Reviews on Rf Ultracavitation Fat & Cellulite Remover
Int J Endocrinol Metab. 2016 Oct; 14(four): e36727.
Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat
Zahra Alizadeh
oneSports Medicine Inquiry Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Islamic republic of iran
twoDepartment of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
Farzin Halabchi
1Sports Medicine Enquiry Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
2Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, IR Islamic republic of iran
Reza Mazaheri
1Sports Medicine Research Center, Neuroscience Found, Tehran Academy of Medical Sciences, Tehran, IR Iran
2Section of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
Maryam Abolhasani
iSports Medicine Research Center, Neuroscience Establish, Tehran University of Medical Sciences, Tehran, IR Iran
Mastaneh Tabesh
1Sports Medicine Research Eye, Neuroscience Institute, Tehran Academy of Medical Sciences, Tehran, IR Iran
Received 2016 January 30; Revised 2016 Jun viii; Accepted 2016 Jun 26.
Abstract
Context
Today, different kinds of non-invasive body contouring modalities, including cryolipolysis, radiofrequency (RF), depression-level laser therapy (LLLT), and loftier-intensity focused ultrasound (HIFU) are available for reducing the volume of subcutaneous adipose tissue or cellulite. Each procedure has distinct mechanisms for stimulating apoptosis or necrosis adipose tissue. In addition to the mentioned techniques, some investigations are underway for analyzing the efficacy of other techniques such as whole body vibration (WBV) and extracorporeal shockwave therapy (ESWT). In the present review the mechanisms, effects and side effects of the mentioned methods have been discussed. The effect of these devices on cellulite or subcutaneous fat reduction has been assessed.
Testify Acquisition
We searched pubmed, google scholar and the cochrane databases for systemic reviews, review manufactures, meta-analysis and randomized clinical trials up to Feb 2015. The keywords were subcutaneous fat, cellulite, obesity, noninvasive body contouring, cryolipolysis, RF, LLLT, HIFU, ESWT and WBV with full names and abbreviations.
Results
Nosotros included seven reviews and 66 original articles in the present narrative review. Most of them were applied on normal weight or overweight participants (body mass index < 30 kg/mii) in both genders with broad range of ages (18 to fifty years on average). In the original articles, the numbers of included methods were: 10 HIFU, 13 RF, 22 cryolipolysis, 11 LLLT, v ESWT and 4 WBV therapies. Six of the articles evaluated combination therapies and seven compared the effects of different devices.
Conclusions
Some of the noninvasive body contouring devices in creature and human studies such as cryolipolysis, RF, LLLT and HIFU showed statistical significant effects on trunk contouring, removing unwanted fat and cellulite in some body areas. Withal, the clinical effects are balmy to moderate, for instance ii - 4 cm circumference reduction every bit a sign of subcutaneous fat reduction during total treatment sessions. Overall, in that location is no definitive noninvasive treatment method for cellulite. Additionally, due to the methodological differences in the existing evidence, comparing the techniques is hard.
Keywords: Body Contouring, Subcutaneous Fatty, Cellulite
1. Context
In the recent years, noninvasive body contouring techniques take go one of the most widespread procedures and are growing fast in areas of esthetic medicine (1, 2). The vast bulk of surgical body contouring methods has inherent risks and complications such as pain, swelling, prolonged recovery, scarring, hematoma or infection, which brand noninvasive procedures increasingly popular (3-five). Co-ordinate to reported information by the American society for artful plastic surgery in 2013, the significant gamble of invasive body contouring procedures has led to 521% growth of noninvasive techniques since 1997 (half dozen). In addition, it has been estimated that noninvasive torso-contouring procedures are growing 21% annualy (seven). Even for shortening postoperative recovery, decreasing bruising and more skin tightening, surgical lipectomy techniques are combined with noninvasive methods (vii).
1.1. Cellulite and Subcutaneous Fatty
Cellulite is a pare discomfort developed by multiple factors (8) just the master etiology is not completely understood (ix). The appearance of skin changes and it becomes similar an "orange peel". Cellulite is commonly found on the thighs and buttocks (8, 10, 11). Cellulite is more common in adult females than males. Up to 98% of females are concerned about their skin changes due to cellulite and the changes decrease their self-esteem (12).
The Nurnberger and Muller scale is the most commonly used nomenclature for cellulite (9, xiii). According to this calibration, 3 grades were defined: I- visible changes with pare clamping or muscle wrinkle; II- visible changes without manipulation; and Iii- visible changes associated with nodules. In addition to Nurnberger and Muller grading-score, contempo classification includes four boosted variables: (i) the number of evident depressions; (ii) the depth of visible depressions; (iii) appearance alterations of pare surface and (iv) laxity class. According to these items, cellulite is classified with three degrees: mild, moderate and astringent (ix). Estimating accurate results of anti-cellulite therapies is not like shooting fish in a barrel but in that location are some practical methods for measuring the outcomes such as real-time scanning ultrasound epitome, iii-dimensional optical skin surface measurement, clinical photographing, histological findings, personal questionnaires, etc. (14-xviii).
Subcutaneous fat is different from cellulite. Equally mentioned before, cellulite is divers by focused and topographic pare changes with an orange-pare expect, yet subcutaneous fat is an indicator of peripheral fat mass, which could be evaluated by circumference and skin fold measurements and variation in these parameters could exist considered as an indicator of cellulite changes. Even so, other cellulite indices such every bit skin elasticity and dermal thickness should be considered besides these measurements (11).
In the past, dissimilar methods of body contouring were assessed in order to specify their prophylactic and influence on subcutaneous fat reduction and the handling of cellulite. Patient satisfaction in the brusque-term and medium-term, durability of the results and time to obtain maximum outcomes, common complication and recovery time were considered in these studies. The objectives of this paper were to review and evaluate prominent methods on noninvasive subcutaneous fat removal and improvement of cellulite and comparing their clinical results. Since, in that location is physiological and biochemical variety between subcutaneous fatty tissue and cellulite, both were included in the review.
2. Evidence Conquering
We used pubmed, google scholar and the cochrane review database websites to find relevant articles in the English language language (abstruse and/or full-text). Systematic reviews, review articles, meta-analyses and randomized clinical trials (published upwardly to February-2015) were considered. The keywords used for our research were as the following: noninvasive torso contouring, subcutaneous fatty, obesity, cellulite, cryolipolysis, radiofrequency (RF), low-level laser therapy (LLLT), infrared calorie-free and high-intensity focused ultrasound (HIFU), extracorpeal shockwave therapy (ESWT) and vibration exercise. To increase the inclusiveness of our search strategy, authors likewise studied the texts to find other relevant cited manuscripts that were not retrieved in the initial search. Given the narrative nature of the review, no formal quality assessment was done.
3. Results
In the primary search, we found 2024 articles with the keywords. Non-English papers, and articles that did not mention clinical efficacy measures or used invasive methods were excluded. Further, manufactures, which focused on the effects of various methods on weight loss or percentage body fat, were omitted. We included seven reviews and 66 original articles in the present narrative review. Nigh of them were practical on normal weight or overweight participants (torso mass index (BMI) < 30 kg/k2) of both genders with broad range of ages (eighteen to 50 years on average). Six of the articles evaluated combination therapies and seven compared the effects of different devices. The summary of the results is mentioned in Effigy 1.
