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PST 010: Nonsurgical Liposuction & Body Sculpting Options — Read the Transcript

April 27, 2018

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Hello, Dr. Stephen Mulholland here at SpaMedica in Toronto, Canada. Welcome to Plastic Surgery Talk and another one of our very popular podcasts. Hope you like this one. It is on non-surgical body sculpting. Lot of questions that come my way at meetings and in meeting with patients is what can you do to kill my fat, unwanted fat in areas of unwanted fat collection without surgery? The answer to that is non-surgical body sculpting, non-surgical liposuction, non-invasive fat destruction. These are all similar names for a whole new area of cosmetic plastic surgery that has grown up in the last six or seven years, which is non-surgical lipo.

We now have five well-documented ways that we can kill fat without surgery. So in general at a centre that’s busy, like SpaMedica, we’re going to have several different ways that we can kill fat, and we’re going to offer you the best combination of those ways to get a non-surgical liposuction result. It’s growing up to be a very refined program. We’re very good at killing one, two, three centimetres in locations where you just don’t like the extra fat. And the risks are almost zero, the costs are very affordable. So non-surgical liposuction, one of the fastest-growing areas in aesthetic medicine.

So what are the different options to destroy your fat non-surgically? Here at SpaMedica, I’ve really invested a lot of time and energy and technology in always having the best ways to kill fat without surgery. It started almost 10 years ago with a technology that’s still available today, that we still use in selected patients. It’s using ultrasound energy, focused beams of ultrasound. We’ve all had ultrasound before, diagnosing babies, diagnosing areas of our body. Ultrasound is gentle, it’s not painful, and when we focus the two ultrasound beams, we can cause a cavitation or an oscillation of the fat cell and destroy it. So that technology is called UltraShape, one the very first technologies. Generally it’s done three times, once every two weeks for a six-week program. So UltraShape uses ultrasound to destroy fat.

We can also use cold environments or hypothermia. We can suction couple the fat through a special applicator, and we can destroy fat with cooling it or hypothermia, cooling the fat cell. That technology is called CoolSculpting. If we can suction couple and cool the fat to about five degrees for up to 60 minutes on the tummy, the love handle, thighs, we can destroy a certain amount of fat, between 20% and 30% of the fat cells exposed will die from sustained cooling. So that’s CoolSculpting, also a technology we’ve used at SpaMedica here for a number of years.

We can also kill fat cells non-surgically with sustained heat, or hyperthermia. Whereas CoolSculpting is cooling the fat cell until we kill some, we can use sustained heating to kill the fat cell. That is called SculpSure. SculpSure uses focused energy on the skin. We cool the skin just like we would do during laser hair removal or a photofacial. We cool the skin so the skin doesn’t get too warm, and we push the laser energy into the fat. So where it’s suction-coupled cooling with CoolSculpting, SculpSure is non-suction couple sustained heating. We get those fat cells up around 45, 46 degrees, sustain that for 25 minutes, not 60 minutes like CoolSculpting, and we can lead again to 20% to 30% of the fat cells exposed dying, a non-inflammatory, non-necrotic, means no redness, no swelling, no downtime fat destruction.

So ultrasound is UltraShape, cooling is CoolSculpting, SculpSure is heating. We can also use electrical energy, electroporation to kill fat cells. This is one of the more successful technologies. It’s going to be multiple treatments, usually one treatment a week for six weeks with something called BodyFX, which is suction-coupled electricity that changes the cell membrane of the fat cell and destroys the fat cell. And after a series of four to six treatments, we can often kill 300 to 400 cc of fat, like a small liposuction.

So electricity is BodyFX, also known in international markets as TiteFX. Ultrasound is UltraShape, sustained cooling is CoolSculpting, sustained hyperthermia or heat is SculpSure. There’s other electrical systems that we can also deploy that can kill some fat, such as Vanquish. Vanquish is a non-touch technique with large applicators that envelop your body but don’t touch your body. And the RF or radio frequency flows through the fat. Generally you do a session that lasts about 45 minutes. We can treat the entire tummy and hip, so the largest spot size in the industry, or both inner and outer thighs at the same time. A series of treatments, four treatments once a week to kill two, three centimetres of fat in a large area, and that’s the Vanquish.

So just like you go with an anti-aging facial consultation, you’re not quite sure what you might need to do. You might need a little Botox, a little soft tissue filler, maybe some laser and energy-based device treatment. Non-surgical liposuction has become very much like non-surgical anti-aging. You come in, we assess your body. Some patients are good for the SculpSure plus some Vanquish, maybe some BodyFX. Others are good for the CoolSculpting, maybe Vanquish, and some type of ultrasound or UltraShape. So we customize the treatment program for you. No matter what you do, it’s going to be a series of treatments, between two and six treatments over six to 12 weeks to shrink significant amounts of fat non-surgically, painlessly, and generally very affordably. So it’s a very exciting program, non-surgical lipo. We’ve got lots of options, we can customize a program for you to get you the best possible permanent fat destruction. These fat cells are dead, they do not come back.

