Excess Subcutaneous Fat
Excess subcutaneous fat is one of the most common cosmetic concerns in the United States. Removal of excess subcutaneous fat has become an increasingly popular procedure in an outpatient setting. A large variety of devices with varying methods of fat remo
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Lindsey Yeh and Sabrina Fabi
Abstract
Excess subcutaneous fat is one of the most common cosmetic concerns in the United States. Removal of excess subcutaneous fat has become an increasingly popular procedure in an outpatient setting. A large variety of devices with varying methods of fat removal or destruction are now available. The methods of treatment range greatly and include tumescent liposuction, injections with deoxycholic acid, cryolipolysis, and treatment with laser and ultrasound devices. The technology, effectiveness, and safety of these various treatments methods are reviewed in this chapter. Keywords
Subcutaneous fat · Tumescent liposuction Cryolipolysis · Body contouring Fat-reduction
L. Yeh Skin Laser and Surgery Specialists of New York and New Jersey, Hackensack, NJ, USA S. Fabi (*) University of California San Diego, San Diego, CA, USA © Springer Nature Switzerland AG 2019 M. Alam (ed.), Evidence-Based Procedural Dermatology, https://doi.org/10.1007/978-3-030-02023-1_50
Epidemiology Over 2/3 of the adult population in the United States is overweight or obese [1]. According to the American Society for Dermatologic Surgery 2017 Consumer Survey on Cosmetic Dermatologic Procedures, the most common concern of those surveyed was excess fat, which is consistent with the data over the past few years. Eighty-five percent of the participants reported that they were bothered by excess weight and more specifically 74% had undesired fat under the chin [2]. Fiftyeight percent of the consumers were considering body sculpting [2]. Not surprisingly, there has been an increasing desire for new methods of excess fat removal and body contouring. The accumulation of fat is influenced by genetic predisposition, lifestyle, diet, as well as aging. Even in those who are not clinically overweight, patients often desire treatment of areas with excess fat that persist despite adherence to a rigorous exercise routine and diet regimen. Others may be genetically predisposed to store fat in undesirable areas including hips, outer thighs, abdomen, waist, and inner thighs. Excess fat in selective areas, such as the submental region, can increase with age and can signify aging and be aesthetically undesirable. Lipomas can develop over time and most commonly present between the fourth and sixth decades of life with a slightly greater incidence in men than women. Lipomas are often solitary; however, 881
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multiple lipomas can be seen in lipomatosis. Other than surgical excision and liposuction for larger lesions, there are limited treatment options. Abnormal distribution of subcutaneous fat can also occur with medications such as highly active antiretroviral therapy and prolonged use of prednisone or systemic diseases such as Cushing’s disease.
I nvasive Body Contouring Techniques and Devices Tumescent Liposuction
Liposuction has been a long-standing procedure for the surgical removal of unwanted subcutaneous fat through small incisions and thin cannulas. Tumescent liposuction was introduced by Je
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