Beyond Lipo: Body Sculpting and Fat Reduction

How to remove fat safely and effectively, without relying exclusively on diet and exercise

How to remove fat safely and effectively, without relying exclusively on diet and exercise


When you are thinking of having a fat removal procedure, your options include invasive (surgical) and non-invasive (non-surgical) procedures. Invasive procedures include liposuction (lipoplasty), in which a hollow tube is inserted into the fat through small skin incisions to suction out and remove fat from localized areas. There are several forms of liposuction, involving the use of suction, ultrasound or laser. Liposuction effectively removes fat but because the volume of fat that may be safely removed is limited, it is a procedure to contour the body, not for weight reduction. Liposuction does not improve skin looseness or cellulite. When performed by a qualified and experienced physician, liposuction is safe and effective. However there is some risk, recovery, and discomfort associated with liposuction which has lead to the growth of non-surgical, non-invasive body contouring.

Two devices that have been approved by the FDA for use in the US are Zerona and Zeltiq Coolsculpting.

Zerona is a non-invasive laser designed for body contouring and according to proponents makes fat cell membranes more porous or “leaky”, thus allowing for fat excretion. Zerona is typically administered in a medical office in 6 sessions stretched over a two week period. Diet, daily exercise, and special niacin based supplements are usually an integral part of the program. Measurements are taken at multiple places on the body, and are added together for the manufacturers reported 3-5 inch circumferential reduction. What this means is that multiple areas are measured, some outside of the treatment area, and added together for a total loss, so that if you measure 10 areas and each shows a loss of a third of an inch, the loss is reported as 3 inches. My concern with Zerona, and why we have chosen Zeltiq Coolsculpting instead as our non-invasive fat reduction choice, is whether it is really effective or not. Double blind, controlled long term studies without a strict diet, exercise, supplements and the variability of tape measure recording of multiple areas are needed.

The newest non-surgical FDA approved method, Zeltiq CoolSculpting, reduces fat by chilling it, which provides an effective non-invasive tool for fat reduction. The applicator is applied to the target bulge with suction and delivers precisely controlled cooling specifically targeting fat which leaves skin tissue unaffected. Fat cells are destroyed and eliminated through the body’s natural processes.

Studies have shown that CoolSculpting gives an average reduction of 22% in fat after one treatment. If additional fat removal in the area is desired, another treatment can be done which will yield an additional 20% reduction resulting in a total fat loss of 40%. Final losses may be more or less, depending on the individual. Some patients experience redness, minor bruising, tingling, or numbness after the procedure, but these are temporary. Results are permanent as the fat cells are destroyed and removed from the body. CoolSculpting’s advantage is that it is completely non-invasive and extremely safe. While the results are not as dramatic as those following liposuction surgery, the absence of any downtime and the safety of the procedure make it a popular choice for fat reduction and body contouring. Like liposuction, it is not intended as an overall weight-reduction program.

There are other procedures that are promoted for body sculpting and fat removal. Focused ultrasound devices like Ultrashape, not approved for use in the US, are used in other countries. From my discussions with other physicians they do work, but there is significant discomfort, and a higher risk of side effects than with Zeltiq Coolsculpting. Mesotherapy (Lipodisolve etc) involves injections of mixtures of medications injected into the fat. The mixtures are often “secret recipes”, none are approved by the FDA. Complications have been lumps, infection and tissue death. Focused ultrasound is currently going through the FDA approval process. If it is approved and turns out to be effective, safe, and tolerable in terms of discomfort, then it will be a welcome addition to non-invasive body sculpting. We shall see. Mesotherapy would have to be standardized, approved by the FDA, be safe and effective before I would consider using it. I don’t think that will happen.

Next: How to know which body sculpting and fat removal procedure is right for you, and which ones have the highest satisfaction rates