Sorting out the technologies available for body contouring can be confusing, and there is quite a bit of hype surrounding these procedures. After talking with doctors and machine manufacturers and reading peer-reviewed research, I have organized these technologies by energy source.
RADIO FREQUENCY
Radio frequency (RF) is a common type of energy used in body contouring, and is based on the use of an oscillating electrical current to create heat in the tissue. RF targets water in the tissue, and because it does not specifically target pigment, it can be used on different skin types. However, because the RF energy is still creating heat inside the tissue, skin temperature and settings must be carefully monitored to minimize the risk of burns. RF is a generic name for several specific technologies, monopolar RF, unipolar RF, and bipolar RF. While each of these technologies applies the RF energy in a slightly different manner, all three create thermal stimulation within the dermis and to a lesser extent, in adipose tissue.When water in the dermis is targeted, some research shows that the structure of the existing collagen is changed (tightened), and there is evidence that new collagen is formed (neocollagenesis). This is the commonly proposed mechanism of action to explain the skin tightening effect and the modest reduction in wrinkles.
When water in the adipose layer is targeted, it is thought that the metabolism of the fat cells (adipocytes) is increased, and in some cases, fat cells are destroyed and triglycerides broken down. This is the prevailing hypothesis behind the fat loss effect.
TYPES OF RADIO FREQUENCY:
MONOPOLAR
In this form of RF, the client is grounded, which means the energy, when delivered through the skin, ultimately ends up in the grounding pad placed on the client. There are different methods of delivering monopolar RF energy. One method involves the constant motion of the handpiece on the skin. Based on my own experience, this method seems to be easier for the client to tolerate, as it avoids creating “hot spots” on the skin in the treatment area.Another variation of body contouring monopolar RF technologies is a device that delivers a series of stamped, single pulses. In some cases, this method may allow hot spots to develop, as the handpiece is kept stationary on one area for up to four minutes.
BIPOLAR
In this form of RF there are two poles (a positive and a negative), which are usually built into the handpiece. The energy travels between the two poles, eliminating the need for a grounding pad. The penetration depth of the energy is determined by how far apart the two poles are on the handpiece.UNIPOLAR
In this form of RF, there is no grounding pad, and only one electrode being used. The energy being emitted is much like a radio tower that broadcasts signals in every direction. According to several manufacturers, unipolar RF penetrates deeper than bipolar RF, and thus can effectively target deeper adipose layers.Ultrasound
AREAS OF COVERAGE
RF devices are used for both facial and body contouring. For body contouring, the most commonly treated body parts are the abdomen, flanks (love handles), upper arms, inner and outer thighs and knees.SETTINGS
Settings should be according to the manufacturers’ parameters, which usually focus on temperature. Aim for 45 degrees Celsius (113 degrees Fahrenheit). Hold that temperature on the treatment area for three to four minutes.CAUTION
Although radio frequency is considered “color blind”, hyperpigmentation can be induced by heat. Caution should be used in treating the darkest skin types, and the treatment area must be carefully monitored to avoid the creation of hotspots. One technique I have learned to assist in reducing the chance of hotspots is to expand the treatment area.SIDE EFFECTS
There are common side effects associated with radio frequency such as erythema, uncomfortable heat and possible blistering. With proper training and techniques, the risk of these effects is significantly decreased.CONTRAINDICATIONS
Pace makers and internal defibrillators are the biggest contraindications for radio frequency. Treatment must also be avoided in any area that contains any type of metal implant. Other contraindications include certain cardiac disorders and pregnancy.TREATMENT TIME, FREQUENCY AND PRICE
Radio frequency prices for body contouring range from $200 for a small area to more than $1,000 for a large area. Many spas offer package deals. Treatments are performed two to three weeks apart. Most clients require six to eight treatments, and annual maintenance treatments are usually needed.COST OF MACHINES
