The Facts on Fat: Which Non-Surgical Procedures Really Work?
M.D. Offers Quick Tips to Sort Out Crowded Marketplace
The fat fight is a booming business. Overall cosmetic surgeries in the U.S. have seen a consistent 9% increase throughout the recession and are projected to reach a record of more than $15 billion in 2012. Liposuction is the fourth most common, with more than 200,000 performed in 2011 alone.
Also on the rise are a dizzying array of non-surgical ‘fat reduction’ procedures that promise to shrink waistlines, eliminate the ‘love handles’ and destroy fat. Most do none of the above and many aren’t even designed to affect fat cells. But they sell.
Mary Engle, director of the FTC's division of advertising practices, says her agency lacks the resources to crack down on ads with exaggerated claims. "Often it doesn't rise to the level of fraud," she says. "There are so many problematic ads out there and we really have to pick and choose what we focus on." This leaves the public to sort through a myriad of elective products and procedures that sound remarkably similar.
With Americans growing increasingly obese, the non-surgical fat-reduction industry experienced an explosion in products and procedures this past year with everything from chemical injectibles, lasers, radio-frequency heating to rubber suits and pills.
“It’s such a crowded marketplace that we’ve confused patients and converted our industry into a circus with barkers and pitchmen selling a lot of junk,” says Bill Johnson, M.D. “Doctors know better, but consumers have a hard time sorting out science from science fiction.”
Johnson is the Medical Director of Innovations Medical in Dallas and has been on the leading edge of the elective body shaping industry in Texas. For almost a decade, he has investigated the claims of fat-reduction technologies to build his practice and service patients. He separates the procedures into three categories: those that don’t work, those that are effective for skin treatment only, and those that effectively reduce fat.
“In the first category, nothing is FDA-approved or effective,” says Johnson “and we can group all the chemical injectibles, wraps and rubber suits under the heading of junk medicine.” For example, Mesotherapy claims chemical mixes injected or inserted under the skin can reduce fat but little medical science supports the concept. Rubber suits are touted for weight loss, not fat reduction. Herbal and contour body wraps are advertised for safe and reliable weight loss, but again no medical science indicates they produce results. Yet these procedures generate millions in sales every year.
The Skin Treatments:
“In the second category, we have a lot of skin treatments that smooth out and tighten the skin, but do little or nothing to reduce fat,” says Johnson. “Some of them do help improve the waistline, thighs or arms, but they do not affect fat cells.”
Several of the more popular treatments include Thermage, Accent, and Ulthera, which treat wrinkles and skin imperfections using radio frequencies to heat the subcutaneous collagen. This process generates the growth of new collagen, tightening the skin. These three procedures have been approved by the FDA.
“Unfortunately, we’ve had a lot of ‘copy-cat’ procedures that have come along lately, designed to sound effective, but they’re not,” he says.
Tripollar, VellaSmooth and VellaShape are three of the similar-sounding procedures that are attracting attention. They each use a slightly different combination of laser, massage and RF frequencies to destroy fat cells, but Johnson says they have little medical science to corroborate the claims.
The Real McCoys:
“In the third category, we have the real deal,” says Johnson. “This is the Holy Grail of elective medicine because we can finally do what everyone has wanted for so long. That is, kill fat cells permanently without an incision.” Johnson educates his patients daily on the facts and fiction of the fat-removal industry. “To be clear, however, even these procedures don’t eliminate fat from your body,” he says. “They eliminate individual fat cells, allowing the body to reabsorb and metabolize the fat normally.”
Johnson says the two most effective treatments in this category are LipoSonix and CoolSculpting. LipoSonix is FDA-approved for fat reduction and uses advanced concentrations of ultrasound to agitate fat cells beneath the skin, destroying them permanently and forcing the fat to be re-deployed elsewhere. The second, CoolSculpting, is a technology developed by Zeltiq and has not yet received FDA approval for fat reduction, but effectively uses a cooling technique to do the same. The fat cells are cooled to a temperature just above freezing, which triggers a natural metabolic process to eliminate them.
An alternative therapy is Zerona that uses a low-level laser to liquefy fat, but leaves the cells in place. Although Zerona has shown a short-term effect in some patients, the fat tends to return to the same areas over time. In addition, it has not been approved by the FDA for fat removal.
Johnson says patients should ask practitioners three basic questions before proceeding with any elective procedure to reduce or eliminate excess fat:
1) Has this procedure been approved by the FDA for this specific purpose?
2) Has this procedure been proven effective to reduce fat by peer-reviewed medical research?
3) What specific results have your patients seen following this procedure?
“Until we have some objective metric to rate the effectiveness of these procedures, patients will have to arm themselves with good information,” says Johnson. “That means asking the right questions and knowing the science.”