The Flowchart of the Search Strategy
Below, we discuss the mutual noninvasive torso contouring methods:
3.i. High Intensity Focused Ultrasound
The concept of applying HIFU for therapeutic aims was introduced in 1942 and for more fifty years HIFU has been used for treating organ tumors, kidney stones and uterine fibroids to subtract the need for ambitious procedures (19-21). Recently, attending was drawn to HIFU devices for reducing adipose tissue and torso contouring (7).
By using an external transducer, HIFU energy cuts off targeted adipose tissue. Yet, it has no furnishings on surrounding tissues. Due to high convergence of ultrasound energy at high frequencies, tissue impairment is limited to a small focal signal. ultrasound energy makes molecular vibrations at the zone, that leads to increasing temperature at targeted tissue above 56°C and coagulative necrosis of fat cells (20, 22, 23).
In that location are diverse types of HIFU devices in the market such as LipoSonix (Medicis Technologies Corporation, Bothell, Washington), which are approved by the nutrient and drug administration (FDA), yet in that location are likewise other ultrasound devices developed for noninvasive body contouring not yet approved by the FDA such as Proslimelt (medical care consulting, Murten, Switzerland), Medcontour (general project, Florence, Italy), Ultracontour (Medixsysteme, Nimes, France), Novashape (UltraMed,Milton,ON, Canada), Accent Ultra (Alma, Buffalo Grove, IL, The states and Vaser-Shape (sound surgical technologies, Louisville, CO, United states of america) (seven, 22).
In 2011, a preclinical animal research on 26 pigs was performed. Treatment was applied by HIFU in i session for each site (25 × 25 mm for each site) and free energy levels varying from 85.3 to 270 J/cmtwo. The written report showed successful decrease of subcutaneous fatty. In addition, no agin effects were seen on the skin, fascia, or other surrounding tissues. No systemic abnormalities in blood chemistry parameters or fat emboli were reported during necropsy (22).
In a randomized, single-blind, sham-controlled written report in 2012, 180 males and females (18 - 65 years) participated with BMI of ≤ 30 kg/g2 and Subcutaneous adipose tissue (Sat) thickness of ≥ 2.5 cm in the treatment region (inductive abdomen and flanks). During the study, participants continued their usual diet and physical action. Patients were divided to iii groups and received HIFU handling at one of the three total doses of energy: 177 J/cm2 (3 passes at 59 J/cm2), 141 J/cm2 (3 passes at 47 J/cm2), or 0 J/cm2 (iii passes at 0 J/cm2; sham group) for well-nigh i minute for each targeted zone and 15 minutes for the total handling session. No abnormalities in blood lipids or inflammatory markers were reported. The almost adverse effects of treatment were pain, ecchymosis and swelling. Post-treatment follow-up at 12 and 24 weeks revealed no pregnant changes in cholesterol, triglycerides, free fatty acids, markers of inflammation and liver or renal role (24). Moreover Jewell et al. confirmed HIFU as a useful method for reducing waist circumference. Subsequently 12 weeks, meaning reduction in waist circumference in the two study groups was reported. The mean decrease in waist circumference was more than 2 cm. All the same, no changes in weight or BMI were reported (25).
Likewise, a retrospective study in 2010 with 85 participants (57 females and 28 males with a mean age of 43.8 years), showed similar findings at ≤ 16-week fallow-up. Hateful energy level of the HIFU device was 134.viii J/cm2 and treatment session duration varied from 60 to 90 minutes. The most common adverse effects of this study were edema, tenderness, ecchymosis, and hard lumps, and merely one participant experienced major pain. No significant change on blood lipids was reported. The average decrease in waist circumference was iv.half dozen cm, 12 weeks after treatment (26).
Shek al. published a single center prospective written report on 12 Chinese participants (ix females and three males, with a mean historic period of 39.5 years), who underwent single treatment on their anterior abdominal wall. Subjects with BMI ≤ 30 kg/mtwo and subcutaneous adipose tissue ≥ 2.5 cm in the targeted zone were recruited in the study. The minimum energy level for the treatment session was 150 J/cm2 and the energy was increased upwardly to patient's tolerance level (hateful 161 J/cmtwo). Initial measures included weight, BMI, and waist circumference. Statistically, a significant subtract in waist circumference at four, eight and twelve-week fallow-up was reported. The average subtract of waist circumference was 1 cm at the twelfth week follow-upward. Nonetheless, there was no significant modify in weight or BMI (xx).
In a clinical trial in Paris, HIFU technique was applied on 25 Caucasian subjects (females with a mean age of 38.nine years) and this treatment was shown to exist a safe process for body contouring, which had a pregnant consequence on abdominal circumference. Hateful BMI of patients was 24.5 and mean baseline intestinal fat thickness was 3.24 cm. Each patient received three treatment sessions at 14-day intervals. According to the reported information, mean changes in circumference from baseline were -2.47 ± 0.44, -3.52 ± 0.46 and -iii.51 ± 0.56 cm on days fourteen, 28 and 56, respectively (27).
To sum up, it seems that HIFU is a condom and efficient applied science for reducing subcutaneous adipose tissue without any meaning consequence on claret lipid or inflammatory markers and with no local adverse effects such as burns or scarring. Studies based on the use of HIFU for torso contouring showed that cocky-reported patient'due south satisfaction is approximately 47% to 86%. These treatment effects are not dependent on diets or daily physical activity. In addition to the to a higher place-mentioned benefits of HIFU, the recovery time of the process is minimal, which can exist considered as an important reward. Nonetheless, according to available evidences no considerable influence was reported on BMI or body weight (20, 22, 25, 26, 28).
3.2. Radiofrequency
Radiofrequency is an electromagnetic wave that was initially used for treating periorbital wrinkles, rhytids and skin laxity (29, 30). Today, RF is extensively used for trunk contouring, peel tightening and cellulite reduction (31).
Radiofrequency is ordinarily used for increasing deeper skin temperature without any epidermal or dermal ablation. It is not but used as an efficient method for contracting or inducing skin tightening but as well as an effective method for reducing fatty in repetition (31, 32). However, there is no standard protocol for treatment time with RF, and the range of therapeutic sessions were widespread between 1 and 24 weeks (xxx). However, college temperature at shorter time could be lethal for adipose tissue but it is non necessarily comfortable for patients; longer time, for example eight to ten minutes, with lower temperature, leads to intended adipose cells impairment (32). One-time researchers insisted that different parameters in addition to time are related to the success of RF, such every bit power and the frequency of treatment sessions, yet the exact protocols in this area are unavailable (30).
Radiofrequency generates heat in dissimilar tissues past transforming energy through three bones mechanisms from electromagnetic field (32). These mechanisms include (i) orientation of electric dipoles that already exists in the atoms and molecules in the tissue; (ii) polarization of atoms and molecules to produce dipole moments; and (iii) displacement of conduction electrons and ions in the tissue. The frequency of an RF device ranges between three kHz and 24 GHz, and the monopolar and the bipolar configuration are used unremarkably in medicine (31).
Vela Smooth was the first RF device, which was used widely for body contouring. Now, in that location are diverse types of RF devices in the market place such as Thermage (SoltaMedical, Hayward, CA, USA), Accent (Alma Lasers), TriPollar (Pollogen, TelAviv, Israel), Freeze (Venus Concepts, Karmiel, Israel) and most recently TiteFX (Invasix).
