Long-term follow-up on patients treated for abdominal fat

01-08-2018

using a selective contactless radiofrequency device

Authors:
Klaus Fritz MD,
Carmen Salavastru MD

Summary
Background and objective

The aim of this study was to evaluate how abdominal circumferential reduction achieved after using a noninvasive radiofrequency device (BTL Vanquish, BTL Industries Inc., Boston, MA) evolves over a 4-year period.


Methods

This is a follow-up on patients who were treated in our practice for abdominal fat in an earlier published multicenter prospective study. Patients were recalled for biometric data collection 4 years (±60 days) after the last treatment. Body and weight measurements were compared to the historical data. Digital images of the treated area were taken. Independent panelists were asked to recognize the original baseline images from the 4-year follow-up images.


Results

The evaluation encompasses 13 subjects. In the original study, these patients lost on average 5.88 ± 4.14 cm of waist circumference (P < .001) while losing on average 1.29 kg. After 4 years, the same subjects had an average reduction of 4.42 ± 2.85 cm (P < .001) compared to the baseline, while gaining on average 0.50 kg. In both cases, the waist change was statistically independent of the weight change (P < .01). The patients preserved on average 75.2% of the original body contouring effect after 4 years as measured by circumference. None of the patients grew in circumference when compared to the baseline. Reviewers recognized the baseline patient images from the follow-up patient images in 82.1% cases. No long-term side effects were observed that would relate to the treatments.

Conclusions

in the study group, patients with ordinary weight changes preserved most of the original waist reduction after 4 years.


1 INTRODUCTION

Over the past decade, the esthetic medicine market has been continuously shifting from invasive procedures to noninvasive treatments. Based on the ASAPS statistics, in 2016 noninvasive cosmetic procedures have grown at a double pace, year over year, compared to surgical procedures.[1] Contrary to surgical approaches, noninvasive body shaping treatments offer modest results. However with advancing technologies, the esthetic changes that can be achieved noninvasively are dramatically improving. The major concern has remained the longevity of the results of noninvasive treatments, as surgical procedures, such as liposuction, are believed to have long-lasting results unless dramatic lifestyle changes occur.[2]
As of today, 5 major noninvasive technologies widely used for the reduction in subcutaneous fat are recognized. These are radiofrequency (RF), low-level laser therapy (LLLT), hyperthermic laser treatment, high-intensity-focused ultrasound (HIFU) and cryolipolysis.[3, 4] All these technologies aim to either temporarily or permanently reduce the volume of adipose tissue, while the exact mechanisms of action differ. They vary from induction of apoptosis (RF),[5, 6] coagulative necrosis (HIFU),[7] release of lipid contents by creating cell membrane pores (LLLT),[8] lipolysis (laser), to fat cell disruption caused by local panniculitis (cryolipolysis).[9]


It has been proven that the number of fat cells stays constant in adulthood and that the fat mass in adult humans is primarily determined by changes in lipid storage in existing adipocytes.[10] A massive weight loss does not reduce the number of adipocytes, only their size. Similarly, significant weight gain results in body fat increase, driven by an increase in adipocyte volume; not their number. Most people combat body size fluctuations in adulthood, because frequent approaches such as food intake control and weight management programs only provide temporary changes in fat cell volume. This suggests that to achieve long-term control over fat mass in a specific body part, the number of adipocytes needs to be reduced.


There is clinical evidence both on animals and humans that significant increase in apoptotic index in adipose tissue can be achieved by applying noninvasive RF device treatments.[5, 6] Apoptosis is defined as programmed cell death[11] which results in cell decomposition and removal. RF may thus be used to reduce the adipocytes by number, not by size.[12] As such, the treatments can potentially cause long-lasting changes in the body's contour and fat mass volume, because the remaining adipocytes are unlikely to expand in size enough to restore the original body contour before treatments. However, very little scientific evidence is out there that would clearly document how body shaping achieved after noninvasive RF treatment develops over time.


An earlier multicenter prospective ethical committee-approved study was published in a peer-reviewed journal, presenting results on patients who had been treated for abdominal fat using a contactless noninvasive radiofrequency device (BTL Vanquish; BTL Industries Inc., Boston, MA, USA). Subjects received 4 weekly treatments and were evaluated at a 1-month follow-up. Significant circumferential reduction was achieved, supported by recognizable before and after digital images. In total, 20 subjects from the original study were recruited and treated in our practice. It is the goal of this study to investigate how the body contour changes originally achieved on those patients have evolved over time.


