# data[].attributes.body
Candidancy:
those with soft, discrete bulges of fat in localised areas that can be adequately pulled away from the body into the device. This

Cryolipolysis is not recommended in patients
who are obese, have amorphous fat, have had previous
abdominal hernia surgery or suffer from cold-induced
metabolic disorders.

Body areas:
- fat reduction in the flank area (FDA approval with CoolSculpt).
-abdomen
-flank
-thighs
-buttocks
-submental area
-bra fat
-back fat
-the upper arms

# data[].attributes.body
A vacuum is used to suction adipose tissue into an appli
cator
cup in which the fat is frozen between two cooling
panels. The cold-initiated damage triggers panniculitis, which selectively induces apoptosis of the adipocytes with
out damaging surrounding tissues.

The destroyed fat is then cleared by macrophages. This inflammatory process peaks at 2 weeks, but lasts for approximately 3 months and is accompanied by a progressive decline in fat thickness

# data[].attributes.body
During the procedure, patients may experience tingling,
stinging and aching associated with the intense cold.
These unpleasant sensations tend to subside after 5–
10 min as the area numbs. The device may also induce
pulling and pinching sensations of the skin.

Post TX:
After a cryolipolysis session, patients should expect some mild temporary bruising, swelling and sensory changes that usually
resolve within days or weeks.

# data[].attributes.body
Low-level laser therapy 635nm
- creates temporary microscopic openings within the cell membrane of adipocytes, allowing lipids to leak out
- does not induce apoptosis of the adipocytes and is deemed no-invasive
- Tx Duration: up to 30mins

1060nm diode laser
- thermally induce inflammatory process (42- 47oC) which disrupts the cell membrane integrity to trigger apoptosis of adipocytes
- Technique: combines with contact cooling to preserve overlong skin and annexe during tx.
- Tx Duration: between 20-25min, minimum 15min prolonged exposure

# data[].attributes.body
A typical treatment session applies controlled cooling at -10°C for 35–60 min; multiple sessions are recommended
to optimise aesthetic results.

Results:
May first be noticed 3 weeks after starting treat ment,
but improvements may continue for up to 6 months.
In patients with an ideal body weight, typically 1–3 treatment sessions are required at least 2 months apart for optimal results.

# data[].attributes.body
A small number of patients may complain of mild-to-moderate pain that subsides within a few days. There are no reports of permanent skin or sensory disturbances, and other adverse
effects are minimal.

Rarely, patients may develop a hardened, tender area of localised adipose tissue known as paradoxical adipose hyperplasia 2–3 months after treatment. In some cases, it may require liposuction, although in others it may resolve spontaneously.

Possible leakage of fat contents from the apoptosed adipocytes raised concerns that serum lipid levels may
become elevated and liver function may be compromised.
Subsequent studies demonstrated no effect of cryolipolysis
treatment on serum lipid levels or liver panel tests.

# data[].attributes.body
- Mild temporary brusing, swelling and sensory changes only lasting up to a few days or weeks.
- Mild to moderate pain lasting for a few days.
- Paradoxical adipose hyperplasia is a possibility 2-3 months post treatment but is rare: Some patients require liposuction or it may resolve spontaneously.

# data[].attributes.body
Based on the principle of volumetric heating and the varied impedance of different skin layers, radiofrequency energy is used to generate heat that selectively targets the collagen-rich tissue layers to contract and denature collagen fibres, which results in immediate skin improvement. Long-term skin rejuvenation occurs secondary to stimulation of fibroblasts, which fuels gradual growth of new collagen and elastic fibres.The thermal injury also induces apoptosis of adipocytes, which is responsible for the fat reduction component of the treatment.

Radiofrequency sessions typically involve heating an area between 43 and 45°C over 20–30 min followed by air-cooling of the epidermis.

# data[].attributes.body
Less than 20 mins insufficient, longer than 25 mins increases risk of dermal injury & subcutaneous nodule formation

No serious adverse effects reported thus far

Mild-moderate pain

Side effects: mild tenderness, mild swelling

Results seen after 3 months, improvements in 1/2 the time

2-12 sessions, 6-8 weeks apart

Contraindications: tattoos, scars, pregnant women, abdominal

Subtle results in comparison to liposuction

No change in lipid serum levels with either tx

# data[].attributes.body
Low-to-medium BMI and significant skin laxity are two features used to identify favourable candidates.

# data[].attributes.body
Some studies have reported improvement with skin tightening after a single treatment, but in clinical practice, multiple treatments are needed, and gradual improvement is seen over the following 2–6 months. Permanency of these effects is still unknown; however, clinical studies demonstrated that 71–97% of patients were satisfied with the body improvements.

# data[].attributes.body
High frequency - Uses heat as the target sites which induces coagulative necrosis of the adipocytes, while also stimulating collagen remodelling.
Temp above 56c causes necrotic process while sparing the nerve and vessels.

