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Great progress has been made in the treatment of excess adipose tissue, although similar progress has not been made in
curtailing the burgeoning obesity epidemic. The need for safe subcutaneous fat reduction is stronger than ever, as obesity is
In the early days of plastic surgery, dermolipectomy, or resection of large segments of skin and fat, was the standard and
only way to remove unwanted fat and extra skin. In 1979, Illouz invented liposuction, which has remained one of the most
popular surgical procedures for the last decade. However, many patients do not want surgery. Weight loss, especially in women,
does not always correspond to reduction of subcutaneous fat. In both men and women, there are frequently regions of diet and
exercise resistant fat deposits, which may be genetic or hormonal in origin. Several studies have shown an improvement in
glucose metabolism and improvement or cure of type II diabetes with significant subcutaneous fat reduction. As interest increases,
medical research has become more and more focused on nonsurgical means of reducing subcutaneous fat. Injection lipolysis has
been around since the early 2000s. Invented by Patricia Rittes, this procedure involves injection of phosphatidylcholine and
sodium deoxycholate. The author?s study in 2007 defined the lytic agent as the detergent, sodium deoxycholate. The procedure
permanently kills adipose cells, and localized fat reduction is also permanent. However, due to poor regulation, the procedure was
performed by unlicensed practitioners, and many of the US ?clinics? offering the procedure went bankrupt.
More recently, new devices have been developed to lyse subcutaneous fat. The Ultrashape device is not FDA approved, but
is used in Europe, Asia, and Canada. It is an ultrasound based device that causes cavitation of the subcutaneous fat with localized
reduction. Liposonix, which uses a HiFu (highly focused) ultrasound energy source, was approved in the US in 2011. It also
provides reduction of a localized area of subcutaneous fat. However, the procedure is expensive and many feel that it is quite
Another device which kills localized fat is Zeltiq, which uses cryolipolysis to reduce localized fat. Several treatments are
necessary in order to achieve optimal results. Another new device is TiteFX, which uses radiofrequency based energy to apply
gentle suction, and to serially heat sections of fatty tissue. When the preset temperature is reached, a burst of RF energy is sent
through the superficial fat. This is more effective than simple bulk heating, which also works, but more gradually. Phase III clinical
trials of this device are being conducted by the author in the regions of the periumbilical abdomen and inner thighs.
There are many noninvasive options for reduction of subcutaneous fat. While maintenance of a healthy diet and exercise plan
are the foundation for long term health, these treatments can help in diet and exercise resistant fat deposits.
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