A diverseness of studies demonstrate smoothening of the cellulite exposure using RF and reduction of subcutaneous tissue, which leads to circumference reduction (16, 17, 33-36). Manuskiatti and colleagues evaluated the effects of a TriPollar RF technology on abdomen and thigh circumferences and cellulite appearance in 39 female subjects with cellulite grade ≥ 2 (Nurnberger-Muller calibration). The subjects received 8 handling sessions, 7 days apart, without any alter in their physical activity and diet. Iv weeks after the last treatment session, the written report showed pregnant circumference reduction of the abdomen and thigh regions. Nevertheless, in that location was no significant reduction in buttocks and arms. In addition, the study showed that TriPollar RF improved the appearance of cellulite (sixteen). For assessing treatment procedure's outcomes, circumference measurements of treated region were done forth with taking real-time scanning images and measuring skin elasticity. The cellulites condition was evaluated in each patient according to the Nurnberger-Muller scale (16).
Del Pino et al. assessed the furnishings of applying unipolar RF [the Accent RF System (Alma Lasers Inc)] on subcutaneous fat of the buttocks and thighs of 26 female person subjects (ages 18 to 50 years) with visible cellulite (grade 1 to 3). Ii treatment sessions, 2 weeks apart, were considered. They used real-time scanning image ultrasound for measuring the distance between the dermis and the camper'due south fascia, and their findings showed that controlled tissue heating with RF could reduce the thickness between the dermis and fascia. The average reduction in thigh and buttocks were ii.64 and 1.eight mm, respectively. Understanding the consequence of treatment sessions from changes on peel texture and clothing leads to patient's satisfaction with the process and was assessed by the studying group (fourteen).
Another study in Spain revealed that RF could improve upper thigh cellulite in females aged 24 - 58 years, and the positive effects remained at least for six months after treatment. Van Der Lugt et al. practical a unipolar, volumetric RF device (frequency between 0.six and two.iv MHz) for 12 sessions, ane week apart. All of the fifty female person subjects (with homogenous cellulite depositions) showed considerable amelioration in buttock skin conditions, which was completely noticeable by real-time scanning ultrasound prototype and comparison the distance between stratum corneum and Camper'south fascia and from the stratum corneum to the muscle, earlier and 2 weeks after treatment sessions. Nearly of the patients were satisfied with the handling. All the same, two months after the last session, slight return was seen in the favorable handling results (17).
Another report in New Bailiwick of jersey revealed that utilization of unipolar RF (Alma Lasers, Buffalo Grove, IL) improved upper thigh cellulite in females. All the subjects were over the age of 30 years with upper thigh cellulite (class 3 to 4, according to the Nurnberger-Muller calibration). Their thigh circumference decreased 2.45 cm on average afterward half-dozen sessions of treatment, i week apart. Nonetheless, at that place were no pregnant changes in body weight and claret lipids afterward the treatment (34).
Sadick and Mulholland (35) reported their experience on the use of RF energies in order to care for cellulite in 35 female person subjects. Each patient received eight to xvi treatment sessions i week apart and target zones were thighs and/or buttocks. Subjects were instructed to keep their normal lifestyle (including diet and fluid consumption). After eight treatment sessions, the hateful reduction in circumference was ii.03 cm.
By reviewing related articles on RF therapeutic effects on peel laxity, Araujo et al. confirmed that up to 96% of erstwhile studies obtained positive outcomes with RF. These information were nerveless past before and subsequently exposure pictures, patient'due south questionnaires, biopsy, etc. (30). Satisfaction for subcutaneous fat reduction with RF was approximately 71 - 97%, according to patients' cocky-reported data (4). However, significant statistical outcomes virtually the effects of RF on skin laxity and cellulite treatment were low and limited (thirty, 37).
In summary, it seems that RF is a rubber and relatively effective method for improving skin appearance and decreasing subcutaneous fat, especially in the belly and thighs. In addition, safety and relatively lower fourth dimension for applying the modality are of import advantages.
three.3. Cryolipolysis
Cryolipolysis is one of the newest procedures for non-invasive fat reduction, which was introduced equally a body contouring technique in 2007 (19, 38). It has a major difference from other modalities such as ultrasound, radiofrequency, etc. (xi). The principle of cryolipolysis is based on higher sensitivity of adipocytes to cold in comparing with other water-rich cells (39).
In 2010, cryolipolysis received FDA clearance for honey handles (Zeltiq). In 2012 and 2014, FDA clearance was obtained for fat removal by cryolipolysis at abdomen and thighs, respectively (seven, nineteen, 40).
The efficiency of the method on reducing fat layer thickness without whatsoever physical damage to circumambient tissue has been proven clinically. Assessing the efficacy of cryolipolysis and its potential side effects in dissimilar subjects showed that not only the procedure was effective in reducing adipose tissue, but also patient satisfaction was high after the treatment session (4, 5, 38-48).
Jalian reported fat cells sensitivity to cold injury in 1902 (19). In 1941, the term "adiponecrosis eastward frigore" was used by Haxthausen for sores, which occurred due to exposure to exceeding cold (49). During the period between 1940 and 1970, instance reports showed gradual fat reduction in the lower cheeks of children who suck on a popsicle and the effect was known every bit "popsicle panniculitis" (5, 50). Such findings led to the advancement of cryolipolysis as a body contouring method (five, 19).
A preclinical animal enquiry to assess effects of controlled cooling on subcutaneous fat was performed in 2008. In this written report, black Yucatan pigs were placed under general anesthesia and their target zones (10 sites for each grunter) were exposed to exceeding common cold temperature within 10 minutes (twenty, -ane, -iii, -five, and -vii degrees C). The iv pigs were controlled on days 1, 2, 7, 14 and 28 subsequently the treatment session and the fallow-up continued up to 3.5 months for i pig. The assessment showed approximately 40% subtract in fat layer thickness without any scarring or damage to surrounding tissues (51). In addition, information technology seems that the best results in fatty dissentious were obtained at lower degrees (five, 51). However, studies have demonstrated that nether temperature conditions as high every bit 1°C, adipocytes are damaged and peradventure their chances of survival decreases. Scientific prove on the effects of temperatures below -seven°C on dermis and epidermis is not available, attributable to the fact that the bulk of research has been carried out under conditions with temperatures over -seven°C (43, 52). Similar to Manstein, Zelickson et al. reported their porcine experiment that underwent cryolipolysis for one session. Their findings showed that the thickness of the superficial fat layer decreased by 33% without any side effects (52).
In human studies, the protocol of cooling has been done by cup-shaped applicators with ii cooling panels. A vacuum pulls the tissue and draws the target zone between cooling panels. The constriction of blood vessels accelerates the cooling process. The treatment session usually takes one 60 minutes (five, 7). Despite the fact that there are not any considerable changes in body fat instantly after the treatment session, unlike studies proved the efficacy of the process on reducing subcutaneous adipose tissue over time (11). In a prospective homo clinical report, Dover et al. revealed a subtract in lateral flank and back fat following cryolipolysis. In this study, 32 subjects underwent a sixty-infinitesimal treatment session. At a 4-calendar month post treatment fallow-up, 84% of subjects showed some degree of fat thickness reduction past photographic assessment. In addition, significant reduction in fat layer (22%) was reported in ultrasound evaluation in ten participants. Furthermore, more than xc% of participants were satisfied with the procedure and no meaning complication was reported (53).
In some other report, 10 subjects (older than xviii years old) underwent cryolipolysis for 30 to 60 minutes on their dear handles. Ii and six months afterwards the handling, fat layer thickness decreased by near 20% and 25.five%, respectively. In addition, weekly neurologic assessment showed that cryolipolysis could make balmy reversible changes in a brusk menstruation, but the changes returned within two months afterward the treatment (43).