Low frequency - Causes mechanical disruption of the adipocytes (can be better tolerated due to non-thermal)

# data[].attributes.body
focused on treating areas that are "non-pinchable" such as outer thighs or slimmer abdomens.

# data[].attributes.body
The ideal candidate for this procedure has mild-to-moderate skin laxity.

# data[].attributes.body
Subtle results in comparison to liposuction

635nm: does not induce apoptosis on adipocytes, increases chance of re-accumulation of lipids thus affecting the permanency of fat-reduction treatment results

# data[].attributes.body
Patients may experience mild heat-related pain during treatment. After sessions, most patients will experience transient, mild erythema and swelling that typically resolves within 24 h.

Less common adverse effects reported include facial tenderness, temporary dysesthesia, subcutaneous nodule formation and fat atrophy; these risks are minimised with high-pass treatment methods and use of bipolar settings.

Close monitoring of the skin appearance during treatment sessions is critical to identify any signs of epidermal injury. Some devices offer an additional safety feature in which a built-in temperature sensor helps to prevent burn-related superficial skin damage.

# data[].attributes.body
Indications: Muscle thickening and strengthening, body contouring, strengthening the rectus abdominal muscles and diastasis

Mechanism of action: Muscle contractions trigger intensive lipolysis with fat cells, which releases a large volume of free fatty acids that damage surrounding adipose tissue. The pulses sent into the tissue strengthens and thickens the muscles.

# data[].attributes.body
- Erythema
- Localised Pain
- Tenderness
- Swelling
- Mild Bruising
All which typically resolve within hours to days.

# data[].attributes.body
Limitations:
Multiple treatments are needed - spaced 3-4 weeks apart with improvement seen over 2-6 months.
However, results will not be as impressive as ablative forms of skin tightening or surgical lifting.

Benefit:
Procedure is safe to perform with no serious adverse effects. Little downtime response.

# data[].attributes.body
3. Benefits versus limitations

Benefits:

- reduces patients’ abdominal waist circumference, adipose tissue thickness, muscle thickness and diastasis recti.

- Gradual increase in muscle thickness and strength over the course of 6 months

- Reduction in the distance between the large abdominal muscles

Limitations:

- The efficacy of treatment may be less significant in patients with a higher BMI

- Contraindications for treatment with HIFEM include pregnancy and patients with metal or electronic implants.

# data[].attributes.headline
4. Statistical Improvements/Side effects (Clinical Impact)

# data[].attributes.subject
4. Statistical Improvements/Side effects (Clinical Impact)

# data[].attributes.body
Subtle skin changes can be seen after one to two sessions, but significant changes may not be seen until 4 weeks after last Tx.

Three clinical trials found that HIFEM treatment significantly reduced patients’ abdominal waist circumference, adipose tissue thickness, muscle thickness and diastasis recti.

-        92% patient satisfaction with abdominal appearance 3 months after completing treatment.

-        ability to lift and tone the gluteal muscles; this leads to a significant improvement in buttocks appearance - associated with a high degree of patient satisfaction

-        reduction in the distance between the large abdominal muscles. Seen in 91% of patients,

Side effects:

-        Complications following treatment with HIFEM are minimal, as transient, mild muscle soreness was the only side effect noted in a minority of patients

# data[].attributes.body
Body contouring, skin tightening and cellulite reduction.

# data[].attributes.body
Increases deeper skin temperature without epidermal or dermal ablation. Radiofrequency generates heat in different tissues by transforming energy through three basic mechanisms from electromagnetic field:

1. Orientation of electric dipoles that already exist in the atoms and molecules in the tissue.

2. Polarisation of atoms and molecules to produce dipole molecules

3. Displacement of conduction electrons and ions in the tissue.

# data[].attributes.body
Benefits: Smoothening of cellulite exposure, reduction of subcutaneous tissue, circumference reduction and reduction in thickness between the dermis and fascia. Relatively safe treatment method.

Limitations: No standard protocol for treatment time with RF, with the range of therapeutic sessions widespread between 1 and 24 weeks. Slight return can be seen in the favourable treatment results at 2 months post treatment. No significant reduction in body weight. Statistical outcomes about the effects of RF on skin laxity and cellulite treatment are low and limited.

# data[].attributes.body
Statistical improvements (clinical impact): 96% of former studies obtained positive outcomes with RF. Satisfaction for subcutaneous far reduction was approximately 71-97% according to patients self reported data. Ultrasound imaging showed reduction in the distance between the dermis, stratum corneum and fascia and the stratum corner and muscle.

Circumference decreased an average of 1.45-2cm after 6-8 sessions.

Side effects: Slight return may be seen in the favourable treatment results a few months post treatment. Over heating over short time periods can lead to lethal destruction of adipose tissue.
Higher temperature + shorter time = lethal for adipose tissue.

