Nowell Solish

Noninvasive Body Sculpting Technologies with an Emphasis on High-Intensity Focused Ultrasound

BackgroundBody-sculpting procedures are becoming increasingly popular in the United States. Although surgical lipoplasty remains the most common body sculpting procedure, a demand exists for noninvasive alternatives capable of reducing focal adiposity without the risks of adverse events (AEs) associated with invasive excisional body-sculpting procedures.MethodsThis report describes the mechanism of action, efficacy, safety, and tolerability of cryolipolysis, radiofrequency ablation, low-level external laser therapy, injection lipolysis, low-intensity nonthermal ultrasound, and high-intensity focused ultrasound (HIFU), with an emphasis on thermal HIFU. The articles cited were identified via a PubMed search, with additional article citations identified by manual searching of the reference lists of articles identified through the literature search.ResultsEach of the noninvasive treatments reviewed can be administered on an outpatient basis. These treatments generally have fewer complications than lipoplasty and require little or no anesthesia or analgesia. However, HIFU is the only treatment that can produce significant results in a single treatment, and only radiofrequency, low-level laser therapy, and cryolipolysis have been approved for use in the United States. Early clinical data on HIFU support its efficacy and safety for body sculpting. In contrast, radiofrequency, laser therapy, and injection lipolysis have been associated with significant AEs.ConclusionsThe published literature suggests that noninvasive body-sculpting techniques such as radiofrequency ablation, cryolipolysis, external low-level lasers, laser ablation, nonthermal ultrasound, and HIFU may be appropriate options for nonobese patients requiring modest reduction of adipose tissue.

A randomized, single-blind, postmarketing study of multiple energy levels of high-intensity focused ultrasound for noninvasive body sculpting.

BACKGROUND High‐intensity focused ultrasound (HIFU) is a nonsurgical, noninvasive body sculpting method. OBJECTIVE To investigate preferences for treatment settings using a HIFU device. MATERIALS AND METHODS HIFU was applied to the anterior abdomen in three passes of decreasing depth (1.6, 1.3, and 1.1 cm) in patients randomized to HIFU energy levels (each of 3 passes [total]) of 47 (141), 52 (156), or 59 (177) J/cm2. The primary assessment was week 12 post‐treatment change from baseline waist circumference at the level of the iliac crest for all treatment groups combined. RESULTS The primary assessment achieved statistical significance (least squares mean 2.51 cm, 95% confidence interval [CI] = −3.14 to −1.88; p < .001), with no significant differences between groups. At week 12, 69% to 86% of patients and 73% to 79% of investigators rated appearance as improved or much improved. The average worst pain (100‐mm visual analog scale) experienced during treatment was mild (47 J/cm2: 17.1 mm, 95% CI = 4.33–29.81 mm; 52 J/cm2: 24.6 mm, 95% CI = 12.24–36.95 mm; 59 J/cm2: 30.9 mm, 95% CI = 18.71–43.17 mm). There were no serious adverse events. CONCLUSION HIFU treatment at different energy levels and multiple tissue depths was well tolerated and effective in reducing waist circumference.

Treatment of hyperhidrosis with botulinum toxin

Focal hyperhidrosis is a common problem that affects up to 2.8% of the population with significant psychosocial implications. Traditional therapies have not proven effective for most of these patients, which further adds to patient anxiety. Botulinum toxin is emerging as a novel treatment for focal hyperhidrosis and is proving to be safe and effective. A therapeutic protocol for focal hyperhidrosis includes an individualized treatment plan for each site of involvement. For those who are affected in the palms and soles, the most common treatments include topical treatment with aluminum chloride, iontophoresis, botulinum toxin,systemic medications, and sympathectomy. For those who have axillary focal hyperhidrosis, iontophoresis is often difficult and botulinum toxin becomes the second line therapy. As of June 2003, BTX A has been approved for the treatment of hyperhidrosis in 13 countries: England, Canada, New Zealand, Australia, Taiwan, Netherlands, Switzerland, Brazil, Argentina, Columbia, El Salvador, Guatemala, and Mexico. With the currently available literature and ongoing studies, it should only be a short time before the U.S. Food and Drug Administration approves botulinum toxin therapy for focal hyperhidrosis in the United States.

OnabotulinumtoxinA and Hyaluronic Acid in Facial Wrinkles and Folds: A Prospective, Open-Label Comparison

Background OnabotulinumtoxinA and hyaluronic acid are effective in improving moderate to severe facial wrinkles and folds, with treatment selection traditionally based upon facial area. Objectives This prospective, multicenter, open-label, crossover study evaluated physician-rated efficacy and patient-rated outcomes following moderate to severe facial wrinkles and folds treatment with onabotulinumtoxinA and hyaluronic acid. Methods 152 subjects (25-65 years) were randomized (1:1) to a treatment-sequence of onabotulinumtoxinA/hyaluronic acid or hyaluronic acid/onabotulinumtoxinA, with initial treatment administered on day 1 and 6 additional visits: week 2 (touch-up); week 4 (crossover); week 6 (touch-up); and weeks 8, 12, and 24 (follow-up). Results Between 92% and 100% of subjects in each treatment-sequence group exhibited at least some improvement from baseline at each study visit in the Physician Aesthetic Improvement Scale and the Objective Observer and Patient Global Assessments of Improvement, with no significant between-sequence differences. Subjects reported looking 3 to 6 years younger at each visit, with significant improvements in glabellar, lateral canthal, and horizontal forehead lines, and nasolabial folds. Treatments were well tolerated. Conclusions OnabotulinumtoxinA and hyaluronic acid provide clinically meaningful improvements as rated by physicians, objective observers, and subjects, with clinical synergy in aesthetic effects and duration of response regardless of treatment administration order in subjects seeking improvement in moderate to severe facial wrinkles and folds. Level of Evidence 2