So, who’s a good candidate for this program? Well, someone who is realistic. If you want the best possible body contouring, you’re generally going to see me, and it’s going to be some version of modern liposuction, like BodyTite, Smartlipo, VASERlipo, but it’s going to involve a minor surgical procedure. That’s the best. But if you want a good result with no invasive treatment, with no downtime, and more affordable, then our SpaMedica non-surgical lipo program’s going to be a good one for you, ’cause we can kill fat very predictably and in a focused way. So realistic, a good result, but it’s not quite lipo. The patient has to be healthy, there can’t be chronic medical diseases such as uncontrolled diabetes or active heart disease with angina. Certainly we want to make sure that you’re not pregnant at the time. You don’t want to do any energy-based treatment when there could be a fetus in the uterus. Of course, no pacemaker, no pacemaker in the heart, no pacemaker in the bladder, and no seizure disorders, ’cause these are radio frequencies, electrical current devices that can stimulate arrhythmias. So those are the contraindications. The most important factor is just a realistic patient who wants a good result, but it’s not quite as good as liposuction. If you fulfill those criteria, then you’re a good candidate for a SpaMedica non-surgical lipo program.

With the non-surgical lipo program, one of the common comments then is, “Okay, it sounds great, but how much fat can I really remove?” And so let’s say you have a pinchable amount of fat. And what are the most common areas? The pot or tummy, the love handles, the outer-inner thighs, the arm or the batwing, the bra line, and a double chin. These are the most common areas for non-surgical lipo. How much fat can you remove? Well, if you grab the fat that you don’t like and imagine two centimetres of pinchable fat reduced, that’s generally what we can do. Generally, about 20% to 30% of the fat in the affected area can be reduced. Now with liposuction, I can make that 85% or 90%, but you have a minimally-invasive surgery. You’ve got bruising, swelling, some downtime, and more risk. This is a risk-free permanent fat reduction. These cells are gone.

So what happens if you have skin that’s not very tight over top of the fat, or you’re worried about skin that’s okay, but would it be loose when the fat is gone? At SpaMedica again, we have a combined program. So not only do we kill the fat, we put you in a series of treatments that involve tightening the skin. So the typical program looks like this. CoolSculpting and SculpSure are done twice, six weeks apart. So you come in, you start with a SculpSure or a CoolSculpting, then on week two, three, four, and five you’re coming in for electrical current treatments, the Vanquish and the BodyFX or the Exilis or the Venus Freeze. We’re tightening your skin with bulk-heating RF while we’re waiting for your second SculpSure or CoolSculpting, which happens after six weeks. So we tighten your skin, kill additional fat in the intervening weeks, and then we do the second treatment of SculpSure or CoolSculpting at the sixth week. So after six weeks, you’ve done all your treatments, you wait six weeks after the last treatment for all the fat cells to die and be washed away. Twelve weeks after you started, or three months, you’re two to three centimetres reduced on the troublesome areas, tummy, love handle, bra line, arms, inner and outer thigh.

What about planning your non-surgical lipo? When will you see a result? Now if you come to see us here at SpaMedica, and you’ve got a wedding in two weeks, you ain’t going to be ready. You need to plan ahead. Even if it’s liposuction, which is a single session treatment, you need to wait a good six to 12 weeks ’til that lipo settles and you’re looking pretty good. Same with the non-invasive lipo program. We do all our treatments over that first six weeks, and then you have to wait six weeks to settle. So you’re starting to look good on the 12th week. So if you’re planning a big event, a reunion, when you want to look awesome and all those other chubby classmates of yours are wondering how you did it, give yourself 12 weeks in a SpaMedica non-surgical lipo program. If your daughter’s getting married or if you have a big event, you got to, you know, going to the Caribbean, you want to look good in that bikini again, give yourself 12 weeks so that you have time for the fat cells to go away.

A special topic that I think deserves its own question is what about the dreaded double chin? Very, very common in men and women. In fact, for men it’s one of the most common requested areas. The double chin is also treatable with non-surgical lipo. We’ve got a couple of options. We can inject a special chemical in the fat of the double chin called Kybella in the United States or Belkyra here in Canada. It works just like a chemical that’s released from your gall bladder when you eat fatty foods. It dissolves and breaks down the fat. Now it takes many weeks for that to do so. So generally we offer energy-based treatments first for double chins. CoolSculpting submentum or SculpSure submentum or BodyFX Mini. So we can cool the double chin and kill some fat. We can heat the double chin. Cooling is CoolSculpting, heating is SculpSure. We can inject deoxycholate or Kybella in a double chin or we can use electroporation called the BodyFX Mini.