2 MATERIALS AND METHODS



2.1 Study Design
Twenty patients (18 female, 2 male) qualified for this trial. These are the patients who had been treated in our practice as part of the earlier multicenter clinical study.
Patients were called in for a 4-year (±60 days) follow-up. Exclusion criteria were as follows: current pregnancy, any fat reduction or body shaping procedure (invasive or noninvasive) received after the original series of treatments, or use of medication or any medical condition known to affect weight levels and/or to cause bloating or swelling, >10% weight deviation (loss or gain) compared to the historical follow-up.


2.2 Outcome measures

To ensure consistency and allow for objective evaluation, the same outcome measures were used as those applied to the 1-month follow-up visit in the original study. Subjects were called in for collection of their biometric data. Weight was recorded. Circumference of abdomen was measured using a spring-loaded tape. Standardized photographs were taken with a single-color background.


On top of that, randomized patient photographs from the baseline and the 4-year follow-up were given to 3 independent reviewers for recognition, to see whether the body contour changes are still visible.
Circumference was compared to the historical data to evaluate how the original body shaping effects after RF treatments evolved over time. Weight data were used as a control indicator. Student's t test was used for statistical evaluation.
All patients were consented for taking their biometric data and to the use of their photographs without limitation for the purpose of this clinical study.



3 RESULTS

Three subjects out of the original group of twenty have not responded to the recall action. Two subjects were excluded because they received additional fat reduction treatments after the original study. Two patients were discarded based on exclusion criteria due to >10% weight loss/gain (1 subject lost 7.0 kg, another 1 gained 10.2 kg compared to the original study). The results are thus based on the remaining 13 patients.
In the original study, these subjects lost on average 5.88 ± 4.14 cm of waist circumference (baseline 98.65 cm to 92.77 cm at 1 month; significance of change P < .001) while losing on average 1.29 kg (73.05 kg to 71.75 kg). At 4 years, the same subjects had an average reduction of 4.42 ± 2.85 cm (baseline 98.65 cm to 94.23 cm at 4 years; significance of change P < .001) while gaining on average 0.50 kg (73.05 kg to 73.55 kg). In both cases, the waist change was statistically independent of the weight change (P < .01, two-sample t test with unequal variances). This means that at 4 years, the study group preserved on average 75.2% of the original body contouring effect as measured by circumference (4.42 cm of 5.88 cm). The results are not affected by the elimination of 2 subjects with >10% weight change, as their inclusion would change the ratio of preserved waist reduction from 75.2% to 74.9%. None of the patients grew in circumference when compared to the pretreatment measurements. Subject ID8 got back to the baseline waist size.


Complete overview of biometric data is presented in Table 1.

Table 1. Changes in patient biometric data over time

At 4 years, the average absolute weight deviation was 1.93 ± 1.43 kg compared to the baseline, with the standard deviation exceeding the arithmetic mean (0.50 ± 2.35 kg). This shows that over the course of the years, subjects' weight evolved inhomogeneously up or down, with the average weight slightly increasing. Despite putting on 3.1 kg, Patient ID3 lost additional 1 cm from her waist size, while Patient ID7 decreased in weight by 1.3 kg but only preserved 66% of the original contouring effect.


On average, the reviewers recognized the baseline image from the 4-year follow-up image in 82.1% cases, suggesting that the contour change is still visible in most patients. Images of 8 subjects were uniformly recognized by all 3 reviewers, images of 3 subjects were recognized by 2 reviewers, and photographs of 2 subjects were recognized by only one evaluator. See Figures 1-4 for examples of the images.

None of the subjects has reported any long-term side effects that would have connection with the treatments.


4 CONCLUSIONS

The primary goal of this study was to investigate how changes in body contour originally induced by a noncontact RF device (BTL Vanquish; BTL Industries Inc.) develop in the long term.


