Selling the Drama
A conversation with Lin-Manuel Miranda on theater, creativity, and the endless...
The first serious way to attack unwanted body fat was liposuction, using equipment originally designed for abortions. It wasn’t long before lasers were added to disrupt the membranes of fat cells and help emulsify them. “Laser liposuction is another example of so much money invested in getting these machines out in the market that they often end up in the hands of untrained people,” says Felmont Eaves, M.D., immediate past president of the American Society for Aesthetic Plastic Surgery. “We see patients who are burned, whose skin looks like cobblestones, who have scars within the fat. Most board-certified plastic surgeons have abandoned the procedure.”
And last July, a study done at the University of Colorado found that among women who had liposuction on their thighs or lower abdomen, the fat returned after a year, redistributed to the upper abdomen, shoulders or arms. Researchers explained that the body “defends” its fat, carefully controlling the number of cells.
Mesotherapy (often called lipodissolve), a treatment that offered fat-melting injections composed of chemicals originally used to dissolve gallstones, proved unsuccessful for one important reason: Body fat exists in a mesh of fibers placed at irregular angles to each other, making it almost impossible for the chemicals to spread out evenly. “I saw lumpy, bumpy and irregular results,” says Baltimore dermatologist Robert Weiss, M.D. “The procedure created a lot of inflammation, tenderness and pain. It would release fat into the bloodstream very quickly.” The FDA has not approved any injection drugs to eliminate fat, and last April it sent warning letters to companies making misleading claims about the products used in lipodissolve, a procedure whose formula usually contains the drugs phosphatidycholine and deoxycholate, and sometimes includes extra components like vitamins, minerals and herbal extracts. The adverse effects included permanent scarring, skin deformation and deep, painful knots under the skin in areas where lipodissolve was performed.
What the FDA has cleared are two new devices that fall under the heading of “cool sculpting.” Fat is more cold-sensitive than other tissues, and the cold causes it to solidify without injuring the skin or underlying muscle. “It works the same way as soup that’s refrigerated overnight, so you can trim the solid layer of fat,” says Dr. Weiss.
With Zeltiq, a part of the body the government calls “individual flanks” (love handles) is pulled into the device and subjected to extreme cold for about an hour. Over a period of about two months, the frozen fat cells die and are slowly released into the bloodstream. Cool sculpting is not meant to address being overweight. “It’s good for a Victoria’s Secret model who just has a little saddlebag,” says New York dermatologist Gervaise Gerstner, M.D.
The other new device, Zerona, is based on technology known as “cold laser,” to produce small reductions in the waist, hips or thighs by causing fat cells to release their contents. Despite FDA clearance in 2010, there are detractors. “It’s a primitive device, with low benefits,” says Harold Lancer, M.D., an assistant clinical professor of dermatology at UCLA School of Medicine. “No reputable physician I know has it in their office.”
The fat returned after a year, redistributed to the upper abdomen, shoulders or arms.
Warning: The FDA has not yet approved UltraShape and LipoSonix, which claim to dissolve fat with technology based on ultrasound.
Cellulite: Myth vs. Reality
Stay away from anyone who claims to be able to get rid of cellulite. “It’s a genetically programmed flaw of the collagen and elastin fibers that runs from the bottom layer of the skin through the fat all the way down to the lining of the muscle,” says Dr. Lancer. “Cellulite is a cobweb of deranged, malfunctioning fibers. We know that salt retention and a high-carbohydrate or high-fat diet have something to do with making it worse in the genetically predisposed person, but is there a way to treat it? Absolutely not. All these supposed treatments work by temporarily swelling the skin, yet none are long-term. Throw yourself down the stairs: The swelling will be so immense that you won’t notice the cellulite. And you must be meticulous about your diet. Eat one potato chip, and you’re basically screwed.”