In general, we need two treatments six weeks apart with CoolSculpting or SculpSure. So we do the treatment under the chin, takes about an hour. You’ll come back on week two, three and four and five, we do bulk-heating radio frequency energy treatments with BodyFX Mini or Exilis or Venus Freeze. Sometimes we’ll inject a little Kybella out to the sides where we can’t get at with the energy-based devices. You do your second treatment after six weeks. And then you’ll wait six weeks and there’s your final result. So just like the body, we can make a double chin much, much better contoured with non-surgical lipo programs. But it is a program, it’s going to take multiple energy treatments, and again you get a pretty good result at 12 weeks.

Now what happens if you gain weight? You’ve done your non-surgical lipo program. You’ve done your multiple energy treatments. You’re pretty happy with your two, three centimetre reduction, and it’s the winter. You get depressed ’cause it’s always cold. Or you have a breakup and you’re feeling badly. Or you have some emotional heating for whatever reason, and you put on 10, 15, 20 pounds. That fat’s going to go somewhere, and it’s going to go back to the fat cells that are left behind in the area you tried to contour. And they’re going to swell up, and it’s going to ruin your result. So even though these fat cells are permanently dead, you need to have a long term and consistent approach to consistent weight maintenance. If you maintain that weight within five to eight pounds of your non-surgical lipo program, you’re going to have a long term and permanent result.

What is the cost of non-surgical lipo? In general, it’s going to be several visits to the medical spa. You’re going to have a number of technologies, and there’s a substantial time commitment. The cost is quite affordable compared to liposuction. In general, whatever you pay for liposuction, the non-surgical lipo program is going to be about half that price. So in general, for a series of two CoolSculpting treatments six weeks apart, two SculpSures six week apart, you’re looking at spending between $2,000 and $3,000 in most large Canadian markets if you’re going to do the tummy and both love handles. If we’re going to have a combined program like here at SpaMedica where you get the Vanquish and you get some bulk-heating radio frequency treatments and we’re tightening your skin, it’s going to be between $3,000 and $4,000 on average. Now if you look at liposuction cost for tummy and hips it’s usually around $8,000. So it’s going to be half the price of a surgical liposuction treatment, it’s going to be permanent destruction of fat. We’re going to be able to tighten your skin and contour the fat quite noticeably and quite predictably.

In the case of my center here at SpaMedica, because I do both BodyTite, Smartlipo, and VASER liposuction and I have all the non-surgical programs, we combine them. So if you’re not happy or completely satisfied with your non-surgical lipo program, we give you a coupon that you can apply against services with me, the more liposuction-type treatments, any time over the next five years after your treatment. So customers, I think, really like that. They like the fact that they can coupon up against lipo if they want to. And we also give them a guarantee. If they don’t get at least one centimetre of pinchable fat reduction, we’re going to give them a free treatment. About 8% to 10% of the time, ’cause some patients are resistant to some energy-based treatments, we’re going to offer you a complimentary treatment of another energy that you didn’t use already, ’cause there’s no point treating the fat cells that they proved to be resistant with ultrasound or cooling. We’ll switch energies to ensure that you get the best possible results. So you’re going to get at least a one centimetre pinchable result. We’re giving you a free treatment, and it’s going to be an affordable treatment that’s about half the price of surgical liposuction.

So how do you decide? How do you decide if I should do liposuction, BodyTite, Smartlipo, VASERlipo with Dr. Mulholland or see his medical spa and go non-surgical lipo. Well, first and foremost, if you’re just adverse to doing surgery, you’re a bit afraid, bit nervous, you don’t have the time or the recovery or the money to do the surgical program, you are automatically a candidate for the non-surgical lipo. If you have a short timeline and you want to get a quicker result, non-surgical lipo. If you are younger with good body contouring and skin tone, and you think that lipo’s a bit invasive for your age, non-surgical lipo. If you’re a little older with loose skin, you may need to see me for better contraction with something like BodyTite. If you are the kind of patient that you don’t care if it’s non-surgical or surgical and you want to have the best result, you’re going to do lipo with me. Now remember lipo is done under local anesthesia. You do not need to do it under general. It’s relatively quick, usually about one hour per zone, and you’re going to get a much better result, but there is the recovery and some risk of surgery.

And so, how do you decide? Decide what your threshold for risk is and recovery. If you want a low-risk, minimally-invasive surgery with the best possible fat reduction, come and see in. Some modern version of lipo’s probably best for you. If you are not going to do surgery, you’re adverse to the concepts of surgery and you want a noticeable improvement that’s certainly invisible and pleasing, then our non-surgical liposuction program with combinations of CoolSculpting, SculpSure, Vanquish, BodyFX, Exilis, and Venus Freeze is probably going to be best for you. What I suggest, come in, have a consultation, start out non-surgical and see where your interests and opportunities lie.

So thanks for joining us, again Dr. Stephen Mulholland here in Toronto, Canada, Plastic Surgery Talk and our podcast series. Today our podcast was on non-surgical lipo techniques. We covered a broad range of interesting topics on how to kill fat without surgery. If you found this interesting, please share across all your social channels. We’d love you to share this information on social, ’cause we think it’s pretty cool. Join us again for our next podcast.

Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
has been practicing plastic surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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