Four years after the last treatment, the subjects preserved on average 75% of their original waist reduction effect as measured by circumference. No data were collected about subjects' lifestyle and/or dietary habits. However, the prevailing waist reduction proved to be highly statistically significant and independent of any weight changes. Weight of the patients evolved inhomogeneously compared to the baseline, with the average change being insignificant (BMI + 0.18 kg/m2).
The prevailing changes in abdominal contours were further confirmed by a relatively high recognition rate of before and after photographs, reaching 82% based on 3 reviewers.
Based on results of 13 individuals, this study suggests that treatments with the investigated device can cause long-lasting changes in abdominal body contours. As seen in the data, the treatments cannot prevent any future weight gains. However, it concludes that in the investigated study group, patients with ordinary weight changes preserve most of the original effects after 4 years.

5 DISCUSSION
Although certain noninvasive body shaping procedures based on thermal effects are widely accepted to be causing permanent fat cell disruption, there is lacking evidence on how the results evolve over a longer period of time. Most published clinical studies incorporated a follow-up evaluation 3-12 months after the actual procedures.


This study discloses data on 13 subjects from 4 years after the original treatments. Though on a smaller patient group, this represents the first indication of how the waist changes may evolve in time. It is unclear whether the long-lasting waist reduction in this group is primarily caused by previous reduction in the number of adipocytes in the treated area. However, this theory is in compliance with other scientific evidence,[10] as the remaining adipocytes might be unable to expand in size enough to restore the original appearance before treatments.
All the patients were treated using the early generation of the device. Hayre et al[13] concluded in a study on 36 subjects that the upgraded device can provide better results. Moreover, the 1-month follow-up period from our earlier study might not have been enough to capture the original treatment results fully. It is not well understood how fast the process is, before a complete disposal of apoptotic cells and cell debris from the body occurs.


Additional scientific research and studies with larger patient groups are necessary to bring more evidence, before any findings of this kind can be generalized.


DISCLOSURES

The authors have no commercial interest in BTL and received no compensation for this study. Klaus Fritz and Carmen Salavastru have no relevant conflicts to declare.

​Natural Weight Loss

12-27-2017

Photo Credit: By mahmoud99725 on Flicker. CC0 License.

When you combine intention with patience, exercise and a healthy varied diet, weight loss IS possible! Whether your goal is to loose 10 pounds, 20, or 100—you CAN do it.

It can be difficult to always eat well, whether stress or boredom strikes, or any number of other emotional triggers. My weaknesses are bread, cheese, cookies, chocolate, candy bars, you name it. I live in Manhattan and can get a deli or restaurant delivery to my door in 10 minutes.....any time of day or night, my buzzer rings and it's here quick. Beautiful, healthy foods I had eaten that day, whether it was oatmeal for breakfast, organic salads or healthy soups or sandwiches, green tea--10 o'clock or midnight hits and I'm starving!

To me, strict diets and fad diets are a buzz load of baloney. Weight loss will happen when you shift your diet towards the wholesome and maintain an active lifestyle. If you slip and eat way too many cookies, and it's happened to me before, it's a good thing. Why on earth would I say that? Because you’ll eventually get sick and tired of that food coma you put yourself into and when you feel energized again, when you've just come home from that walk or aerobics class, your body will be craving healthy food it needs -- vegetables, fruits, wholesome soups and proteins, etc. You'll remember how run down and groggy you felt after over eating and your body will crave celery, leafy greens, citrus fruits, rice, fish, red wine, or the numerous other healthy foods you enjoy.

Hoodia can help curb your appetite, try it along with green tea. It works for me very nicely especially at night when I need it. Hoodia is a potent diet supplement that is extracted from a spiny, cactus-like succulent plant, and has been used for generations by nomadic South African Bushmen as an appetite suppressant during long hunting trips through the Kalahari Desert which is 362,500 square miles! From the CBS broadcast on 60 Minutes which praised Hoodia, Lesley Stahl says, "Imagine not being hungry all day without feeling side effects typical of most diet pills, like a racing heart or queasy stomach." If you are having trouble loosing weight Hoodia could be your best bet.

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​Body Contouring

12-11-2017

From Wikipedia, the free enciclopedia

Photo Credit: By Tim Gouw on Pexels, CC0 License.

Body contouring is a procedure that alters the shape of the human body. It includes procedures that eliminate or reduce excess skin and fat that remains after previously obese individuals have lost a significant amount of weight, in a variety of places including the torso, upper arms, chest, and thighs.