The cost of a new device will be around $90,000 with certified pre-owned prices starting around $35,000. Some of the devices require disposables to be used for the treatments, so you will have additional costs.PROS/CONS
The stamping method is very easy to learn, but the in motion method may require more training to master.ULTRASOUND
In addition to RF energy, there are body contouring machines that incorporate ultrasound (sound waves). There are two different types of ultrasound technology being used: focused pulsed ultrasound and high intensity focused ultrasound.AREAS OF COVERAGE
Common areas for treatment with focused pulsed ultrasound include the lower and upper abdomen, the hips, flanks, as well as the inner and outer thighs.SETTINGS
Treatments are usually measured in pulses, not heat.HOW IT WORKS
Focused ultrasound waves will oscillate fat cells until they implode, which is a process called cavitation. Cavitation disrupts the fat cell membrane. Bubbles are created in the fluid between the cells, which cause the surrounding fat cells to implode and be liquefied. This mechanical acoustic effect can cause selective fat cell disruption without injury to other structures.CONTRAINDICATIONS
Contraindications to focused pulsed ultrasound treatments include pregnancy, skin ulcerations in the area, infection or skin cancer directly in the area of treatment. It shouldn’t be used over bony areas, tattoos or scars.TREATMENT TIME, FREQUENCY AND PRICE
Usually, three treatments per area are required at a two-week interval for optimum efficacy. They are usually sold in a package of three, and pricing tends to range from $2,500 to $3,000 for the package.COST OF MACHINES
The cost of a new device will be around $150,000. The treatments require disposables, so there are additional costs.PROS/CONS:
Depending on the machine being used, the results for the client may be directly related to technique practiced.HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)
AREA OF COVERAGE
Common areas for treatment include the lower/upper abdomen, and flanks.HOW IT WORKS
HIFU works by heating the target tissue above 56 degrees Celcius. This causes molecular vibrations that destroy fat cells and tissue (via ablation), subsequently reducing the fat layer with the body’s normal inflammatory response, eliminating the cellular debris.CONTRAINDICATIONS
Contraindications include pregnancy, skin ulcerations in the area, infection or skin cancer directly in the area of treatment. It shouldn’t be used over scars.SIDE EFFECTS
Pain, bruising, tenderness, hard lumps and swelling. Most clients need some type of pain management for the procedure to be tolerable.TREATMENT TIME, FREQUENCY AND PRICE
Currently published protocols indicate that usually, only one treatment is done, but prices can range from $1,500 to $3,000 per area.COST OF MACHINES
The cost of a new device will be around $90,000 with certified pre-owned prices starting around $35,000. Some of the devices require disposables to be used for the treatments, so there are additional costs.PROS/CONS
Because some pain management may be necessary, medication may need to be prescribed, which requires a medical professional.CONTROLLED COOLING (CRYOLIPOLYSIS)
AREA OF COVERAGE
Common areas for treatment include the lower and upper abdomen, flanks and thighs.HOW IT WORKS
The principle behind cryolipolysis is the premise that adipocytes (fat cells) are more susceptible to cold than other cells. The precise application of cold temperatures triggers apoptosis (cell death) of the fat cells, which invokes the inflammatory response. This leads to slow elimination of debris by surrounding macrophages.CONTRAINDICATIONS
Cold sensitive disorders, Reynaud’s disease and pregnancy.SIDE EFFECTS
Side effects include temporary redness to the skin, bruising, and transient numbness that usually resolves within two weeks following treatment.TREATMENT TIME, FREQUENCY AND PRICE
There will be one or two treatments, usually performed eight weeks apart to allow for the inflammatory process to resolve. Pricing is typically $700 for one area/one treatment with discounts on additional areas.COST OF MACHINES
The cost of a new device will be around $90,000, with certified pre-owned prices starting around $35,000. Some of the devices require disposables to be used for the treatments, so you will have additional costs.PROS/CONS:
The fat that’s being treated must be soft, and the amount must be capable of fitting into the applicator. However there must be enough fat in the area being treated in order to perform this treatment.Treatments to spot reduce fat or tighten the skin are a big focus in the esthetic industry. Technology is beginning to offer solutions to help these problem areas, providing a great opportunity for the spa industry.