Cellulite reduction and fat cell reduction

Plastic surgeons have had a long and pioneering history in the art and science of body contouring. From the advent of liposuction in the late 1970s and early 1980s, the practice of body contouring has seen the growth of less-invasive and more-effective liposuction techniques. When one combines men and women together, liposuction is still the most common surgery performed by esthetic plastic surgeons in North America and liposuction remains the number one esthetic procedure performed by plastic and cosmetic physicians worldwide. In 2009, it was estimated that there were 700,000 liposuction procedures performed in the United States (approximately 500,000 by board-certified plastic surgeons and the rest by cosmetic physicians) or 4% of all elective surgeries. The number of liposuctions is anticipated to double over the next 4 years to 1.5 million procedures or 8% of all elective operations in United States. This growth in body-contouring surgery is reflective in general of the expansion in the body mass index (BMI) of the average North American. The BMI and average weight of North Americans is increasing at an alarming rate; in fact, obesity is one of the most challenging epidemics facing North American health care. Fully 30% of Americans have a BMI higher than 30 and another 30% have a BMI between 27 and 30, making more than 200 million Americans candidates for weight loss programs and focal or generalized body-contouring procedures when weight loss has been achieved. Some experts project that by 2015, 75% of adults will be overweight, with 41% obese.

Increasing numbers of consumers desiring esthetic body-contouring changes are seeking less-invasive, less-traumatic, and more-effective procedures than traditional suction-assisted liposuction (SAL). Although, SAL is still perceived as the gold standard in nonexcisional body-contouring techniques by most plastic surgeons, recent developments in energy-based liposuction, including third-generation ultrasound (UAL), laser-assisted lipolysis (LAL), and RF-assisted liposuction (RFAL) may offer reduced ecchymosis, swelling, pain, and enhanced skin contraction when compared with SAL.

However, as popular as the various forms of liposuction remain, the fastest growth market segment in esthetic medicine is in the area of noninvasive body contouring. This reflects the underlying paradigm of many patients: that any surgery, no matter how “minimally invasive,” is not what they want. As this timely issue in Clinics in Plastic Surgery is devoted to noninvasive and minimally invasive esthetic techniques, it is important that the modern plastic surgeon and the specialty of plastic surgery in general, be well versed in the various nonsurgical procedures and technologies that patients may use to enhance their figure and form, or, increasingly, offer these modalities in conjunction with their surgical body-contouring practice. In 2009, the global market for all body-shaping platforms was expected to reach $361.9 billion with more than 9 million procedures performed. The annual growth in noninvasive body-contouring procedures is estimated to expand by 21% per year.

This article focuses on the noninvasive body-contouring modalities that have become available in the US and North American markets over the past few years, as well as those that are imminent (selling worldwide but pending approval by the Food and Drug Administration [FDA]). We review the basic science and peer-reviewed articles on clinical outcomes. At the conclusion of the article, some basic business models on incorporating noninvasive body-contouring procedures into an esthetic plastic surgery practice are discussed.

It is an exciting time in esthetic plastic surgery and the growth in noninvasive plastic surgery techniques affords the forward-thinking plastic surgeon the opportunity to treat many more patients who either are not ready for invasive techniques or will never consider incisional plastic surgery. We hope this article provides a solid basis for understanding the noninvasive body-contouring options available in 2010.