Obesity is in epidemic proportions in the US and many parts of the world. It is defined as a condition where a person's body mass index (BMI) is 30 or greater. BMI is calculated by dividing the patient's weight in kilograms by their height in meters, squared. Normal weight individuals have a BMI that ranges from 18 to 25. Overweight people have a BMI from 26 to 30, with 30 and above people considered obese. Once the BMI reaches 35 and above, patients are considered morbidly obese. From a BMI of 30 and above a person's life span is shortened. In addition, obesity negatively affects the economic health of a society as well as other aspects of adult and child health, often for life. Childhood obesity is on the rise in Europe as well.

Nonsurgical methods

Nonsurgical body contouring is a rapidly growing field. Common methods used include low-level laser therapy (LLLT), cryolipolysis, radiofrequency energy, suction massage, and high-frequency focused ultrasound.

Now, doctors are able to use non-invasive technology to achieve a reduction in size of certain body areas, increased tone in lax or redundant skin and a diminished appearance of cellulite.

Usual results

While considered major surgery, the outcome of body shaping can require several months to see the full effects of the procedure.

When researchers at the University of Pittsburgh enrolled 18 bariatric patients just before the subjects decided to undergo body contouring, their average age was 46, plus or minus ten years. The researchers studied the patients’ body perception, quality of life and mood at three and six months after the body contouring procedures. They found the subjects’ quality of life improved and significantly enhanced their moods which had remained stable at the six-month point. Most body lifting patients return to non-strenuous work in about two to three weeks.

Except for brachioplasty, virtually all body shaping procedures require the patient to wear a support or compression garment for two to six weeks. The garment speeds and aids in healing.

Patients can usually drive again within one to three weeks, depending on the extent of the surgery, their health and general robustness.

​What is a Vampire Facial?

11-27-2017

De Wikipedia , la enciclopedia libre

Crédito de la foto: por mahmoud99725 en Flicker . Licencia CC0 .

El facial de vampiro es el mismo que el plasma rico en plaquetas (PRP), un concentrado de proteína plasmática rica en plaquetas derivada de sangre total, centrifugada para eliminar los glóbulos rojos. Tiene una mayor concentración de factores de crecimiento que la sangre entera, y se ha utilizado para fomentar una respuesta de curación rápida en varias especialidades, en particular odontología, ortopedia y dermatología.

Como una fuente concentrada de plasma sanguíneo y plasma condicionado autólogo, PRP contiene varios factores de crecimiento diferentes y otras citoquinas que pueden estimular la curación de tejidos blandos y articulaciones. La principal indicación en medicina deportiva y ortopedia son las tensiones musculares agudas, tendinopatía y lesiones músculo-fasciales y la osteoartritis.

Las principales indicaciones en dermatología para PRP son la alopecia androgénica, la curación de heridas y el rejuvenecimiento de la piel. Para la preparación de PRP, se usan diversos protocolos, con un principio subyacente de concentración de plaquetas a 3-5 veces los niveles fisiológicos, luego la inyección de este concentrado en el tejido donde se desea la curación.

En el campo de la estética y la cirugía plástica, la aplicación clínica es particularmente amplia y se llama cirugía plástica regenerativa. El PRP asociado con el tejido adiposo se administra para la reconstrucción mamaria, defectos faciales de partes blandas, úlceras y cicatrices en las extremidades inferiores.

Se obtuvieron resultados prometedores en el tratamiento de la alopecia androgenética, como se desprende de los estudios científicos publicados desde 2013. Entre ellos, el factor de impacto más significativo es el estudio clínico-clínico aleatorizado de la evaluación clínico-instrumental del efecto del PRP en la alopecia androgenética publicado en 2015 por Pietro Gentile et al y un equipo multidisciplinario de la Universidad de Roma Tor Vergata El efecto del plasma rico en plaquetas en el crecimiento del cabello: un ensayo aleatorizado controlado con placebo.