Shek et al. reported their experience on Chinese subjects with visible key fat burl (on the abdomen and/or honey handles). Subjects (males and females, higher up 18 years quondam) were divided to two groups. Group A received ane treatment session on the abdominal fat bulges and grouping B received two treatment sessions on 2 sites (abdomen and flank), 60 days apart on average. Later two months, 14% abdominal adipose tissue reduction in group A, and 14 and 13.4% fat reduction in belly and flank region, respectively in group B, was shown by caliper measurement. Moreover, it was reported that increasing the number of treatment sessions to two, improved the positive results. In this report, the fatty layer reduction in the abdomen region rose by 7.2%, two months after the last treatment, and 4.three% improvement was found in the flank. This was statistically significant for abdominal fat (48).
Zelickson et al. demonstrated that using cryolipolysis for treating inner thigh fat bulges could be safety and effective for male and female person subjects. They assessed 45 patients (mean age 48.i years and mean trunk mass index 24.6 kg/m2), who underwent one treatment session with a flat loving cup applicator. At two- and four-month fallow up sessions, photographic evaluation, circumferential measurements and ultrasound imaging was performed. The results showed a 0.nine-cm reduction in inner thigh fatty bulges at a sixteen-week fallow upwards, and 93% of the participants were satisfied (39). In a similar report on subjects with BMI of upwards to 40kg/thou2, a single treatment session on inner thighs was performed. Comparing photographs and ultrasound imaging at a four-month fallow-up showed a xx% fatty reduction (3.iii mm) on average (41).
The shape of the applicator has recently been inverse to a new generation of sharply-contoured device. A clinical report, in 2014, assessed the effectiveness of this new applicator on flanks. In this study, ten female subjects (mean historic period 42.2 years and hateful torso mass index 24.3kg/thou2) received two treatments for each flank with l% overlap. Photographic evaluation showed 43% comeback in reducing fat bulges on boilerplate in a follow-upward later on iii months without significant side effects (40).
In a multicenter study, 518 males and females received the treatment in dissimilar target zones, including belly, back, buttocks, inner thighs and knees. At the 12-week fallow up, treated sites were evaluated past skin fold thickness. Overall, 94% of subjects experienced fatty reduction in comparing with the controlled side. In addition, a 23% decrease in adipose tissue at the treated sites was reported. Blind investigation with photographs revealed fat layer thickness reduction in 73% of the patients. In addition, the results suggested the greatest reduction on abdomen and flank and the least changes on thighs, knees, and buttocks (44).
A comprehensive review in Canada showed the efficacy and safe of cryolipolysis in reducing thigh, abdomen, arm, and back fatty bulges. In this study, investigators assessed the treatment process at 464 sites, during iii years. The major treatment zones were abdomen and flank but some treatments were performed on other zones. Pare texture, laxity and cellulite were improved later the handling (42).
The long-term effect was not clear. In two case reports, it was mentioned that two males, who underwent cryolipolysis handling sessions were successful in keeping the fat reducing results, two and 5 years after the procedure (54).
In summary, using cryolipolysis for body contouring is effective for patients with separate fat bulges. However, information technology seems that the procedure is not pronounced for obese patients with considerable skin flaccidity (55). cryolipolysis is not dependent on the operator and this should be considered equally an advantage for the technique, still long handling sessions are an important disadvantage (vii). Kennedy et al. as well reported that in most studies, assessing effects of cryolipolysis were done by patient questionnaires, anthropometric measurements, clinical photographing, etc. Self-reported satisfaction on reducing subcutaneous fat in patients was more seventy% (4).
3.4. Low-Level Laser Therapy
Low-level laser therapy is another noninvasive method for reducing adipose tissue and received FDA clearance in 2010. Before that, LLLT was widely used for treating other problems such equally neurologic, ophthalmic, dental and dermatologic diseases (56-58).
Although there are some evidences, which evidence the effects of LLLT on reducing fat in combination with liposuction, the evidences for the effects of this method as a stand up-alone procedure, are non sufficient (56). Applying LLLT for fat removal has no observable consequence on surrounding tissues and does not increase tissue temperature. Moreover, information technology takes fourth dimension to bear witness its own result on the treated zone. The laser beam energy is defined by the ray dosage that is emitted to the body (7).
The type of device available in the market, works at a moving ridge-length of 635 nm and has 4 adjustable artillery. Ane handling session with LLLT lasts upwardly to half an hour and 6 to 8 sessions is required in gild to obtain optimum results. In addition, manufacturers encourage consumers to utilise some supplements such as vitamin B5 and L-carnitine, Ginkgo biloba or green tea to reinforce circulatory and lymphatic systems (56).
Using LLLT for fatty reduction and body contouring is based on experiences, which showed that applying 635-nm laser leads to deflation of temporary tiny openings within membrane of adipose cells and releasing fats into the interstitial space. The result of these changes is reduction of unwanted fat. Notwithstanding, the openings have no destructive effect on torso cells only allow lipids enter the interstitial infinite and excrete from the body. Information technology seems that the above-mentioned machinery is the upshot of photoexcitation process of cytochrome c oxidase in mitochondria's respiratory chain (56, 59, 60). The first experiments of using LLLT with the possible mentioned mechanism, demonstrated that applying 635 nm, x mw intensity for six minutes caused approximately 99% fatty reduction (60), though later studies such as the experience of Brown et al. did non support the these findings (61).
In 2009 Jackson et al. reported that applying LLLT to reducing torso fatty could exist effective on overall circumference. They assessed 67 overweight participants (BMI 25 to 30 kg/m2), which underwent LLLT (635-nm lite with two.5 mW power) for two weeks (iii handling sessions in each week). Later on treatment by LLLT (Zerona lipolaser was the start device that received FDA clearance), a total of 891-mm fat reduction was observed beyond waist, hips, and thighs. Maximum fat reduction was reported across the waist (2.66 cm). However, two weeks subsequently the last handling session, a vii.8-mm increase in circumferences was seen in three treated zones (62). In some other clinical study, Jackson et al. reported that treating 689 subjects with LLLT (12 treatment sessions within xiv days) leads to 13.13-cm circumferential reduction in waist, hips, thighs, arms, knees, cervix and chest (63).
Caruso-Davis et al. used 635 - 680 nm LLLT (Meridian LAPEX 2000 lipolaser system, Tiptop medical Inc. Anyang, Korea) for reducing adipose tissue. Forty subjects with BMI of < 30 kg/m2 participated in their experiment and received eight treatment sessions (half an hr for each session) within one calendar month. Average fat reduction on waist circumference later the last treatment session was equal to two.15 cm (64). There were two studies, which measured patient's satisfaction after the treatment procedure. In the study of Nestor et al., satisfaction was reported upward to 80% but in the research of Lach et al. reduction of subcutaneous fat in normal weight women was nearly 32% (1, 65).
In decision, while some studies introduced LLLT as an effective method for body contouring and fat removal, more than studies are needed to prove efficacy and safety of this method.
3.five. Extracorporeal Shockwave Therapy
Extracorporeal shockwave therapy has been a method for treating kidney stones since 1980 (45). In add-on, the process has been used for curing lesions and wounds. Nowadays, the device is being used for body contouring and treating cellulite (66, 67).
Although the full machinery of ESWT is not articulate nonetheless, it seems that it is based on converting electric free energy to mechanical free energy (68). The energy created in this process is express to target zones by affecting acoustical interfaces and no significant changes in surrounding tissue are observed (66).
The ability and effectiveness of the device is afflicted by shockwave energy, the frequency of the generated waves, the number of pulses, and the number and interval of re-treatments (69).
