211: Noninvasive Body Contouring Flashcards
What are the patient selection criteria for skin tightening procedures?
Most appropriate for mild to moderate skin laxity without severe sagging.
Cosmetic complaints that will not resolve include crepe-like skin, pigmentary abnormalities, extremely saggy skin with underlying loss of substructure and fat-pad integrity, and severe photodamage.
What devices are commonly used for fat reduction treatments?
- Radiofrequency energy: Direct energy deeper and more diffusely than skin tightening.
- Therapeutic ultrasound: Direct energy deeper and more diffusely than skin tightening.
- Cryolipolysis: Fat is destroyed by freezing; overlying dermis & epidermis are spared.
- Chemical adipocytolysis: Deoxycholate emulsifies fat cells; FDA approved for submental fat reduction only.
- Laser lipolysis: Melt fat by direct tissue injury; can augment liposuction as it also tightens skin.
- Tumescent liposuction: Accesses fat through tiny apertures that reepithelialize without sutures into barely visible punctate scars.
What are the expected outcomes of skin tightening treatments?
1-2 mm of brow elevation at 60-90 days for forehead & upper face; modestly more defined jawline or neck contour with slightly reduced skin excess for lower face; more subtle tightening for midface.
What complications can arise from noninvasive body contouring procedures?
Expected complications include erythema, edema, intraoperative discomfort, wheals, punctate marks, pinpoint bleeding, burns, seromas if area is overtreated.
Specific complications for cryolipolysis include tenderness, paresthesia, numbness; for chemical, bull frog-like double-chin and underneck swelling; for laser, burns, seromas; and for other, bruising, hematomas, seromas.
What is the clinical significance of combining treatments in noninvasive body contouring?
Repeat treatments should be spaced 1-3 months apart to allow for wound healing and collagen remodeling. Combining treatments can enhance overall effectiveness and optimize results by addressing multiple concerns simultaneously.
What are the expected outcomes of noninvasive body contouring for the forehead and upper face?
Noninvasive body contouring can achieve 1-2 mm of brow elevation within 60-90 days.
What are the potential complications of laser-based devices in noninvasive body contouring?
Complications include burns, seromas, and pinpoint bleeding.
What is the role of fibrous septae shrinkage in fat reduction?
Shrinkage of fibrous septae compresses the subcutis, contributing to fat reduction.
What is the significance of muscle growth in improving cellulite?
Muscle growth increases the size of the compartment under the fat, pressing the fascia against the subcutis and dermis, which flattens cellulite.
What are the expected complications of overtreatment in noninvasive body contouring?
Overtreatment can lead to seromas, asymmetry, and skeletonized appearance.
What is the mechanism of action for high-frequency ultrasound in noninvasive body contouring?
High-frequency ultrasound penetrates deeply into the skin without injuring overlying structures, targeting fat cells.
What is the role of thermal necrosis in noninvasive body contouring?
Thermal necrosis creates small volumetric zones of heat injury, leading to collagen contraction and skin tightening.
A 45-year-old woman with mild skin laxity and crepe-like skin seeks treatment. Which noninvasive body contouring method is most appropriate for her condition?
Skin tightening methods such as light-based devices (e.g., CO2 laser) or radiofrequency devices are most appropriate for mild skin laxity and crepe-like skin.
A patient has small pockets of fat resistant to diet and exercise. What is the recommended treatment, and what should the patient ensure before undergoing it?
Fat reduction treatments like cryolipolysis or laser lipolysis are recommended. The patient should be at or above their normal weight before the treatment.
Why might weight loss not improve cellulite, and what alternative methods can help?
Weight loss does not improve cellulite because it is a condition of the superficial subcutis, not the deeper fat. Physical exercise can help by increasing muscle mass, which flattens cellulite.
A 30-year-old woman with localized dimpling on her thighs seeks treatment. What is the ideal approach for her condition?
Cellulite removal methods such as subcision or light and massage devices are ideal for localized dimpling, especially in younger women aged 20-50.
What is the mechanism behind cryolipolysis, and which body area is particularly responsive to this treatment?
Cryolipolysis destroys fat by freezing while sparing the dermis and epidermis. It is particularly effective for treating love handles.
A patient complains of saggy skin with underlying loss of fat-pad integrity. Why might noninvasive body contouring not be suitable for them?
Noninvasive body contouring is most appropriate for mild to moderate skin laxity and cannot address severe sagging or loss of fat-pad integrity.