Composición

Se coloca sangre completa en la centrífuga antes de la centrifugación en dos etapas

Hay cuatro categorías generales de preparación de PRP basadas en su contenido de leucocitos y fibrina: PRP rico en leucocitos (L-PRP), PRP reducido en leucocitos (P-PRP, PRP puro o reducido en leucocitos), fibrina rica en plaquetas leucocitaria y plaquetas puras rica fibrina

La eficacia de ciertos factores de crecimiento en la curación de diversas lesiones y las concentraciones de estos factores de crecimiento que se encuentran dentro de PRP son las bases teóricas para el uso de PRP en la reparación de tejidos. Las plaquetas recogidas en PRP se activan mediante la adición de trombina y cloruro de calcio, que induce la liberación de los factores mencionados de los gránulos alfa.

A partir de 2009, la Administración de Alimentos y Medicamentos de los EE. UU. Ha aprobado dos métodos de preparación de PRP. Ambos procesos implican la recolección de sangre completa del paciente (que está anticoagulada con citrato dextrosa) antes de someterse a dos etapas de centrifugación (TruPRP) (Cosecha) (PRP puro) diseñado para separar la alícuota de PRP del plasma pobre en plaquetas y los glóbulos rojos. En humanos, el recuento típico de plaquetas en sangre es de aproximadamente 200,000 por μL; el PRP terapéutico concentra las plaquetas en aproximadamente cinco veces. Existe una gran variabilidad en la producción de PRP mediante diversos equipos y técnicas de concentración.

Hasta la fecha, no hay estudios que documenten de manera confiable los efectos adversos asociados con el tratamiento con PRP, posiblemente debido a una metodología deficiente e inconsistente.

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10 Easy and Natural Ways to Get Rid of Acne

11-21-2017

By: RD Laser Skin

Photo credit: mahmoud99725 via Foter.com / CC BY-SA.

Become acne free forever. Get 10 super easy and effective ways to get rid of acne.

Are you looking for acne solutions that really work? The good news is, whether you're a teenager or an adult suffering from acne, you don't have to live with it. Here you can find 10 super easy and effective ways to get rid of acne.

1. Do not pick, press or rub your pimples. These actions actually increase the sebum production and rupture the membranes below your skin. The infection and sebum will spread underneath your skin and cause more pimples. Also, you risk increasing the chances of leaving scars on your face.

2. Wash your face twice a day using a mild soup. It is even better if you can buy sulfur-based soap especially for acne. If your skin is too oily, use a soap with benzoyl peroxide. Do not use rough sponges, brushes, or anything similar on your face. You shouldn't, however, over-wash your face because it will actually stimulate your sebaceous glands to produce more sebum which will increase your acne.

3. Check if it is because of the food. For many people, food allergy can cause very serious acne condition. You should avoid eating too much oily and spicy food. Recent studies have shown that acne can also be caused by milk which contains hormones as well as seafood with relatively high levels of iodine. If possible, cut down on those foods. Other foods you may consider avoiding are: sugar, dairy products, deep-fried food, meat, nut butters, etc. On the other hand, it is believed that green vegetables, vegetable fuices and foods rich in zinc can help alleviate acne condition.

4. Drink more water every day. "Eight glasses of water a day can keep acne away." says Jennifer Thoden, a respected acne expert. The reason is that water can carry waste material out of our body and it really helps heal and prevent acne flare-ups.

5. Do not wear makeup if possible. Makeup products can clog your pores, cause more blackheads and pimples. If you have to wear makeup, make sure it is water-based. Be sure to clean your makeup brushes regularly and cleanse your skin before you sleep.

6. Do not use oily products. Avoid products such as hair pomades, intense oil-based facial moisturizers, and oily cleansers.

7. Keep your face clean. Do not rest your chin on your hands or constantly touch your face. Regular shampoo your hair and keep it off your face, especially when you sleep.

8. Exercise moderately as it helps in blood circulation and eliminataion of toxins.

9. Stay stress-free. Studies have shown that stress not only worsens acne flare-up, it also worsens the overall skin condition. Talk to your friends, listen to your favorite music, or take a walk in the park. There are many things you can do to be stree free.

10. Get Sunshine and fresh air. Sunshine stimulates vitamin D in the body, an essential vitamin for healthy skin. Fresh air and sunshine can also reduce stress (tip #9) and increase oxygen to the skin. Don't get burnt in the sun though. Burnt and heavily tanned skin forms a layer on the skin that doesn't exfoliate quickly enough and can lead to blocked pores.

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