The usually used form of ESWT in treating soft tissue is defocused, low-energy shockwaves, which comes in contrast with focused, high-free energy ESWT and is unremarkably applied for delay-union or non-union fractures (69).
Information technology seems that applying extracorporeal shockwave could be an effective method for treating cellulite due to pare collagen remodeling (66). Angehrn et al. assessed the shockwave effects on cellulite of 21 women. The participants received 12 sessions of low-energy defocused ESWT (96000 shots for each person) during half-dozen weeks in the lateral thigh. Afterwards the last session, high-resolution ultrasound measurements and personal questionnaire showed some degrees of improvement on their skin elasticity (66).
Another randomized-controlled trial in 2013 was performed to investigate the effects of ESWT along with practice on cellulite. The intervention group received half-dozen sessions of focused ESWT on gluteal and thigh areas (2000 impulses, 0.35 mJ/mm2) every i to two weeks. Six sessions of SHAM-ESWT was performed on the control group. Daily gluteal strength trainings were prescribed for both groups. The results showed significant comeback in skin appearance and cellulite severity scale, but no effect on thigh circumference was reported (67).
It seems that ESWT could be considered as an effective method for body contouring and cellulite treatment, yet further studies are required to decide the outcome of this technique on circumference reduction.
3.half-dozen. Vibration Practice and Weight Reduction
Current ACSM guidelines for weight reduction suggest moderate-intensity aerobic practise in add-on to a moderate caloric restriction, which further improves weight loss. Other practise modalities such as resistance grooming take received a lot of attention for weight loss. An exercise mode that needs lilliputian time and physical exertion but provides advantages to increment muscle function and possible weight loss would be of interest to well-nigh people. 1 such exercise mode is vibration exercise (lxx).
Vibration exercise kicks off a fast and repetitious eccentric-concentric activity that induces muscular work and increases metabolic rate (70). This is done by standing on a machine with an oscillating platform or some other devices such equally vibrating slimming belt or handheld devices. Depression frequency vibration (v - 45 Hz) increases muscle activity via stimulating the muscle spindle, involving the spinal reflex appliance, which may increase free energy expenditure and might exist favorable for weight reduction (lxx). In fact, the vibration transferred to the muscle-tendon circuitous results in a stretch-shortening action, which stimulates musculus spindles and evokes subsequent musculus contractions via monosynaptic and poly-synaptic reflexes. These reflexive muscle contractions increase local metabolic charge per unit (71).
Vibration exercise is a very popular do mode and in that location are different types of vibration machines in fettle centers and gyms. There are many reports in the literature suggesting that vibration exercise is an efficient method for reducing workout time while improving muscular performance to increment energy expenditure and subtract torso fat. It has been reported that a 10-minute vibration do is equal to a one-60 minutes of conventional practise (70). It has been suggested that increased fat oxidation both during and afterward practise and catecholamine release may crusade weight loss in lean people who appoint in vibration exercise but the underlying mechanisms remain unequivocal (70).
Recently, the ability of vibration do to increment skeletal muscle perfusion in the lower limb has been reported in the literature. The amount of increase in musculus blood menstruation seems to exist related to the vibratory load and is due to reflexive muscular contractions during vibration exercise (71). In some reports, there is a positive linear correlation betwixt vibratory load and muscle perfusion (71). A systematic review by Fuller et al. in 2013 indicated that vibration exercise increases muscle perfusion, peculiarly in the lower extremities, with the amount of increase in perfusion being positively related to the vibratory load (71).
The effect of whole body vibration practice on torso composition has been evaluated in different studies. Milanese et al. explored the short-term effect of whole body vibration (WBV) exercise on anthropometric measurements. Fifty obese women were randomly allocated to a x-week WBV training group or a non-exercise control group. Whole torso vibration do consisted of 14 minutes of vibration grooming on the WBV device (Bioplate RF, BIOS, Milano, Italia) with aamplitude of 2 - 5 mm and frequency of 40 - 60 Hz, twice a week. Earlier and after the 10-week experimental period, anthropometric assessments and dual-energy x-ray absorptiometry (DXA) were carried out. The results showed that compared to the command grouping, subjects submitted to WBV exercise had significantly lower BMI, total body and trunk fat, sum of pare-folds and body circumstances. These results suggested that WBV exercise improved body limerick and might be a useful addition to lifestyle recommendations (72).
Another study in Kingdom of belgium by Roelants et al. investigated the furnishings of 24 weeks of WBV training on trunk composition compared with fitness grooming on 40-eight untrained females. Vibration platform (35 - xl Hz, two.v - 5.0 mm; Power Plate®) was used for WBV training. The fitness grouping performed a standard cardiovascular (15 - 40 minutes) and resistance grooming (leg printing and leg extension exercises 20/8 RM). Body limerick was adamant by the underwater weighing method and 12-points skinfold thickness assessment. After 24 weeks, there were no significant changes in weight, percentage of trunk fat or skinfold thickness in any of the groups. A significant strength proceeds was observed in both groups. The results of the study showed that although WBV training didn't reduce weight and subcutaneous fatty, it could increase muscle strength comparable to the strength gain post-obit a standard fitness training program (73).
To sum up, the results of studies on vibration practice are contradictory and it is difficult to draw any conclusion near its effects on trunk composition, especially on local fatness. Although vibration practice has gained popularity for weight loss and body contouring, it does not accept the capability to substitute aerobic exercise in terms of energy costs. However, it seems that similar resistance training, vibration practice does have a positive effect on blood flow (70, 71), which could increase metabolic rate in relevant areas and can improve fat free mass and muscle strength without any meaning effect on skinfold measurements (73).
3.7. Combination Therapy
For increasing positive results of body contouring methods, in some studies, combination treatment regimens were used such equally combination of cryolipolysis and shockwave, RF and suction, etc. Moreover, in some cases, especially in the cellulite therapeutic approach, manual massage is considered (4, 18, 37). It seems that the results can amend past combining several techniques. For instance, in one study the all-time abdomen circumference reduction was observed by using cryolipolysis in combination with ESWT, however in another study, the best results in buttocks fat removal were gained past using 635-nm LLLT in combination with vibration therapy (45, 57). In some other research, when the HIFU technique was combined with RF therapy, positive outcomes were nearly 72%, which was assessed by a satisfaction survey (74). However, the existing evidences in this field are very express.
4. Conclusions
According to the existing evidences in animal and human studies, some of the noninvasive techniques such as cryolipolysis, RF, LLLT and HIFU have shown statistically pregnant effects on torso contouring, removing unwanted fatty and cellulite. However, the reported effects of such devices were mild to moderate and the mentioned methods have footling or no effect on torso weight reduction and full per centum of body fat. On average, circumference reduction later noninvasive methods was 2 - cm. Moreover, there were major differences in the investigation methods peculiarly target zones, number and time of fallow-up sessions and blazon of measurements or outcomes. Therefore, comparing the effectiveness of these methods was besides hard. The follow-up sessions in nigh studies were planned six, 12 or 24 weeks later on treatment sessions and evidence on long-term outcomes or recurrence of subcutaneous fat afterward 24 weeks is inadequate. One of the most of import aspects of body countering methods is patient satisfaction following handling, which is not noticeable in most cases considering most of the participants wait like outcomes to surgical procedures. Focusing on the part of noninvasive torso contouring methods on cellulite or subcutaneous fat every bit a sole defining method is too challenging. As a former experiment showed, some methodological faults in studies, such equally lack of an stop-point for cellulite severity or absence of clinical statistical analysis, brand it very hard to obtain confirmed results and it seems in that location is no definitive treatment method for cellulite and subcutaneous fat.
