Have you ever wondered how to reduce fat without surgery?

Have you ever said to yourself “My diet is not working, but I don’t want surgery. What other options are out there?”

There are so many competing non surgical devices out there. They all say they reduce fat without surgery. But do they work? Which is the the best one?

Recently a scientific paper was published in a peer reviewed well respected Plastic Surgery publication. The author reviewed the science behind all the currently available devices to see if they worked. He is totally non biased, does not work for any of the device companies and was not paid for this work. The article was published in The Aesthetic Surgery Journal, 2015, Vol 35(3) 279 – 293, author Reza Nassab, MBA, MSc, FRCS (Plast).

In this discussion I am going to summarize his findings for you in a fair and balanced manner.

Mechanical Suction
Endermologie. Their most recent devices are called Integral and Endermolab. I used to own one of these in an earlier model. Results varied widely, but overall I did not find this machine to be very effective.

Mechanical Suction and Thermal Energy
TriActive (Cynosure). This device is mostly aimed at trying to improve cellulite. It works with low energy laser, cooling, suction and massage. About 1 in 5 women noted improvement of the thighs in one study after twice a week for 6 weeks. There were only 20 patients in this study and no large studies have been done to confirm that this is correct.
SmoothShapes (Cynosure). This is a dual wavelength laser-suction and massage device. Patients had 2 treatments on the outer thigh per week for 4 weeks. Just under 4 in 5 women saw cellulite improvement in 6 months. There were only 20 patients in this study and no large studies have been done to confirm that this is correct.

Radiofrequency
VelaShape and VelaSmooth (Syneron Candela). These devices combine infra-red light, mechanical suction and bipolar radio-frequency. VelaShape is more powerful than VelaSmooth. In several studies a little over half the women noted some cellulite improvement. Bruising was a reported complication and one case of skin crusting. In the end both these devices appeared to have equal and limited improvements.
Thermage (Solta Medical). This device improves body contouring and also skin tightening of the face, particularly around the eyes. One report indicated that the device is effective at improving the wrinkled skin around the belly button. There were mild issues with swelling and redness. One study combined Thermal with pulsed-dye laser with one treatment and then pulsed-dye by itself for 2 more treatments at 4 weeks apart. 60% to 90% reported some improvement in the appearance of stretch marks.
Accent (Alma Lasers). This uses monopolar radio frequency. The majority of patients showed some improvement and in one study the average thigh reduction was about 1 inch in circumference.
TiteFX (Invasix). This is newer and uses suction-coupled with radio-frequency. 25 patients had one treatment a week for 6 weeks and were reviewed at 3 months. There were no significant complications. 90% of patients saw improvement in their cellulite, with a thigh reduction of up to 1.5 inches.
Vanquish (BTL Industries, Inc). This is a high frequency field radio frequency device where the applicator does not actually touch the skin. No complications noted except for mild redness for a short time. In 35 patients the average waistline loss was just under 2in. It may work better in those patients who have more fat to lose.

Exilis (BTL Industries, Inc). This uses focused radio frequency to produce a heat effect, but there are no major published studies to show if this works or not.
Venus Freeze (Venus Concept). This is multipolar radio frequency and pulsed magnetic fields that generate heat, resulting in skin tightening and wrinkle and cellulite reduction. However, there are no major published studies to show if this works or not.

Ultrasound
Ultrashape (Ultrashape) This is pulsed ultrasonic waves at controlled depths. In one study 82% of patients reported some improvement but in another study with Asian patients there was no improvement. Maybe it does not work well in the Asian population.
Liposonix (Solta Medical) This is focused ultrasound and has some similarities to Ultherapy, which we are now using to non surgically tighten the skin of the face. The focused energy causes fat cells to fall apart and they are absorbed by the body and the fat is dispersed. 95% of the disrupted fat cells are gone at 4.5 months. The side effects are pain during and after treatment, bruising, redness, sensation changes and swelling, lumps and tenderness. All are temporary. In one study 70% of patients were pleased with their results at 3 months.
VASERshape (Solta Medical) The author could not find any studies in the literature to show if this device is effective.

Cryolipolysis (Cold therapy)
Coolsculpting (Zeltiq). This device carries FDA clearance to “effect the appearance of fat” in the sides and abdomen. The fat tissue is suctioned up and held between 2 cooling panels for 30 to 60 mins. This causes fat cells to die. Patients receive one session and are reviewed 4 months later. In one group 84% reported seeing some improvement in the fat layer. About 2 thirds have some degree of loss of feeling which returns in under 4 weeks. Side effects can include redness of the skin, firm “clay like” or stiff skin, bruising, severe pain, increased sensitivity of the skin, lumpiness under the skin. A newer device from Italy combines cold treatment with shock waves

Low Level Laser
Zerona (Erchonia Medical) It uses a red laser light at 635nm. Their most recent device is the Verju Laser. It replaces the Zerona. It uses a green laser at 532nm. It is 25% more powerful than the Zerona. This device is FDA approved and has been tested in a number of studies which included sham controls and “blinded” (meaning they did not know if the treatment was real or a sham) observers. In one study the average reduction of waist, hip and thighs was 3.27ins. Interestingly they also measured areas that were not treated and found fat reduction in those areas too. There is now interest that this could be a method of total body slimming. The effect of the laser may be increased by infiltrating the fat with a wetting solution first. The laser appears to cause pores (small holes) to appear in fat cells and fat comes out into the space between the fat cells. The fat is then removed from the area by the body. The patient can enhance the result by reducing calorie intake, exercising and drinking additional fluids. There has been no reported complications. The patient cannot feel the laser treatment.

To be fair and open with everyone I own a Verju Laser and I am pleased the Zerona got a good review in this article. Because the Verju is 25% more powerful I believe it is 25% better than the Zerona. In my opinion this is the most effective and pain free and risk free device available today to reduce fat without surgery.