Noninvasive Body Contouring Techniques: What Is the Evidence?

Introduction

Noninvasive body contouring (NIBC) techniques are a new alternative to traditional techniques used for the treatment of lipodystrophy and reduction of unwanted subcutaneous fat. Interest in studying this topic is increasing congruently with patient demand, however, it is unclear what the quality of evidence regarding the various techniques and outcomes measures is.

 

Methods

A comprehensive literature review of NIBC technologies was performed using technical and trademark names. Techniques included cryolipolysis, low-level light laser (LLLL), radiofrequency energy devices (RFED), high frequency focused ultrasound (HFUS), suction massage, and thermal devices. Studies describing a combination of techniques were excluded. Information on number of studies/patients, ASPS level of evidence (LOE I to V), subcutaneous fat reduction, statistically significant findings, and adverse effects was collected.

 

Results

There was heterogeneity in reporting, quality of evidence, and outcome measures. Twenty-five studies (1,344 patients) reported on cryolipolysis. The majority was LOE IV (21 studies, 84.0%), with one LOE II (4.0%), and 3 LOE III (12.0%) studies. Of the 4 studies with LOE III or higher, only 2 reported statistically significant findings. In comparison to contralateral untreated thighs, cryolipolysis was found to have an average fat reduction of 2.6mm (LOE III). Furthermore, treatments at -12°C were more efficacious than those at -15°C, decreasing submental fat by an average of 1.76mm (LOE II).

 

Eighteen LLLL studies were identified (1,641 patients), the majority of which were LOE IV (15, 83.3%) with one LOE I (5.6%) and two LOE II (11.1%) studies. Of the three studies with LOE III or higher, all reported positive and statistically significant results. Notably, LLLL resulted in a significant cumulative girth loss of 2.15cm (LOE II). MRI revealed significant mean fat reduction of 17% at 3 months (LOE II). A randomized control study (RCS) revealed LLLL to significantly reduce overall circumference measurements of specifically targeted regions, including the waist (0.98in), hip (1.05in) and bilateral thighs (0.85in, 0.65in) (LOE I).

 

Ten HFUS were identified (855 patients), of which 80% were LOE IV. There were two studies LOE III or higher (LOE I, LOE III), both of which presented positive findings that were not statistically significant. The LOE III study (85 patients) found an average of 4.6cm decrease waist circumference after 3 months. The LOE I study (164 patients) found that HFUS led to a 2.9mm decrease in fat thickness.

 

Nine studies (227 patients) reported on the use of RFED, the majority of which were LOE IV (8, 88.9%). A single LOE III study (20 patients) found a significant reduction of abdominal circumference from time of treatment at 1 (92.6 cm vs 96.2cm) and 3-month (93.3cm) follow-up. Four studies reported on suction massage (258 patients), all of which were LOE IV. Only one RCT (LOE I) reported on thermal devices and found positive results with regards to cellulite improvement.

 

Conclusions

There is a paucity of Level I-III evidence studies on NIBC technologies. Among NIBC modalities, cryolipolysis and LLLL appear to have the most evidence-based support. Nonetheless, higher-level studies should be pursued in this area of plastic surgery.