Acknowledgments
The authors admit the Tehran University of Medical Sciences for facilitating the data drove.
Footnotes
Authors' Contribution:Study concept and design: Zahra Alizadeh and Reza Mazaheri. Drafting of the manuscript: Zahra Alizadeh, Mastaneh Tabesh and Farzin Halabchi. Critical revision of the manuscript for important intellectual content: Zahra Alizadeh. Report supervision: Zahra Alizadeh and Maryam Abolhasani.
References
1. Nestor MS, Newburger J, Zarraga MB. Body contouring using 635-nm low level laser therapy. Semin Cutan Med Surg. 2013;32(one):35–40. [PubMed] [Google Scholar]
2. Adatto MA, Adatto-Neilson RM, Morren G. Reduction in adipose tissue volume using a new high-ability radiofrequency technology combined with infrared light and mechanical manipulation for body contouring. Laser med sci. 2014;29(5):1627–31. doi: 10.1007/s10103-014-1564-x. [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]
3. Afrooz PN, Pozner JN, DiBernardo BE. Noninvasive and Minimally Invasive Techniques in Body Contouring. Clin Plast Surg. 2014;41(4):789–804. doi: 10.1016/j.cps.2014.07.006. [PubMed] [CrossRef] [Google Scholar]
four. Kennedy J, Verne S, Griffith R, Falto-Aizpurua L, Nouri K. Non-invasive subcutaneous fat reduction: a review. J Eur Acad Dermatol Venereol. 2015 Sep;29(ix):1679–88. doi: 10.1111/jdv.12994. [PubMed] [CrossRef] [Google Scholar]
5. Avram MM, Harry RS. Cryolipolysis™ for subcutaneous fatty layer reduction. Laser surg med. 2009;41(10):703–8. doi: 10.1002/lsm.20864. [PubMed] [CrossRef] [Google Scholar]
6. Cosmetic Surgery National Data Depository financial institution Statistics , Cosmetic Surgery National Data Bank Statistics. US: American Social club for Aesthetic Plastic Surgery; 2014. [cited 21 July 2014]. Bachelor from: http://www.surgery.org/media/statistics. [Google Scholar]
7. Mulholland RS, Paul MD, Chalfoun C. Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level light amplification by stimulated emission of radiation therapy. Clin Plast Surg. 2011;38(iii):503–20. doi: 10.1016/j.cps.2011.05.002. seven-3. [PubMed] [CrossRef] [Google Scholar]
8. Janda K, Tomikowska A. Cellulite-causes, prevention, handling. [in Polish] Ann Acad Med Stetin. 2014;threescore(1):29–38. [PubMed] [Google Scholar]
9. Soares JL, Miot HA, Sanudo A, Bagatin Due east. Cellulite: poor correlation between instrumental methods and photograph evaluation for severity classification. Int J Cosmet Sci. 2015;37(1):134–40. doi: 10.1111/ics.12177. [PubMed] [CrossRef] [Google Scholar]
x. Hamishehkar H, Shokri J, Fallahi S, Jahangiri A, Ghanbarzadeh S, Kouhsoltani M. Histopathological evaluation of caffeine-loaded solid lipid nanoparticles in efficient treatment of cellulite. Drug Dev Ind Pharm. 2015;41(10):1640–vi. doi: 10.3109/03639045.2014.980426. [PubMed] [CrossRef] [Google Scholar]
11. Krueger North, Mai SV, Luebberding S, Sadick NS. Cryolipolysis for noninvasive torso contouring: clinical efficacy and patient satisfaction. Clin Cosmet Investig Dermatol. 2014;7:201–5. doi: 10.2147/CCID.S44371. [PMC gratis article] [PubMed] [CrossRef] [Google Scholar]
12. Pavicic T, Borelli C, Korting HC. [Cellulite--the greatest skin problem in healthy people? An approach]. J Dtsch Dermatol Ges. 2006;4(10):861–seventy. doi: 10.1111/j.1610-0387.2006.06041.x. [PubMed] [CrossRef] [Google Scholar]
thirteen. Nurnberger F, Muller G. So-called cellulite: an invented disease. J Dermatol Surg Oncol. 1978;four(three):221–9. [PubMed] [Google Scholar]
14. Emilia del Pine M, Rosado RH, Azuela A, Graciela Guzman K, Arguelles D, Rodriguez C, et al. Result of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs. J Drugs Dermatol. 2006;5(8):714–22. [PubMed] [Google Scholar]
xv. Khan MH, Victor F, Rao B, Sadick NS. Treatment of cellulite: Office II. Advances and controversies. J Am Acad Dermatol. 2010;62(three):373–84. doi: 10.1016/j.jaad.2009.10.041. quiz 385-6. [PubMed] [CrossRef] [Google Scholar]
16. Manuskiatti W, Wachirakaphan C, Lektrakul N, Varothai South. Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot written report. J Eur Acad Dermatol Venereol. 2009;23(7):820–seven. doi: 10.1111/j.1468-3083.2009.03254.x. [PubMed] [CrossRef] [Google Scholar]
17. van der Lugt C, Romero C, Ancona D, Al-Zarouni M, Perera J, Trelles MA. A multicenter study of cellulite handling with a variable emission radio frequency system. Dermatol Ther. 2009;22(1):74–84. doi: 10.1111/j.1529-8019.2008.01218.x. [PubMed] [CrossRef] [Google Scholar]
18. Zerini I, Sisti A, Cuomo R, Ciappi S, Russo F, Brandi C, et al. Cellulite treatment: a comprehensive literature review. J Cosmet Dermatol. 2015;xiv(3):224–xl. doi: 10.1111/jocd.12154. [PubMed] [CrossRef] [Google Scholar]
19. Jalian H, Avram MM. Cryolipolysis: a historical perspective and current clinical practice Seminars in cutaneous medicine and surgery. 2013;46 [PubMed] [Google Scholar]
twenty. Shek SY, Yeung CK, Chan JC, Chan HH. Efficacy of high-intensity focused ultrasonography for noninvasive torso sculpting in Chinese patients. Lasers Surg Med. 2014;46(four):263–9. doi: 10.1002/lsm.22232. [PubMed] [CrossRef] [Google Scholar]
21. Wu F, Wang ZB, Chen WZ, Wang W, Gui Y, Zhang M, et al. Extracorporeal loftier intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in Cathay: an overview. Ultrason Sonochem. 2004;eleven(3-4):149–54. doi: 10.1016/j.ultsonch.2004.01.011. [PubMed] [CrossRef] [Google Scholar]
22. Jewell ML, Desilets C, Smoller BR. Evaluation of a novel high-intensity focused ultrasound device: preclinical studies in a porcine model. Aesthet Surg J. 2011;31(4):429–34. doi: 10.1177/1090820X11405026. [PubMed] [CrossRef] [Google Scholar]
23. Haar GT, Coussios C. High intensity focused ultrasound: concrete principles and devices. Int J Hyperthermia. 2007;23(ii):89–104. [PubMed] [Google Scholar]
24. Jewell ML, Weiss RA, Baxter RA, Cox SE, Dover JS, Donofrio LM, et al. Safety and tolerability of high-intensity focused ultrasonography for noninvasive body sculpting: 24-week information from a randomized, sham-controlled written report. Aesthet Surg J. 2012;32(vii):868–76. doi: x.1177/1090820X12455190. [PubMed] [CrossRef] [Google Scholar]
