Let a fat-erasing wand work its magic, and walk away with a smoother, svelter body in an hour — no incisions, pain or downtime. That’s the sell behind noninvasive body contouring, one of the fastest-growing areas of cosmetic dermatology, according to a 2018 study published in the journal Cutis.
As performed by dermatologists or plastic surgeons, “contouring” is an umbrella term for a group of nonsurgical procedures that promise to trim fat in a few different ways. They’re getting more popular too: Procedures that focus on fat reduction, like CoolSculpting, increased 7 percent between 2016 and 2017, according to the American Society of Plastic Surgeons. Procedures for temporary cellulite removal, such as VelaSmooth, rose 19 percent in the same period. Across the board, a 2016 study found, contouring increased 521 percent between 1997 and 2013.
“These companies are responding to the consumer drive of not wanting to have surgery, which is driven by an irrational fear of general anesthesia,” said Manish H. Shah, a plastic surgeon in Denver. “It’s also the convenience factor of not having to take time off work for recovery.”
Noninvasive contouring has a few advantages over surgical alternatives like liposuction, such as minimal side effects and, at least in theory, a lower price point. But that doesn’t mean they’re the right fix for everyone. “Most of the ‘risks’ of these noninvasive procedures,” said Katerina Gallus, a plastic surgeon in San Diego, “are not understanding the requirement for multiple treatments to obtain an impactful result, and the resulting expense.”
Before you fall under the spell of the fat-melting wand, it’s worth understanding what different types of noninvasive procedures can and can’t do.
Body contouring basics
Put simply, noninvasive body contouring techniques use devices that either heat up or freeze fat cells underneath the skin to reduce the appearance of “stubborn fat,” such as so-called bra bulge, love handles and banana rolls, a term for banana-shaped fat pockets right below the buttocks. Heating techniques either use radiofrequency, as with TruSculpt, or high-intensity focused ultrasound. The fat-freezing approach, used by CoolSculpting, is called cryolipolysis. Laser-therapy fat removal also falls under the contouring umbrella, but it works in a slightly different way; the light source shrinks fat cells through a photochemical process rather than a thermal one.
Once fat cells die from contouring procedures, the body excretes them over a period of two to three months, yielding a smoother appearance in treated areas. Most people require several treatments to achieve desired results, which is why noninvasive procedures can cost as much or more than surgery.
These noninvasive techniques are designed for shaping surfaces and spot fat reduction in specific areas rather than weight loss, according to Sheila Nazarian, a plastic surgeon in Beverly Hills, California. Even with liposuction, she said, patients might not see any weight loss, simply because fat doesn’t weight that much.
“They’re best for focal reductions of fat,” Shah said, “but there’s not a lot of destruction of fat cells outside that small zone.”
The most popular fat-reducing technique is freezing, which one recent study found to be less painful and more effective than laser therapy or high-intensity focused ultrasound. In addition, older patients with severe skin laxity (i.e., very loose skin) or sun damage aren’t good candidates for HIFU.
Results from laser treatments for body contouring can appear within six weeks after the procedure, but they’re not permanent, unlike results from radiofrequency and cryolipolysis.
Everyone asks for CoolSculpting
The leading brand name in body contouring is CoolSculpting. “It’s the 800-pound gorilla in the room that everyone knows about because they have the greatest marketing budget,” Shah said. “It’s definitely one option, but there are a number of others.”
CoolSculpting is best for patients who are around their ideal weight and want to get rid of loose skin caused by significant weight loss or aging, Nazarian says. In her practice, often patients will come in asking for CoolSculpting. But if they’re not good candidates for it, Nazarian might steer them toward procedures likely to produce better results, such as a combination of liposuction to remove fat and a radiofrequency technique such as BodyTite to firm up so-called problem areas.
“Patients with significant weight loss will likely need surgery,” she said, because “CoolSculpting can’t do anything about sagging skin.”
Despite these limitations, CoolSculpting is more popular than ever, says Jacob D. Steiger, a plastic surgeon in Boca Raton, Florida. First approved in 2010, CoolSculpting has been around longer and been subject to more research than comparable procedures. The devices used to perform the treatments have also continually improved, Steiger says. CoolSculpting was first geared toward people who essentially had the bodies they wanted, aside from stubborn bulges. But market expansion came with an increased demand for fat reduction from people without fitspo-model physiques. So the company started marketing to them too.
“Theoretically, you can treat your entire body with CoolSculpting,” he said, “but it would easily end up costing around $10,000, or much more than liposuction,” the average cost of which is about $3,300. Plus, patients won’t see results from CoolSculpting until the body disposes of its dead fat cells, which takes at least six months.
CoolSculpting is a somewhat hands-off procedure to perform; it uses applicators that are attached to the skin and monitored by machine. Radiofrequency procedures like TruSculpt, however, require doctors to maneuver handheld devices. As a result, they’re more labor-intensive but also more precise, Shah says.
Like CoolSculpting, Shah said, “Radiofrequency is not for people with obesity. Although it’s used on pretty much anybody, that’s not the way it should be done. It’s meant to achieve small volume losses in patients who are fairly fit.”
Also popular is SculpSure, a laser technique that heats up and pops fat cells with laser applicator packs applied to the body. The process, which takes around 25 minutes, can be uncomfortable, and patients typically don’t see results for about three months.
What the ads may not say
Contouring procedures performed poorly or on the wrong candidates can produce undesirable results, like body indentations, Steiger says.
CoolSculpting only reduces fat exactly where the applicator is placed, which is why small body areas, like below the belly button, are a better target than larger areas like the outer thighs. Overzealous fat reduction in one area can make surrounding untreated areas appear a little plumper.
With heating procedures, issues can arise if patients don’t follow orders to drink enough water beforehand. Without proper hydration, Shah says, the heat won’t reach its target and kill the fat cells like it’s supposed to.
Patients also need to understand that if they gain weight, the fat has to go somewhere. It will accumulate in areas surrounding those treated with contouring technologies, but not the treated areas themselves. Because substantial weight gain after treatment can yield a lumpy appearance, these procedures make more sense for people who are likely to stay within their current weight range.
And although it’s rare, some people might get bigger rather than smaller as a result of CoolSculpting: Paradoxical adipose hyperplasia is a cryolipolysis side effect where fat cells in treated areas increase rather than die. There’s no way to detect who might be susceptible to the condition, and researchers don’t know why it happens, Shah says.
Still, it’s a highly unlikely complication: “I’ve only seen it twice,” Steiger said, “and lipo or excision fixes it.”
Although noninvasive body contouring techniques don’t require surgery, a good plastic surgeon might be best able to help you decide if you need noninvasive or surgical procedures (or both) to achieve desired results.
But whether you choose a reputable cosmetic dermatologist or a plastic surgeon, Nazarian says, “you really have to do your homework.” She advises patients to make sure prospective surgeons are board-certified and have hospital privileges (meaning they’re cleared to perform procedures in a hospital). “A hospital won’t allow you to perform a procedure that’s outside your scope of training,” Nazarian said. A massive Instagram following, she notes, doesn’t say anything about a surgeon’s training or qualifications.