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Step into science fiction: A futuristic-looking machine is trained on you. It begins to emit a low-level hum, but you don’t feel a thing. You read or play games on your BlackBerry. Then you go home.
A few weeks later, the little tummy bulge that has annoyed you for years is gone. Same with the love handles. Or your thighs are a couple of inches smaller.
The procedure didn’t hurt. It involved no surgery, no anesthesia, no downtime. You just wrote a check—but one that wasn’t as big as if you’d had liposuction on those areas of fat that wouldn’t budge despite the morning sit-ups.
Good news: This isn’t fiction. In 2010, the Food and Drug Administration approved two devices that perform just that way. Zerona shrinks fat cells using cold laser light, and Zeltiq kills fat cells by freezing them. These approvals are the first in a new category of medical devices that eliminate fat without surgery. They work, but there are caveats.
ZELTIQ: FREEZE AWAY FAT
Ever left an ice pack on your body too long and noticed red skin and hardened, slightly numb flesh when you lifted it? That “damage” is a clue to how Zeltiq works.
The FDA already had approved a similar machine developed and marketed by Zeltiq for pain relief during dermatology procedures. The company submitted further research, requesting approval for a new use: cold-assisted lipolysis. In other words, reducing the size of a fat layer, a process that could diminish love handles, too generous thighs and buttocks, and sagging necks and arms.
“To a dermatologist, this doesn’t sound incredible at all,” says Jennifer MacGregor, assistant professor of dermatology at Georgetown University Hospital, who also practices at DC’s Washington Institute of Dermatologic Laser Surgery. Because she took part in Zeltiq clinical trials, MacGregor has been using it to zap fat for two years. “The idea is based on well-understood science, and the animal and human studies have yielded consistent results.”
Patients relax in a reclining chair. A gel pad is put over the area to be treated to protect the skin. The Zeltiq device sucks on the targeted bulge, then exposes the fat to cooling for about an hour. Fat cells are damaged, but skin, blood vessels, and nerves are not. Patients may experience a little tingling or numbness.
Within three to four months, studies show, about 22 percent of the fat layer dies off for good. The injured adipocytes, or fat cells, are absorbed and eliminated by the body.
Potential side effects? Nothing serious. Some people experience a little redness or tingling, which goes away in a day or two. FDA officials were concerned about possible effects on the liver as the damaged fat cells are eliminated, but studies showed normal blood chemistries. As the FDA noted, “the slow release of fat from the injured adipocytes is much less per day than the potential fat consumed by a person eating such items as French fries or a hamburger.”
Who responds? Everybody, according to ultrasound studies of treated fat. That doesn’t mean everybody can actually spot a change, especially after one session. While one treatment might do the trick for small areas of fat, multiple sessions are the norm—stubborn areas typically get four sessions. The best candidate, says MacGregor, is someone “at or near their ideal body weight, with modest, localized bulges of fat—think love handles, back-fat bulges around the bra area in women, saddlebags, and the upper and lower abdomen.”
“I’d say about 95 percent of my patients can readily see the difference, and the rest see no appreciable changes,” says Scott Gerrish, an internist with practices in Timonium and Vienna. “Nobody knows why some people don’t have changes they can see.”
If treated on the belly, both men and women tend to see a one-to-two-inch reduction, some considerably more with repeat treatments. There’s no restriction on how many sessions a person can have, although the treatment area is limited by the amount of fat that can be sucked into the device. Generally, about a hand-size area can be treated at one time. A patient might elect to concentrate on a poochy tummy, then right afterward another trouble spot. Love handles are treated one at a time.
Zeltiq can’t be used on hard, tight fat because it won’t fit into the device. (The excess weight many men carry around their midsection—called brown, or visceral, fat—is actually firm; the kind that jiggles is known as white fat.) Zeltiq is contraindicated for those who are pregnant or have an umbilical hernia and for a few rare medical conditions.
In the Washington area, Zeltiq runs about $500 a session, but many doctors offer a reduced per-session price for patients who get multiple treatments. To find a doctor equipped with Zeltiq, see coolsculpting.com.
ZERONA: ZAP FAT WITH LASER LIGHT
Lasers are typically thought of as hot, but “cold” lasers that emit variable-frequency pulsed waves are used in surgery for pain relief and now to get rid of fat.
“It does seem too good to be true, but there’s a lot of science behind this,” says Steven Hopping, a cosmetic surgeon and otolaryngologist in DC. A former president of the American Academy of Cosmetic Surgery and a professor of surgery at George Washington University, Hopping has had a Zerona machine for about a year and a half.
With Zerona, a patient lies down and a four-armed device is positioned over the body. To treat the tummy and thighs, the laser eye in the middle of the contraption is positioned over the abdomen, while the four arms are over the thighs.
The laser is on for 40 minutes a session. Often, six sessions are spaced over a two-week period. Patients typically feel nothing, though some experience a tingle.
