Although liposuction has been a popular procedure for cosmetic surgeons for decades, the opportunity for the broader aesthetics community to enter the body contouring market became viable recently with the introduction of non-invasive fat reduction technologies. Several devices have since entered the market, each offering a slightly different approach to this explosive market. With the advent of any new treatment area, it is seductive to invest to open a new revenue stream, particularly one that can be generated by physician extenders. Non-invasive fat reduction has undoubtedly been very lucrative for early adopters. But as the field becomes populated with more practitioners and devices, will it continue to be? And, as always, we must consider the specific benefits of any devices/procedures to our patients, and whether these technologies make logistical sense for our practices.

In general, the ideal candidates for non-invasive fat reduction are close to their desired weight with focal areas that don't respond to exercise and diet. None of the current devices can remove fat as efficiently or effectively as liposuction. For the office that does liposuction, that means a potential role either in finessing a prior liposuction or maintenance afterward. For the office without liposuction, these non-invasive devices serve a primary treatment role, perhaps analogous to non-invasive tissue tightening for the face versus face-lift surgery. They are offered to the patients who either aren't physically or emotionally ready for the more definitive invasive treatment.

So, is non-invasive body contouring a good fit for your practice? Assuming you've been convinced of the scientific validity of a given device, then comes the practical discussion: Is there the physical space for the treatments or staff to do them or just supervise? No one device is yet perfect for all candidates. Is it clinically reasonable to invest in just one technology knowing that it isn't right for a portion of your patient population? If one technology is a winner for your office, does it make sense to improve the efficiency of each treatment by buying two of that same device? Alternatively, is it better to invest in more than one technology, and, if so, is it financially or physically viable for your office to purchase more than one technology? And what if it is more efficient to have more than one of a given device? With how many other offices and medispas are you competing?

All of these are important factors when considering any new technology, device, or procedure in our field. Certainly, the ability to reduce fat and reshape the body non-invasively is a game-changer in aesthetic medicine. Several devices are already in second or third generation with significant improvements compared to the originals. Expectations for further improvements as well as the potential for FDA-approved lipolytic agents in coming years suggests the potential for this area to evolve and blossom in the same way fractionation changed the resurfacing market and modern fillers, soft tissue augmentation. But it continues to be important to balance our embrace of the “new” with equal parts caution. Our patients and the continued evolution of our specialty demand it.

heidi waldorf steven dayan

—Heidi Waldorf, MD, FAAD and Steven Dayan, MD, FACS