Demand for body contouring treatments is the fastest-growing segment of the aesthetics market. Driven by advances in technologies, these devices are often adaptions of established medical and physiotherapy devices, as well as some which are completely unique.
The most well-known of all body treatments is CoolSculpting. Launched way back in 2010, this was a totally new innovation developed by Harvard scientists who noticed that ice lollies caused some children to develop dimples. It uses sub-zero temperatures to destroy fat cells which are then naturally processed by the body. CoolSculpting is not only the oldest of all of the body technologies but remains the most popular. With more than 9 million treatments performed, the key to its success is in the name. CoolSculpting is not only effective at removing fat cells but, with the variety of applicators available in different sizes, it can truly sculpt the body as a surgeon would but without the need for needles or downtime. For those wanting to target stubborn areas of fat, CoolSculpting removes as much as 30% of the area treated in just one session.
The process of freezing fat causes the cells to die, and the same is true for heating, which can be achieved with both radiofrequency and lasers options. Treating with heat, however, is a little more complicated than freezing (cold temperatures naturally numbing the area) as both lasers and radiofrequency need to heat the fat to temperatures of around 45 degrees and for as much as an hour each time. Lasers and radiofrequency treatments have been available since around 2015 but are often less popular as the procedure can be uncomfortable. They are also less targeted, being more suitable for general fat reduction than achieving definition. Heat-based treatments also need to be repeated several times to achieve what freezing can with a single visit.
While fat reduction remains the most sought-after body treatment, one of the biggest innovations in recent years was the launch of muscle-building devices. This category of treatments was started by BTL which introduced their EmSculpt in 2018. The EmSculpt device uses high-intensity focused electromagnetic energy (HIFEM) which is magnetic waves of very low frequencies (3-5 kHz) that transmit through the tissue to cause muscle contractions. EmSculpt stimulates the muscles at a much higher rate than can be achieved naturally which means muscles can be built faster than working at the gym. Initially, a lot of interest was driven by those seeking six-packs, or to tighten and lift their buttocks, but the muscle-building technology is just as applicable for those wanting help with medical concerns such as diastasis recti. A lot of people I see in my practice are women postpartum and their bellies are affected by pregnancy weight gain but also a weakening of the abdominal wall. EmSculpt’s abilities to strengthen the muscle extends beyond the purely aesthetic and can address underlying health concerns at the same time.
Since the launch of EmSculpt, a number of similar devices have become available, including some that utilise electrical stimulation (ES). ES works like a TENS machine which is used to stimulate nerves and treat pain. While ES at the right frequency will cause muscles to contract, the ability of ES to stimulate muscles to work hard enough to cause real change is limited. Users can identify if a machine is using ES as it will have sticky pads which attach to the skin via wires with the sensation being more superficial compared to HIFEM which feels much more like a real muscle workout deep in your abs.
The makers of EmSculpt were also the first to use radiofrequency for fat reduction, having launched their Vanquish device in 2015. I use the Vanquish in my clinic and find it is ideal for reducing abdominal fat ahead of more targeted treatment with CoolSculpting. In 2020, BTL combined the EmSculpt and Vanquish treatments into one machine called the NEO. The NEO is very popular given it targets both fat reduction and muscle building at the same time and has gained a huge celebrity following in the USA.
Other recent innovations have included Truflex Plus from Cutera, which is based on ES technology, and the EON laser from Dominion Technologies. The EON is not yet available in the UK but this device uses lasers to target fat while overcoming the typical discomfort associated with this modality by integrating a cooling system. Results for the EON appear to be very effective, and for those wanting a general reduction in their abdomen, it looks like it will be an exciting option when it arrives.
When delivering fat reduction procedures, skin quality is a consideration, with post-treatment laxity the most pronounced concern. When dealing with skin laxity, the production of collagen is important and is often part of the natural healing and repair process following both CoolSculpting and heat-based fat reduction treatments. Where the skin tightening post-treatment is unsatisfactory then radiofrequency delivered using a combined micro-needling device such as Morpheus8 is ideal. Morpheus8 for the face and neck launched in 2018 with the body tip (a doctor-only treatment as the pins penetrate up to 8mm into the skin) following in 2020. This device causes thousands of micro-wounds across the surface of the skin while radiofrequency energy passes deeper into the dermis – together they supercharge collagen production which helps to renew and tighten any loose skin which might hang around.
Beyond energy treatments, an amazing new product was launched in 2021 by Sinclair. This is a revolutionary new filler product specifically for the body. Lanluma, which is a biostimulating dermal filler, has been specifically formulated to reshape and contour the body and can also be used to reduce the signs of cellulite and wrinkles. In my practice, I use this more often to add volume to areas but it can be used in smaller amounts to treat and improve skin texture with its stimulating effects helping to improve skin quality.
The biggest news in body treatments of late was the launch of the all-new CoolSculpting Elite in April 2021. This updated fat freezing machine from the makers of the original CoolScutlping is the most studied non-surgical treatment. With more than 100 studies having been published the safety and efficacy of the treatment are well known. This is a super-smart looking device that has the benefit of more than ten years of real-world experience. This knowledge has been applied to what the original did but can do so much faster. Patients treated with CoolSculpting Elite begin to see changes in as little as 4 weeks which are due to key design changes in the applicators as well as a double capacity chiller. These new applicators hug the treated area even closer with their C-shape design which means more even cooling passes through the skin but without the uncomfortable pulling and pinching of the old style system.
While the number of technologies is increasing, the benefits for those seeking to slim down their bellies or tone and tighten their abs is not necessarily better. Major names in aesthetics spend huge amounts on R&D to ensure their machines are not only effective but safe too. Worryingly, just like luxury goods, a market for copycat devices has developed. These copycat machines can be purchased online, or are purchased and rebranded by local sales companies and sold as cheap alternatives to the ’expensive’ big brands. What is missing from these machines however is the testing, compliance, and support. There are no laws that prevent these machines from reaching the UK consumer and until regulations improve it is very much buyer beware. It is important to research the treatments and the clinics that offer them.
While aesthetic devices offer alternatives to surgical interventions, the skill and input of the practitioner remains an important part of the treatment process. In my practice, I have found that patient selection is important as not everyone is suitable for every treatment. While generally safe, there are contraindications that prevent some people from having treatments and it is important when choosing a clinic that you find one that provides sufficient medical oversight. Expect to be seen in person by a doctor prior to treatment, undergo a physically examined and full health history will be taken in a properly managed clinic. Until regulations improve, it is important that anyone seeking treatments takes the time to do their research and ensure that their practitioner is not only able to deliver the treatment but support them if anything goes wrong.