Q: “I am the owner of a new aesthetic clinic and am considering including a non-invasive treatment that targets fat in my menu. What exactly is cryolipolysis and how does it work??”



A: “The story of how cryolipolysis became a preferred method for non-invasive fat removal is a rather peculiar one. Who would have thought that kids eating too many popsicles could lead to an advancement in the medical sciences!? Well, that is exactly what happened when in 1970 Epstein and Oren reported fat necrosis in the cheek of an infant after sucking on a popsicle! Studies revealed that it was caused by inflammation of the fat cells in the cheeks which caused them to be dissolved with time. In 2007 Drs Anderson and Manstein from Harvard University did further work and the “popsicle panniculitis” phenomenon paved the way for what we now know as cryolipolysis or fat freezing which they developed. The two doctors published their first clinical reports of successfully removing “love handles” with fat freezing and received FDA approval for this method in 2010. Subsequent approval was obtained for various other parts of the body including abdomen, back bra strap area, inner and outer thighs and under the buttock cheek, as well as underarms and submental. The physiological basis for this treatment is simple in that selective extraction of heat from adipocytes in subcutaneous tissue for an extended period result in immediate fat cell demise and gradual apoptosis, a natural controlled cell death. Lipids from the fat cells are slowly released and transported to the lymphatic system to be processed and eliminated. This is a very important point to be highlighted when educating potential patients considering this treatment method. Ideal candidates are patients who are following a healthy diet, who are exercising and who would like to improve their body shape by eliminating stubborn localised pockets of fat. So how exactly does it work? Numerous types of machines are available, some combining various technologies like radio-frequency or ultrasound cavitation, others only cryolipolysis via either 2 or 4 treatment handles. A vacuum is used to suction the skin and subcutaneous fat layer into the treatment cups where the cooling plates are situated. Good contact is required for efficient cooling therefore a variety of different sized handles are available, and a qualified therapist will be able to secure the handles comfortably to the treatment area. A quality machine will offer an initial period of skin warming before the cooling starts, this increases patient comfort significantly, and it should also have an emergency stop button for the patient to use when they feel they need it. Depending on the thickness of the fat layer treatment settings can be adjusted between 0 and -15 ◦Celsius, and from 30 to 60 minutes, followed by manual massage. Results for the area will become visible after 6-8 weeks and a repeat treatment can be scheduled after 45 days if required. Optimal results are visible between 3 and 6 months. The treatment is described as comfortable, especially once the initial tugging sensation caused by tissue being drawn into the applicator is relieved by the cooling of the area. Patients can return to normal activities directly after treatment and minimal side-effects have been reported.” Dr Andrea Botha (M Tech Chiro) 2019