Your Questions
Your Questions
Q: Dr. Eppley, I was interested in getting a consult for myself for the Vanquish vs. Exilis for several areas. I was also going to potentially buy a gift for my significant other as he is very concerned about abdominal fat. He also is considering Liposuction, so I looked that up. In your article about Liposuction you indicated that non-surgical, non-invasive fat removal methods are often not realistic and over hyped. Now, I am not sure whether to pursue the consult for the Exilis and/or Vanquish.
A: Any non-invasive body contouring procedures can not be compared in results as to what surgery can do. (e.g., liposuction) They rarely are even close. In general, there is a often a disconnect between patient expectations and what these types of treatments can do. Between a patient’s hopefulness and device marketing (by both manufacturer and practitioner), there is ample opportunity for patients to be disappointed. This does not mean that these devices are not beneficial and can not create moderate body contouring results, but each patient needs to be assessed individually to determine how non-surgical vs. surgical ROI (return on investment) compares. That requires a thoughtful and honest discussion which I regularly do for many potential patients seeking such treatments. I own both Vanquish and Exilis, so I have great insight into their potential value, but I also have no interest in patients making a ‘poor investment’ either if they are not good candidates for them. I would recommend that you and your husband come in and talk to me about it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a consult scheduled with you in the next few weeks for a breast lift and removal/replacement implants. I was also wondering if you could answer some questions about the differences between Exilis, Vanquish, Venus Freeze, Cool Sculpting and I-lipo. A friend of mine has tried the I-lipo. I have read about all of them online. Hard to tell what the “best” option for a little targeted fat loss and skin tightening would be. Maybe they are all good options.
A: In today’s world of non-invasive/non-surgical body contouring, there are a number of devices that are currently available for some degree of fat loss and a little bit of skin tightening. (and I want to emphasize the phrase ‘a little’) All available devices are based on some form of penetrating energy from ultrasound, infrared, radiofrequency and thermal sources. They all claim effectiveness but whether one is better than the other can never be proven since there are no comparative clinical studies of them. I have used most of these devices and, in the properly selected patient, can offer some reasonable results. Currently we use Vanquish and Exilis for the best non-invadive body contouring results, They are best used in those patients who are never going to have surgery to those that want to give it a try with actual surgery as a final treatment if needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some areas on my stomach and thighs that have a little extra fat and some loose skin. I do not want to undergo surgery however to make them better, that is just too much for me. I know that there are a lot of different non-invasive body contouring treatments out there that claim effectiveness. The one that has me intrigued the most is Exilis based on my research. How does Exilis work and what has been your experience with these treatments?
A: Exilis produces its effect through the use of highly controlled radiofrequency waves. It delivers high energy levels down to an inch under the skin. Its delivery technology allows that energy to be delivered without injury to the skin through a synchronized pulse delivery and cooling method. Thie keeps the treatments comfortable without risk of skin injury. (burns) It effects fat by breaking down their cell walls so the lipid contents are released and absorbed. It help tighten skin through a process known as neocollagenesis, which is the unraveling of the collagen fibers by the energy and the subsequent stimulation of fibroblasts to produce new collagen resulting in dermal thickening and increased skin density.
The transducer delivery system allows 17 different body areas to be treated from the eyelids down to the hands and everything in between. Our experience has been extremely favorable in properly selected patients who have been educated about achieveable results without surgery. Incremental, lasting and measureable results can be obtained in four treatment sessions or less of Exilis for many patients.
Dr. Barry Eppley
Indianapolis, Indiana
The desire for fat reduction is a near universal one that crosses all age, gender and ethnic lines. From the countless number of diet and exercise approaches to the opposite choice of liposuction surgery, loss of body fat can be successfully done with varying degrees of individual effort. But between these two ends of the fat loss spectrum lies the developing field of non-invasive body contouring. The concept of losing fat without surgery through an external device is both appealing and promising.
External ‘machine-driven’ methods for fat reduction are not new. Whether it was the belt-driven shaking machines from the first half of the last century to sitting in a sauna box and sweating it off, letting something else do the work and hopefully losing weight will always catch the public’s attention. Taking a pill, of course, is the simplest and requires the least amount of effort. But you probably didn’t get overweight or develop those few fat areas by taking pills, so it seems unrealistic that you can lose this fat by pills alone. While science and technology has come a long way, does today’s non-invasive body contouring devices really work…or are they just a modern-day version of the old ‘shaking machine’?
The newest technology for non-surgical body contouring is Zerona. This is an external cold laser that helps make fat cells leaky and loss some of their lipid contents. While people think of a laser as being a focused beam of light that hits a target and causes it to vaporize or melt, cold laser technology is different. It can pass through the skin without injuring it and penetrate up to 5 cms (2 inches) in depth. This can reach localized fat and exert its photochemical effect. The concept of photochemical-induced leakiness of fat cells is a bit hard to grasp but its physics are a little similar to the way cell phones actually work. I have a hard time wrapping my mind around cell phone technology to understand how all these messages and images are flying around and get to their intended recipients….even when I am on an elevator or a plane. But despite my ignorance I have plenty of evidence every day that it does work. So I won’t hold it against photochemical-induced fat loss simply because I don’t completely understand the science behind it.
The effects of Zerona on fat is very short-lived so multiple treatments are needed, spaced but a few days apart. Over a course of several weeks and multiple treatments, many patients have been shown to lose several inches around the waist, hips and thighs. But along with the treatments it is advised to drink water and take a niacin supplement to support the lymphatic clearance of the released fat. Herein lies the important difference from today’s technology and yesterday’s devices of hope…the use of some modest lifestyle changes and good patient selection.
Non-invasive body contouring is not a substitute for what liposuction can achieve or for the large amounts of weight loss that occur from bariatric surgery. Rather it is intended to benefit those who have some stubborn areas of fat that are just not responsive to what you can do at home with your best efforts. And for those who do not feel they have enough of a fat problem to justify surgery or want to do anything to try and avoid that solution. By using these criteria, most patients that use Zerona have more modest fat collections. This size of the problem and the modest lifestyle changes that are part of the program account for the generalized success and satisfaction that occurs from this non-invasive body contouring device.
Dr. Barry Eppley
http://eppleyplasticsurgery.com/
Indianapolis, Indiana