25. Jewell ML, Baxter RA, Cox SE, Donofrio LM, Dover JS, Glogau RG, et al. Randomized sham-controlled trial to evaluate the prophylactic and effectiveness of a high-intensity focused ultrasound device for noninvasive torso sculpting. Plast Reconstr Surg. 2011;128(1):253–62. doi: 10.1097/PRS.0b013e3182174278. [PubMed] [CrossRef] [Google Scholar]
26. Fatemi A, Kane MA. High-intensity focused ultrasound effectively reduces waist circumference past ablating adipose tissue from the abdomen and flanks: a retrospective example series. Artful Plast Surg. 2010;34(5):577–82. doi: x.1007/s00266-010-9503-0. [PubMed] [CrossRef] [Google Scholar]
27. Ascher B. Safe and efficacy of UltraShape Contour I treatments to amend the appearance of body contours: multiple treatments in shorter intervals. Aesthet Surg J. 2010;30(2):217–24. doi: ten.1177/1090820X09360692. [PubMed] [CrossRef] [Google Scholar]
28. Gadsden E, Aguilar MT, Smoller BR, Jewell ML. Evaluation of a novel high-intensity focused ultrasound device for ablating subcutaneous adipose tissue for noninvasive body contouring: prophylactic studies in man volunteers. Aesthet Surg J. 2011;31(four):401–10. doi: 10.1177/1090820X11405027. [PubMed] [CrossRef] [Google Scholar]
29. Narins RS, Tope WD, Pope K, Ross EV. Overtreatment effects associated with a radiofrequency tissue-tightening device: rare, preventable, and correctable with subcision and autologous fatty transfer. Dermatol Surg. 2006;32(1):115–24. [PubMed] [Google Scholar]
30. Araujo AR, Soares VP, Silva FS, Moreira Tda S. Radiofrequency for the handling of peel laxity: mith or truth. An Bras Dermatol. 2015;xc(five):707–21. doi: 10.1590/abd1806-4841.20153605. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
31. Weiss RA. Noninvasive radio frequency for skin tightening and body contouring. Semin Cutan Med Surg. 2013;32(ane):9–17. [PubMed] [Google Scholar]
32. Franco W, Kothare A, Ronan SJ, Grekin RC, McCalmont Th. Hyperthermic injury to adipocyte cells by selective heating of subcutaneous fat with a novel radiofrequency device: feasibility studies. Lasers Surg Med. 2010;42(five):361–70. doi: x.1002/lsm.20925. [PubMed] [CrossRef] [Google Scholar]
33. Alexiades-Armenakas One thousand, Dover JS, Arndt KA. Unipolar radiofrequency handling to meliorate the appearance of cellulite. J Cosmet Light amplification by stimulated emission of radiation Ther. 2008;ten(three):148–53. doi: 10.1080/14764170802279651. [PubMed] [CrossRef] [Google Scholar]
34. Goldberg DJ, Fazeli A, Berlin AL. Clinical, laboratory, and MRI analysis of cellulite handling with a unipolar radiofrequency device. Dermatol Surg. 2008;34(2):204–9. doi: x.1111/j.1524-4725.2007.34038.ten. discussion 209. [PubMed] [CrossRef] [Google Scholar]
35. Sadick NS, Mulholland RS. A prospective clinical report to evaluate the efficacy and safety of cellulite handling using the combination of optical and RF energies for subcutaneous tissue heating. J Cosmet Light amplification by stimulated emission of radiation Ther. 2004;six(iv):187–90. doi: 10.1080/14764170410003039. [PubMed] [CrossRef] [Google Scholar]
36. Wanitphakdeedecha R, Manuskiatti W. Treatment of cellulite with a bipolar radiofrequency, infrared oestrus, and pulsatile suction device: a pilot study. J Cosmet Dermatol. 2006;5(iv):284–viii. doi: 10.1111/j.1473-2165.2006.00271.10. [PubMed] [CrossRef] [Google Scholar]
37. Luebberding S, Krueger N, Sadick NS. Cellulite: an evidence-based review. Am J Clin Dermatol. 2015;16(four):243–56. doi: x.1007/s40257-015-0129-5. [PubMed] [CrossRef] [Google Scholar]
38. Klein KB, Zelickson B, Riopelle JG, Okamoto Due east, Bachelor EP, Harry RS, et al. Non-invasive cryolipolysis for subcutaneous fat reduction does not affect serum lipid levels or liver function tests. Lasers Surg Med. 2009;41(10):785–90. doi: 10.1002/lsm.20850. [PubMed] [CrossRef] [Google Scholar]
39. Zelickson BD, Burns AJ, Kilmer SL. Cryolipolysis for safe and effective inner thigh fat reduction. 2015;47(2):120–7. [PMC complimentary article] [PubMed] [Google Scholar]
forty. Bernstein EF, Blossom JD, Basilavecchio LD, Plugis JM. Not-invasive fat reduction of the flanks using a new cryolipolysis applicator and overlapping, two-cycle treatments. Lasers Surg Med. 2014;46(10):731–5. doi: 10.1002/lsm.22302. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
41. Boey GE, Wasilenchuk JL. Fat reduction in the inner thigh using a paradigm cryolipolysis applicator. Dermatol Surg. 2014;forty(9):1004–9. doi: ten.1097/01.DSS.0000452628.99209.4f. [PubMed] [CrossRef] [Google Scholar]
42. Carruthers J, Stevens WG, Carruthers A, Humphrey S. Cryolipolysis and skin tightening. Dermatol Surg. 2014;40 Suppl 12:S184–9. doi: ten.1097/DSS.0000000000000229. [PubMed] [CrossRef] [Google Scholar]
43. Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its furnishings on peripheral nerves. Aesthetic Plast Surg. 2009;33(four):482–8. doi: ten.1007/s00266-008-9286-eight. [PubMed] [CrossRef] [Google Scholar]
44. Dierickx CC, Mazer JM, Sand M, Koenig S, Arigon V. Condom, tolerance, and patient satisfaction with noninvasive cryolipolysis. Dermatol Surg. 2013;39(8):1209–16. doi: ten.1111/dsu.12238. [PubMed] [CrossRef] [Google Scholar]
45. Ferraro GA, De Francesco F, Cataldo C, Rossano F, Nicoletti One thousand, D'Andrea F. Synergistic furnishings of cryolipolysis and stupor waves for noninvasive body contouring. Aesthetic Plast Surg. 2012;36(3):666–79. doi: 10.1007/s00266-011-9832-7. [PubMed] [CrossRef] [Google Scholar]
46. Kim J, Kim DH, Ryu HJ. Clinical effectiveness of not-invasive selective cryolipolysis. J Cosmet Laser Ther. 2014;16(v):209–thirteen. doi: ten.3109/14764172.2014.946050. [PubMed] [CrossRef] [Google Scholar]
47. Sasaki GH, Abelev N, Tevez-Ortiz A. Noninvasive selective cryolipolysis and reperfusion recovery for localized natural fat reduction and contouring. Aesthet Surg J. 2014;34(3):420–31. doi: ten.1177/1090820X13520320. [PubMed] [CrossRef] [Google Scholar]
48. Shek SY, Chan NP, Chan HH. Non-invasive cryolipolysis for torso contouring in Chinese--a first commercial feel. Lasers Surg Med. 2012;44(2):125–30. doi: 10.1002/lsm.21145. [PubMed] [CrossRef] [Google Scholar]
49. Haxthausen H. Adiponecrosis Eastward Frigore. British J Dermatol. 1941;53(iii):83–9. doi: ten.1111/j.1365-2133.1941.tb10506.x. [CrossRef] [Google Scholar]
50. Beacham BE, Cooper PH, Buchanan CS, Weary PE. Equestrian cold panniculitis in women. Arch Dermatol. 1980;116(9):1025–7. [PubMed] [Google Scholar]
51. Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: a novel method of non-invasive fat removal. Lasers Surg Med. 2008;40(9):595–604. doi: 10.1002/lsm.20719. [PubMed] [CrossRef] [Google Scholar]
52. Zelickson B, Egbert BM, Preciado J, Allison J, Springer 1000, Rhoades RW, et al. Cryolipolysis for noninvasive fat cell devastation: initial results from a pig model. Dermatol Surg. 2009;35(10):1462–70. doi: 10.1111/j.1524-4725.2009.01259.x. [PubMed] [CrossRef] [Google Scholar]
53. Dover JA, Burns J, Coleman South, Fitzpatrick R, Garden J, Goldberg D. A prospective clinical study of noninvasive cryolipolysis for subcutaneous fat layer reduction-interim report of available subject data Lasers in surgery and medicine. Hoboken: John wiley and Sons; 2009. [Google Scholar]
54. Bernstein EF. Longitudinal evaluation of cryolipolysis efficacy: two example studies. J Cosmet Dermatol. 2013;12(ii):149–52. doi: ten.1111/jocd.12036. [PubMed] [CrossRef] [Google Scholar]
55. Nelson AA, Wasserman D, Avram MM. Cryolipolysis for reduction of excess adipose tissue, Seminars in cutaneous medicine and surgery. United states of america: Saunders; 2009. [PubMed] [Google Scholar]
56. Jalian H, Avram MM. Trunk contouring: the skinny on noninvasive fat removal. Seminars in cutaneous medicine and surgery. USA: Saunders; 2012. [PubMed] [Google Scholar]
57. Savoia A, Landi S, Vannini F, Baldi A. Low-level laser therapy and vibration therapy for the treatment of localized adiposity and gristly cellulite. Dermatol Ther (Heidelb). 2013;3(1):41–52. doi: 10.1007/s13555-013-0026-x. [PMC gratis article] [PubMed] [CrossRef] [Google Scholar]
58. Stonecipher KG, Kezirian GM. Wavefront-optimized versus wavefront-guided LASIK for myopic astigmatism with the ALLEGRETTO Wave: three-month results of a prospective FDA trial. J Refract Surg. 2008;24(iv):S424–30. [PubMed] [Google Scholar]
59. Elm CM, Wallander ID, Endrizzi B, Zelickson BD. Efficacy of a multiple diode light amplification by stimulated emission of radiation arrangement for body contouring. Lasers Surg Med. 2011;43(2):114–21. doi: 10.1002/lsm.21016. [PubMed] [CrossRef] [Google Scholar]
threescore. Neira R, Arroyave J, Ramirez H, Ortiz CL, Solarte E, Sequeda F, et al. Fat liquefaction: effect of low-level light amplification by stimulated emission of radiation energy on adipose tissue. Plast Reconstr Surg. 2002;110(iii):912–22. word 923-5. [PubMed] [Google Scholar]
61. Avci P, Nyame TT, Gupta GK, Sadasivam M, Hamblin MR. Low-level light amplification by stimulated emission of radiation therapy for fat layer reduction: a comprehensive review. Lasers Surg Med. 2013;45(6):349–57. doi: 10.1002/lsm.22153. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]
62. Jackson RF, Dedo DD, Roche GC, Turok DI, Maloney RJ. Depression-level laser therapy as a not-invasive arroyo for torso contouring: a randomized, controlled study. Lasers Surg Med. 2009;41(ten):799–809. doi: ten.1002/lsm.20855. [PubMed] [CrossRef] [Google Scholar]
63. Jackson RF, Stern FA, Neira R, Ortiz-Neira CL, Maloney J. Application of low-level laser therapy for noninvasive torso contouring. Lasers Surg Med. 2012;44(3):211–vii. doi: 10.1002/lsm.22007. [PubMed] [CrossRef] [Google Scholar]
64. Caruso-Davis MK, Guillot TS, Podichetty VK, Mashtalir N, Dhurandhar NV, Dubuisson O, et al. Efficacy of low-level light amplification by stimulated emission of radiation therapy for trunk contouring and spot fat reduction. Obes Surg. 2011;21(6):722–9. doi: ten.1007/s11695-010-0126-y. [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
65. Lach Eastward. Reduction of subcutaneous fat and improvement in cellulite appearance by dual-wavelength, low-level laser energy combined with vacuum and massage. J Cosmet Light amplification by stimulated emission of radiation Ther. 2008;10(4):202–9. doi: 10.1080/14764170802516680. [PubMed] [CrossRef] [Google Scholar]
66. Angehrn F, Kuhn C, Voss A. Can cellulite be treated with depression-free energy extracorporeal stupor wave therapy? Clin Interv Aging. 2007;two(4):623–30. [PMC free commodity] [PubMed] [Google Scholar]
67. Knobloch K, Joest B, Kramer R, Vogt PM. Cellulite and focused extracorporeal shockwave therapy for non-invasive body contouring: a randomized trial. Dermatol Ther (Heidelb). 2013;3(two):143–55. doi: ten.1007/s13555-013-0039-5. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
68. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012;7:eleven. doi: 10.1186/1749-799X-seven-11. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
69. Antonic 5, Mittermayr R, Schaden W, Stojadinovic A. Evidence supporting extracorporeal shock wave therapy for acute and chronic soft tissue wounds. Wounds. 2011;23(7):204–15. [PubMed] [Google Scholar]
70. Cochrane DJ. Is vibration practice a useful add-on to a weight management program? Scand J Med Sci Sports. 2012;22(6):705–13. doi: x.1111/j.1600-0838.2011.01411.x. [PubMed] [CrossRef] [Google Scholar]
71. Fuller JT, Thomson RL, Howe PR, Buckley JD. Event of vibration on musculus perfusion: a systematic review. Clin Physiol Funct Imaging. 2013;33(1):1–ten. doi: 10.1111/j.1475-097X.2012.01161.x. [PubMed] [CrossRef] [Google Scholar]
72. Milanese C, Piscitelli F, Zenti MG, Moghetti P, Sandri M, Zancanaro C. 10-week whole-trunk vibration training improves body composition and muscle strength in obese women. Int J Med Sci. 2013;10(3):307–xi. doi: 10.7150/ijms.5161. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
73. Roelants M, Delecluse C, Goris K, Verschueren Southward. Effects of 24 weeks of whole body vibration grooming on torso limerick and musculus strength in untrained females. Int J Sports Med. 2004;25(ane):ane–five. doi: 10.1055/s-2003-45238. [PubMed] [CrossRef] [Google Scholar]
74. Chang SL, Huang YL, Lee MC, Chang CH, Chung WH, Wu EH, et al. Combination therapy of focused ultrasound and radio-frequency for noninvasive torso contouring in Asians with MRI photographic documentation. Lasers Med Sci. 2014;29(1):165–72. doi: x.1007/s10103-013-1301-x. [PubMed] [CrossRef] [Google Scholar]
Manufactures from International Periodical of Endocrinology and Metabolism are provided here courtesy of Kowsar Medical Institute
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5236497/
0 Response to "Reviews on Rf Ultracavitation Fat & Cellulite Remover"
Post a Comment