Fats cells are emulsified, causing them to collapse and be emptied via the body’s lymphatic system. The shrunken fat cells remain but are smaller.
In the study that prompted FDA approval, more than 80 percent of those in a Zerona trial lost an average of 3.64 inches combined over their waist, hip, and thigh areas. A control group that didn’t get Zerona averaged half an inch. The fat loss was evident in photos of participants.
Although it wasn’t required in the trial, patients getting Zerona now are asked during treatment to avoid caffeine and alcohol, drink lots of water, and take a proprietary—some might say overpriced—vitamin supplement called Curva. Critics suggest that the Zerona effect is attributable to these things, but everyone in the FDA study did just Zerona without the diet and exercise modifications and still saw measurable effects.
As with Zeltiq, Zerona seems to have no adverse side effects. The laser operates at too low a level to affect deeper body tissues or skin. Blood studies conducted on those undergoing treatment were normal, and some people who had high or borderline-high cholesterol saw improvement.
In studies, more than 80 percent of patients responded to treatment. Hopp
ing says that perhaps 75 percent of those he treats are pleased; the rest experience little to no effect. Wanda Dyson, a DC internist who has a Zerona, reports about the same numbers, adding that with more sessions the likelihood of a response appears to increase. Both doctors say they’ve had a few patients lose as much as 12 inches.
“Men are especially good candidates because they tend to carry fat around the waist,” says Hopping. “That fat often responds well.”
Deborah Johnson of Arlington, a patient of Dyson’s, initially signed up for six Zerona treatments on her abdomen, thighs, and back. They worked so well that she got three more.
“I started on a Monday, and by that weekend I was in my closet trying on clothes I hadn’t been able to wear in a long time,” Johnson says. She did Zerona last February and, when interviewed in December, said she had not only maintained the lost inches but lost more: “It inspired me to keep exercising and eating well.”
“I love Zerona as a way to jump-start a healthy lifestyle change,” says Dyson. “People come in on a diet plateau, start seeing inches go away, then stick with their diet and exercise program.”
Nobody can predict whether you’ll respond a little, a lot, or at all. A quick scan of Internet sites such as RealSelf.com shows that many consumers think Zerona is overhyped. That’s also true for Zeltiq, but to a lesser extent.
Zerona can’t be used to remove firm fat, only marshmallow flab. It should be avoided if you’re pregnant or have a pacemaker. Some evidence suggests that Zerona may not work as well on people with diabetes or thyroid impairment, because their lymphatic systems may be slow to get rid of material in collapsed fat cells. Finally, no studies have shown how long the effects last.
Zerona runs about $2,500 to $2,800 for a package of six treatments. A list of local physicians who have the device is at myzerona.com.
ULTIMATE BODY SCULPTING
Zeltiq and Zerona are handy for losing a modest amount of fat, but to guarantee a sculpted look, liposuction “is still the gold standard,” says Michael Will, a board-certified cosmetic, oral, and maxillofacial surgeon in Urbana, Maryland.
More fat can be removed by liposuction—and it’s gone forever. Will says that patients often come in asking for Zerona, but about half opt for a different procedure once they realize their expectations are “beyond what Zerona can deliver.” Some get a tummy tuck. More often, they opt for liposuction.
That procedure goes by many names these days: Laser liposuction, ultrasound liposuction, SlimLipo, Aqualipo, CoolLipo, ProLipo. The terms just indicate a different manufacturer’s device; all of them break up and liquefy fat cells before removing them with a cannula, a long suction tube.
Whether done in a hospital, a clinic, or a doctor’s office, liposuction is real surgery. Sometimes general anesthesia is used, but the trend is toward local sedation with the patient awake and given calming drugs. To reduce postsurgical swelling, patients wear a compression garment for about two weeks. Final contours can take up to six months to appear.
A patient should expect scarring where the cannula enters, although the marks fade. How sore someone is afterward varies according to pain tolerance as well as how much fat was removed and from how many sites.
Other risks involved with lipo include possible infection and an uneven or rippled result. Five to 10 percent of patients need a second, shorter session to make adjustments. While anesthesia today is very safe, there’s always a degree of risk, especially with general.
Any licensed doctor can perform liposuction. You’re safest in the hands of one who is board-certified in a surgical speciality and has performed lipo many times. Always ask if you’ll be continually attended while under anesthesia and whether emergency resuscitation equipment is available as well as staff trained to use it. If the answer to either question is no, go elsewhere.
The cost varies, from $3,000 to $5,000 per area of the body. A discount often is offered if several spots are done at the same time. The best way to find a doctor is to ask friends for referrals. You’ll find a list of top plastic surgeons, many of whom do lipo, in The Washingtonian's database of Top Cosmetic Surgeons.
This article first appeared in the February 2011 issue of The Washingtonian.
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