in terms of effectiveness. “The FDA cares whether or not it’s safe, so these devices are all safe,” says Anolik. “How effective each one is depends on who you talk to.” The fact that there are now multiple options means different types of patients can be better accommodated, says dermatologist Bruce Katz, director of the Juva Skin and Laser Center in New York: “It’s a great time—there’s a lot we can do, and it’s important to remember that one device isn’t always the best solution for everyone.”

Some of the new treatments warm the fat beneath the skin with radiofrequency, lasers, or sonic energy; others use cold to accomplish a similar end; still others use enzymes. All bring about selective fat cell death (apoptosis), and all target small areas of fat—on the abdomen, above the knees, beneath the chin, just above the derriere, on the inner and outer thighs, even the upper arms—as opposed to liposuction, which is still the gold standard in more-significant-amounts-of-fat removal. While liposuction comes in various intensities, all of it is at least minimally invasive (meaning there’s downtime).

Freezing

The device that started it all, CoolSculpting, freezes areas of fat beneath the skin, inducing apoptosis (the skin itself remains unfrozen because of cryoprotective barriers placed on the skin, which are part of the treatment). Because it was first, it tends to be the standard that other technologies are compared against. “For a flat stomach, or for love handles, you can really get substantial changes with CoolSculpting,” says Anolik. The technology has recently improved, he says, decreasing treatment time from an hour to 35 minutes, and allowing for treatment of multiple sites at once. “Think of love handles, for instance,” he says. “You used to have to do two separate treatments, each an hour long, and now you can do them both in 35 minutes.”

Another new development is CoolSculpting: It now works for a double chin, says Anolik. “Almost ⅔ of the people I see are bothered by a double chin, and there was never any option for them—and now there are two good ones. The response rate for CoolSculpting is pretty great for the double chin so far. We also have Kybella, an injected enzyme that breaks apart fat cells—it’s not a frightening substance, it’s used in our digestive systems to digest fat, and because it’s a drug, it comes with drug studies, on thousands of people. We usually get a significant change with 2-4 treatments.” Both approaches involve at least a week of social downtime, as Anolik puts it, and some tenderness and soreness, though he notes that there’s less downtime and soreness with CoolScultping. On the body, CoolSculpting involves little to no downtime. “If you do a large area, you might experience some crampiness, a little pinkness, swelling, numbness, or tingling, but you can go to the gym that day,” he says. Katz sees potential in an ultrasound-generated cooling technology called UltraShape: “I like that it’s a probe, put wherever you need it, unlike CoolSculpting, which pulls the fat into an applicator, so you have less control over where you’re treating,” he says.

Heat

A number of therapies direct heat to the fat layer beneath the skin, aiming to induce apoptosis in just the way freezing does. SculpSure creates the heat with laser technology; BTL Vanquish ME uses a radio-frequency field that’s applied evenly over an area; both are next-generation for a number of reasons, Engelman says. “The biggest difference is how quickly you’re able to see results,” she says, “CoolSculpting takes a couple months following treatment, but results with Vanquish ME start to show after two to three treatments.” Engelman also says patients can find CoolSculpting uncomfortable, while she compares the Vanquish ME to lying under a warm heating blanket. (The device doesn’t actually touch your skin, but hovers over the entire abdomen area, treating it all at once.) “And Vanquish ME has the largest spot size in the industry—so it provides smooth and even treatment,” she says. “Other treatments use spot/smaller applicators that get connected together to treat a larger area, sometimes resulting in lines of demarcation.” The treatments take 45 minutes, and Engelman says she sees best results when she treats immediately afterward with a device called Cellutone that increases blood flow and provides an even quicker, more even result.

Katz, on the other hand, says he sees the best results with SculpSure. “It takes less time than CoolSculpting—25 minutes—and I find the results are better aesthetically,” says Katz. “You can put the applicator anywhere there’s a little bulge of fat, whereas with CoolSculpting you’re limited by the amount the applicator pulls into the device. It really works everywhere: a larger spot like the abdomen, smaller ones like the upper arms or knees—it’s great.”

Because it’s heat, Katz continues, there’s the possibility of tightening as well as fat removal.

All of these devices treat fat, but are not specifically designed to treat laxity, it’s important to note. “Tightening with heat could work—it definitely works for laxity in the face—but it’s not proven,” says Anolik. He says he’s exploring using Ulthera, an ultrasound heat-targeting device that’s become the gold standard in tightening the face and neck, on small areas of the body: “It’s important to remember that with an area like, say, your whole abdomen, that’s a lot of force pulling down with gravity.”

Katz says he’s seen good results in terms of tightening with a fractional resurfacing technology, EndyMed, used on the body. “It’s the new kid on the block,” he says. “They have a body handpiece that works well.” He also likes the slightly more invasive Therme-RF radiofrequency laser which emits its energy through a cannula inserted under the skin.

The fat-melting devices also don’t treat cellulite, which involves fat but also bands of connective tissue that hold the fat together; Anolik likes a technology called Cellfina for cellulite—but it’s a more invasive treatment involving a needle under the skin, and some soreness and bruising.

Most importantly, again, it’s small amounts of fat that are getting removed. “It’s not major surgery like a tummy tuck—where you’ve got scars and recovery times, or even liposuction,” says Anolik. “It’s not a ticket to binge,” says Engelman. “But it can give you that little boost needed to get rid of stubborn fat, or even jump-start a new fitness plan.”

No matter which device initially appeals, consult a doctor whose office works with multiple devices, says Anolik: “I’d caution the public to go to a board-certified dermatologist or plastic surgeon who has access to several of these technologies, so they can help you find what’s right for you, rather than just sell you on the device they happen to have.”