A Smarter Approach to a Slimmer Waistline – Part 2

According to the American Society for Aesthetic Plastic Surgery, liposuction continues to be the number one leading cosmetic surgical procedure in 2016, and has seen a 134% increase in the number of procedures performed since ASAPS initiated in 1997. 1

The demand for body contouring is growing so rapidly and this has sparked many new non-invasive technologies to cater to people who are unsuitable candidates for surgery and downtime.

The devices that are available on the market deliver some form of energy that creates changes in the adipocytes (fat cells), which results in shrinkage, apoptosis or necrosis (fat cell death). Some of the energy sources are:

  1. Laser light
  2. Radiofrequency
  3. Acoustic shock waves
  4. Cold (Cryolipolysis)
  5. High-intensity Ultrasound

Many patients have asked me which method is the best for them, at the moment, there is no gold-standard procedure yet, and the methods highlighted above differ by:

  1. Mechanism of action
  2. Response rate
  3. Side effects
  4. Level of discomfort
  5. Number of treatments required


In Malaysia, to date, the top two non-invasive body contouring technologies being used are:

  1. Cryolipolysis – COLD
  2. Radiofrequency – HOT

Freeze the Fat


The device for cryolipolysis has an applicator which is applied to the targeted treatment area, allowing tissue to be vacuumed up between 2 cooling panels for 30 to 60 minutes per treatment session. The current FDA-cleared market leader for cryolipolysis is CoolSculpting by Zeltiq.

An early animal study showed that subcutaneous fat exposed to cold had nearly 80% reduction in fat layer and temperature of -5 to -7 celcius had higher possibility of fat damage after 28 days.2

Some of the temporary side effects with cryolypolisis:

  1. Erythema (redness of skin)
  2. Bruising from the vacuum hand piece
  3. Clay-like skin
  4. Pain
  5. Nodular or diffuse infiltration at treatment area

This would be an ideal method to use for smaller, defined fat accumulation areas where one can benefit from shorter and fewer treatment sessions which will mean time and cost savvy!

Heat the Fat

There are various types of radiofrequency (monopolar/bipolar) device that can be used for body contouring. Heat generated by the radiofrequency device at the adipose tissue can cause apoptosis (cell death) of the fat cells.

Personally, I’ve always been more on the team ‘HOT’ because I find treatments using heat more comfortable, therefore in the past years I have tried many radiofrequency devices as part of body contouring regime, but what caught my attention in 2014 was Vanquish ME by BTL Aesthetics. The first non-contact radiofrequency machine that selectively targets fat cells and has minimal effect on other surrounding tissues.



The applicator is placed 1cm above the skin of targeted treatment area and duration of one treatment session is about 45 minutes.

Recommended treatment sessions depend on the targeted circumferential loss, but generally, 4-6 sessions can result in a reduction between 4-8cm in abdominal circumference.

Some of the temporary side effects:

  1. Erythema (redness of skin)
  2. Tenderness
  3. Panniculitis – (localised volumes of fibrosis-encapsulated fat)

Vanquish would be ideal for large body area in patients with high BMI, ie>25 as a single application can easily cover the abdomen and flanks (love-handles) bringing it close to competing with liposuction for those not willing to undergo surgical procedures. 3

In conclusion, there is no ‘one-method-fits-all’ when it comes to achieving that slimmer waistline. Different people have different targeted treatment areas and fat volume, therefore a full and thorough assessment is crucial to ensure treatment regime are the most optimal!


  1. International Society of Aesthetic Plastic Surgery. Global Statistics. Available at: http://www.isaps.org/news/isaps-global-statistics.
  2. Manstein D, Laubach H, Watanabe K, et al. Selectivecryolysis: a novel method of non-invasive fat removal. Lasers Surg Med. 2008;40:595-604.
  3. Chilukuri S, Mueller G. “Hands-Free” Noninvasive Body Contouring Devices: Review of Effectiveness and Patient Satisfaction. Journal of Drugs in Dermatology. 2016;15:11:1402-1406.