Where Are We in 2023? A Q&A on Non-Invasive Body Contouring

The past decade has seen rapid growth in the realm of non-invasive body contouring technologies to reduce small areas of fat, improve muscle tone and the appearance of cellulite, and reduce skin laxity.^1,2

The range of non-invasive body contouring modalities approved by the US Food and Drug Administration include cryolipolysis; heating technologies such radiofrequency (RF) energy, light-based energy, and ultrasound; and non-thermal approaches including low-level light therapy, high-intensity focused electromagnetic field (HIFEM), and massage or vibration.1

These approaches have quickly gained popularity among patients seeking alternatives to surgical body contouring approaches. While non-invasive techniques also carry certain risks and produce more subtle results than surgical techniques, the non-surgical techniques offer a favorable safety profile with less recovery time at a lower cost compared to surgery. “When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety,” according to Mazzoni, et al.2

Research findings suggest that combining several non-invasive contouring techniques may optimize patient results. Recent studies have shown reduction in the circumference of various body parts with a combination treatment of HIFEM, RF, and targeted pressure energy (TPE), as well as combined treatment with RF and TPE.3,4

As we approach the end of 2023, Modern Aesthetics® checked in with Mathew M. Avram, MD, JD, director of Dermatologic Surgery at Massachusetts General Hospital and director of the Mass General Dermatology Laser and Cosmetic Center, to gauge his overall perspective on the current status of the field of non-invasive body contouring.

In your view, what are the most exciting innovations in non-invasive body contouring to date?

Mathew Avram, MD, JD: The most notable recent innovations in non-invasive body contouring are in treatments for cellulite. We have new methods of long-term reduction in the appearance of cellulite without the requirement for physicians to invest in expensive technology to offer these procedures. Targeted verifiable subcision (TVS) is an important advance in this area.

In a single-arm, open-label, multicenter study published in January 2023, Stevens, et al evaluated the safety and efficacy of a single TVS procedure in 74 women aged 21 to 55 years with moderate or severe cellulite on the buttocks and/or thighs. The results demonstrated an improvement on the Cellulite Severity Scale of 1.5 ± 0.9 (P<0.0001), with no device-related serious adverse events noted at the 30-day follow-up.5

Surprisingly, the market for cellulite advances has been limited to date. This may be due to a legacy of years of ineffective treatments that have left a skeptical patient population wary of new advances in the treatment of this extremely common condition.

What are some of the most notable advances in techniques or devices that are currently on the horizon in the field of non-invasive body contouring?

Dr. Avram: The most promising innovation may be subcutaneous fat reduction with injected ice slurry. This technology is not yet commercially available. Developed by Massachusetts General Hospital dermatologists, this technique takes advantage of the ability to target and reduce fat with a physiologic ice slurry. The temperature of the slurry preferentially targets fat rather than surrounding tissue.

In the first-in-human study investigating this technique, ultrasound and tissue histology showed that a single injection induced cryolipolysis, with no serious adverse events. Brusing and erythema represented the most common adverse events.6

What future developments would you and your patients most like to see in this area?

Dr. Avram: Techniques that can provide significant improvement in body skin laxity represent the biggest unmet need for patients. Often, those who have excess, unwanted fat also have issues with skin laxity. A combination treatment that targeted both effectively, safely, and reproducibly would address a common cosmetic issue.

What is your overall view of the present state of non-invasive body contouring in 2023?

Dr. Avram: The revolution in noninvasive body contouring began over 10 years ago and has changed the way we practice. Advances in this area have eliminated the need for invasive procedures to achieve body contouring, while reducing downtime and the most serious adverse side effects associated with those procedures. These treatments do not approach the results of invasive surgical procedures, however.

There are now more devices on the market that aim to provide non-invasive body contouring. They are not all the same, and some work better than others. Nonetheless, the noninvasive body contouring revolution continues and will accelerate in the next few years.

1. US Food and Drug Administration. Non-invasive body contouring technologies. Accessed August 8, 2023. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/non-invasive-body-contouring-technologies

2. Mazzoni D, Lin MJ, Dubin DP, Khorasani H. Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition. Australas J Dermatol. 2019;60(4):278-283. doi:10.1111/ajd.13090

3. Duncan DI, Busso M. Effectiveness of combined use of targeted pressure energy, radiofrequency, and high-intensity focused electromagnetic fields to improve skin quality and appearance of fat and muscle tissue in different body parts. J Cosmet Dermatol. 2023;22(1):200-205. doi:10.1111/jocd.15280

4. Busso M, Born T. Combined monopolar radiofrequency and targeted pressure energy for the treatment and improvement of cellulite appearance on multiple body parts. J Clin Aesthet Dermatol. 2023;16(5):35-39.

5. Stevens WG, Green JB, Layt C, et al. Multicenter pivotal study demonstrates safety and efficacy of a new cellulite procedure: 3-month results. Aesthet Surg J. 2023;43(1):97-108. doi:10.1093/asj/sjac179

6. Kandula P, Javorsky E, Austen WG Jr, Kaminer MS. Injection cryolipolysis: First-in-human Study. Plast Reconstr Surg Glob Open. 2021;9(9):e3818. doi:10.1097/GOX.0000000000003818