Longer time + lower temperature = intended adipose cell damage.

# data[].attributes.body
-Mechanism of action: Acoustic wave therapy, high intensity ultrasound therapy.
-Better used as a complementary therapy, in combination with cryolipolysis. No significant reduction is achieved with shock wave therapy as a standalone treatment.
-Is used by physiotherapists for tendonitis and other ligament issues.
-1x treatments weekly over 6 weeks.

# data[].attributes.body
There is controversy around the efficacy of this, but it is marketed to help with weight loss.
MOA
- Low frequency vibrations (5-45Hz) increase muscle activity by stimulating the muscle spindle and causing muscle contractions through mono and polysynaptic reflexes.
- This is said to increase energy expenditure and metabolic rate, and therefore cause weight reduction
- suggested to increase fat oxidation both during and after exercise
- positive correlation with skeletal muscle perfusion and blood flow.

One study found a positive result with whole body vibration (WBV) and decrease in BMI, body fat, trunk fat
Another study found no significant difference between control and WBV group
Suggested to be used in line with regular exercise and healthy lifestyle/diet
Both groups suggested that WBV could supplement blood flow to skeletal muscle which could help with muscular strength
Results are inconclusive

# data[].attributes.body
Treatment involves at least four 30-min sessions spread evenly over the course of 2 weeks. Following this, one treatment every 3–6 months is recommended to maintain results.

# data[].attributes.headline
HIFU:Mechanism of action:The HIFU device utilizes ultrasound energy to make molecular vibrationsat the zone of treatment, leading to an increase in temperatureat the targeted tissue above 56°C and coagulative necrosis offat cells.TX parameters used:In a clinical study on animals were (25 _ 25 mm for each site) and energy levelsvarying from 85.3 to 270 J/cm2. Study showed full decrease of subcutaneous fat at tx site.In Human studies:Study 1:HIFU treatment at one of the three total doses of energy: 177 J/cm2 (threepasses at 59 J/cm2), 141 J/cm2 (three passes at 47 J/cm2), or 0J/cm2 (three passes at 0 J/cm2; sham group) for nearly oneminute for each targeted zone and 15 minutes for the totaltreatment session.Adverse effects noted: Pain, swelling, ecchymosis or a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.Results: 2cm reduction in waist circumference, no mention of effect on cellulite specifically.Study 2:Parameters used 134.8 J/cm2 and treatment session duration varied from 60 to 90 minutes.Adverse effects:  The most common adverse effects of this study were edema, tenderness, ecchymosis, and hard lumps, and only one participant experienced major pain.Results: waist circumference was 4.6 cm, 12 weeks after treatmentConclusion:HIFU is a safe and efficient technologyfor reducing subcutaneous adipose tissue withoutany significant effect on blood lipid or inflammatory markersand with no local adverse effects such as burns or scarring.Studies based on the use of HIFU for body contouringshowed that self-reported patient’s satisfaction is approximately47% to 86%. These treatment effects are not dependenton diets or daily physical activity. The recovery time of HIFU is minimal. No considerable influence was reported on BMIor body weight.

# data[].attributes.subject
HIFU:Mechanism of action:The HIFU device utilizes ultrasound energy to make molecular vibrationsat the zone of treatment, leading to an increase in temperatureat the targeted tissue above 56°C and coagulative necrosis offat cells.TX parameters used:In a clinical study on animals were (25 _ 25 mm for each site) and energy levelsvarying from 85.3 to 270 J/cm2. Study showed full decrease of subcutaneous fat at tx site.In Human studies:Study 1:HIFU treatment at one of the three total doses of energy: 177 J/cm2 (threepasses at 59 J/cm2), 141 J/cm2 (three passes at 47 J/cm2), or 0J/cm2 (three passes at 0 J/cm2; sham group) for nearly oneminute for each targeted zone and 15 minutes for the totaltreatment session.Adverse effects noted: Pain, swelling, ecchymosis or a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.Results: 2cm reduction in waist circumference, no mention of effect on cellulite specifically.Study 2:Parameters used 134.8 J/cm2 and treatment session duration varied from 60 to 90 minutes.Adverse effects:  The most common adverse effects of this study were edema, tenderness, ecchymosis, and hard lumps, and only one participant experienced major pain.Results: waist circumference was 4.6 cm, 12 weeks after treatmentConclusion:HIFU is a safe and efficient technologyfor reducing subcutaneous adipose tissue withoutany significant effect on blood lipid or inflammatory markersand with no local adverse effects such as burns or scarring.Studies based on the use of HIFU for body contouringshowed that self-reported patient’s satisfaction is approximately47% to 86%. These treatment effects are not dependenton diets or daily physical activity. The recovery time of HIFU is minimal. No considerable influence was reported on BMIor body weight.