What are the expected outcomes of noninvasive body contouring for the lower face?
Noninvasive body contouring for the lower face can result in a modestly more defined jawline or neck contour with slightly reduced skin excess.
What complications might arise from cryolipolysis, and how common are they?
Complications from cryolipolysis include tenderness, paresthesia, numbness, and rare reports of fat growth stimulation.
How does laser lipolysis work, and what additional benefit does it provide?
Laser lipolysis melts fat through direct tissue injury and also tightens the skin, which can augment liposuction.
What is the role of neocollagenesis in noninvasive body contouring, and how long does it take?
Neocollagenesis involves the formation of new collagen and occurs over 30-90 days, contributing to skin tightening.
A patient has severe photodamage and pigmentary abnormalities. Why might noninvasive body contouring not resolve their concerns?
Noninvasive body contouring is not effective for severe photodamage or pigmentary abnormalities.
What is the principle behind subcision, and how does it improve cellulite?
Subcision severs fascial bands and releases fibrous attachments around subcutaneous fat depressions, elevating the depressed area mechanically.
What is the mechanism of action for therapeutic ultrasound in fat reduction?
Therapeutic ultrasound directs energy deeper into the skin, using thermal effects to heat adipocytes or mechanical effects to break fat cells apart via acoustic shock waves.
What are the expected outcomes for cellulite treatment on the buttocks compared to the thighs?
Better-demarcated round dimples on the buttocks respond better to treatment than larger, irregular dimples on the thighs.
What is the primary mechanism of action for radiofrequency devices in noninvasive body contouring?
Radiofrequency devices direct energy deeper and more diffusely into the skin, causing collagen contraction and shrinkage of fibrous septae.
What is the significance of the concept of ‘popsicle panniculitis’ in cryolipolysis?
‘Popsicle panniculitis’ is the mechanism by which fat is selectively destroyed by freezing, sparing the overlying dermis and epidermis.
Why might liposuction exacerbate cellulite instead of improving it?
Liposuction removes superficial fat, which can worsen the appearance of cellulite by disrupting the superficial subcutis.
What are the expected complications of chemical adipocytolysis, and how are they managed?
Complications include swelling, tenderness, warmth, and temporary nerve dysfunction. These are typically temporary and resolve on their own.
What is the recommended technique for maximizing the effectiveness of noninvasive body contouring?
Several lower-energy passes with densely placed zones of thermal necrosis are recommended to maximize effectiveness.
What are the limitations of noninvasive body contouring in reducing visceral fat?
Noninvasive body contouring does not reduce visceral fat, as it targets only subcutaneous fat.
A patient experiences erythema and edema after a noninvasive body contouring session. Are these expected outcomes?
Yes, erythema and edema are expected outcomes of noninvasive body contouring.
What is the role of collagen denaturation in skin tightening?
Collagen denaturation causes collagen contraction, which contributes to skin tightening.
What is the ideal patient profile for cellulite removal using noninvasive methods?
The ideal patient is a 20-50 year old woman of normal weight with few localized areas of cellulite.
What are the expected outcomes of noninvasive body contouring for the midface?
Noninvasive body contouring for the midface results in more subtle tightening compared to other areas.
What is the mechanism of action for chemical adipocytolysis, and what is its FDA-approved use?
Chemical adipocytolysis uses deoxycholate to emulsify fat cells and is FDA-approved for submental fat reduction.
What are the expected outcomes of combining multiple noninvasive body contouring treatments?
Combining treatments can optimize results by addressing different layers and mechanisms, such as skin tightening and fat reduction.
What is the role of light-based devices in skin tightening, and how do they work?
Light-based devices like CO2 lasers ablate the epidermis and partial dermis, causing skin tightening through collagen denaturation.
What is the significance of spacing treatments 1-3 months apart in noninvasive body contouring?
Spacing treatments allows for wound healing and collagen remodeling, optimizing results.
What are the limitations of noninvasive body contouring in addressing extremely saggy skin?
Noninvasive body contouring cannot address extremely saggy skin with underlying loss of substructure and fat-pad integrity.
What is the mechanism of action for tumescent liposuction, and how does it differ from traditional liposuction?
Tumescent liposuction accesses fat through tiny apertures that reepithelialize without sutures, leaving barely visible scars.
What are the expected outcomes of noninvasive body contouring for small pockets of subcutaneous fat?
Partial or complete permanent resolution of small pockets of diet- and exercise-resistant subcutaneous fat can be achieved.
