Dr. Jeanine Downie discusses non-Invasive fat removal, including evolution of technology, treatment approach, results, and combination therapies.
Jeanine B. Downie, MD, Director, Image Dermatology, Montclair, New Jersey
“This is a lecture I gave … where we talked about noninvasive fat melting/body contouring and did [a demonstration] with the LIPOcel (Perigee) device,” said Jeanine B. Downie, MD, who presented on noninvasive fat removal during the Device and Novel Therapies Demos panel at the Cosmetic Bootcamp Summer Meeting 2023 in Aspen, Colorado.
According to Dr. Downie, working with Perigee is easy, and LIPOcel, a high-intensity focused ultrasound (HIFU) device, does not require much in the way of disposables.
“It’s much like the Liposonix technology from the previous cycle, 5 to 7 years ago, except with this machine you don’t have to be ‘twilighted.’ You can drive yourself to the practice, we do the LIPOcel, and then you drive yourself home. It’s not as painful at all but it still works because it produces true apoptosis. That is how you can tell whether a machine for noninvasive fat melting works because apoptosis is the elimination of fat cells.”
LIPOcel can be used on the stomach, flanks, inner thighs, and to eliminate fat, said Dr. Downie.
“It eliminates targeted fat cells permanently, induces a metamorphosis of the collagen fibers, and it can (for some people, depending on the quality and tone of their skin) achieve a lifting effect.”
Macrophages transport the heated fat cells to the lymphatic system where they are discharged, she said.
“That’s why I encourage patients to drink a lot of water before, during, and after the procedure.”
A noticeable but temporary volume reduction takes place immediately post procedure, but actual results can be seen about 12 weeks after 3 treatments that are spaced 1 month apart; 4 treatments are sometimes indicated for optimal results, she said.
“We weigh and measure the patients. We take a lot of photographs and then get started with the procedure. The majority of patients take the procedure quite seriously—they’re exercising and are trying to eat healthy.”
Dr. Downie recommends patients go on the high-protein Mediterranean diet, including fish, chicken, some meats and olive oil, avoid processed food, and minimize sugar because of the glycation and inflammation it causes, said Dr. Downie.
“With this machine you don’t have to ‘twilight’ the person because there is significant contact cooling, which reduces pain and protects the epidermis. You can go for a higher energy [setting] because of the contact cooling system. Knock on wood, I have not had any burns with the LIPOcel.”
Treatment time depends on the area being treated. For example, it can take about 45 minutes to treat a moderately sized abdomen in the office, said Dr. Downie.
The technology can be used in males and females and all races and ethnicities, Dr. Downie said.
“There’s no downtime post LIPOcel.”
But there can be slight edema and bruising post treatment. Some patients have complained of itching, she said.
According to Dr. Downie, it’s important to keep patients accountable as they monitor results.
“I weigh and measure every time they come in because there are patients who think it’s a get out of jail free card. I assure them that it’s not. If the patient is a woman that is having her period, she has to tell me that she’s bloated. If they’ve been partying and drinking beer all weekend, they need to tell me that.”
LIPOcel treatment is not indicated for pregnant or lactating women or patients with fat below 1 cm. The company recommends the treatment for patients with a body mass index (BMI) below 30, but Dr. Downie has treated patients with up to a 32 BMI, she said.
“In terms of very negative side effects … burns have been reported. You need to pay attention to what the patient is saying, and it’s real-time feedback.”
Combination Treatments
Combination treatments can address patients’ concerns that LIPOcel alone cannot. For example, the patient treated for abdominal fat during the Cosmetic Bootcamp demonstration had a large abdominal scar from an emergency gallbladder removal, said Dr. Downie.
“If somebody has a large scar they don’t like, we can do LIPOcel then INTRAcel [Perigee] radiofrequency microneedling to reduce the scar size. Patients should know that LIPOcel is not going to take away the scars.”
Sculpting is possible by combining LIPOcel with Emsculpt Neo (BTL), said Dr. Downie.
“Emsculpt Neo is electromagnetic energy and causes true apoptosis or death and destruction of fat cells, as well. It burns 30% fat and builds 25% muscle, which helps significantly with diastasis recti. A lot of times I’ll debulk the abdomen with the LIPOcel then use the Emsculpt Neo. The Emsculpt Neo also is great for all skin types, races and ethnicities, and both sexes.”
For some patients who have smaller abdomens to begin with, Dr. Downie said she might use the LIPOcel followed by the Emsculpt Neo to get rid of the fat that is less than 1 cm.
“Some are thrilled and some say they want [more] off. Then, I’ll do Kybella [Allergan], which is ‘liposuction in a needle.’ I did the clinical trials for Kybella, which is deoxycholic acid. We’ll put that into the ‘trouble spots’ where the fat has not completely gone away, and people want more muscle showing.”
Disclosures: Dr. Downie is a speaker and consultant for Perigee.
