Skinside Out

Welcome to SkinSide Out, where Science Meets Beauty, hosted by Dr. Zain alongside Heather, Courtney, and Crystal. In this episode, the team dives deep into the world of body contouring. They discuss the rise of non-invasive technologies like CoolSculpting, their personal experiences with these treatments, and the common complications that can arise. They also explore other contouring methods such as radiofrequency, laser light therapy, and ultrasound, and provide insights into tumescent liposuction as the gold standard for effective body contouring. Tune in to hear expert opinions on the importance of a healthy lifestyle and expectations for cosmetic procedures. Don't forget to like, follow, and leave a review!

00:00 Introduction to Body Contouring
01:11 CoolSculpting: The Popular Non-Invasive Treatment
02:32 Risks and Downsides of CoolSculpting
04:36 Personal Experiences with CoolSculpting
05:53 Alternative Body Contouring Technologies
09:58 Electromagnetic Muscle Toning and Fat Loss
12:42 Exploring Thermage and Ultrasound Therapy
13:23 The Reality of Fat Loss Treatments
13:43 Introduction to Tumescent Liposuction
14:25 Different Types of Liposuction
14:55 Risks and Recovery of Liposuction
16:11 Trends in Liposuction and Fat Transfer
17:25 Complications and Considerations
22:25 Ideal Candidates and Final Thoughts
23:54 Conclusion and Next Episode Teaser

Creators and Guests

Host
Courtney Carroll, LE
Courtney Carroll, LE is a licensed aesthetician with extensive experience performing non-invasive cosmetic treatments and customized skincare.
Host
Dr. Zain Husain, MD
Dr. Zain Husain, MD FAAD FACMS is a dual board-certified dermatologist and Mohs micrographic surgeon with fellowship training in cosmetic dermatology.
Host
Heather Murray, PA-C
Heather Murray, PA-C is a distinguished board-certified and fellowship-trained dermatology physician assistant specializing in medical and cosmetic dermatology.

What is Skinside Out?

Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.

22 Skinside Out
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[00:00:00]

Dr. Zane: Welcome to Skin Side Out where Science Meets Beauty. I'm your host, Dr. Zane with Heather, Courtney, and Crystal. Today we're talking all about body contouring, so let's get right into it.

Crystal: I think this will be an interesting topic with all of the GLP ones, um, you know, coming into play. Mm-hmm. Um, I feel like a lot of these non-invasive technologies were.

You know, before GLP ones. Yeah. Mm-hmm. And so now they've kind of taken over from some of these.

Dr. Zane: Yeah. I mean, honestly, I feel like med spas aren't really [00:01:00] investing in these technologies anymore. And the ones that. Have in the past are just sitting with dust collecting on these devices. So I'm so glad I did not invest in this.

Crystal: Yeah. Um, I think first and foremost, everyone knows CoolSculpting it's probably the most popular, um, you know. Non-invasive body fat treatment that I think everyone's heard of. Um, so CoolSculpting is, um, you know, basically freezing the fat. Um, and it is a procedure where they will take these, um, like planks essentially and place them on abdomen, legs, arms underneath the jaw area, um, and let that sit.

And it freezes so much, um, at such a high temperature that it's essentially freezing the fat without damaging the skin. So, um, it's incredibly painful. Me and Dr. Singh can both vouch for that.

Dr. Zane: Yeah. I almost passed out. They, that massage.

Crystal: Yeah. They will do a massage after [00:02:00] where, um, once the, um, planks come off, they, yeah, they'll massage that whole area.

I think it's like for 10 minutes or something. Mm-hmm. And. It was the most nauseating feeling that I've ever experienced, and I've broken my arm four times. So I feel like that's saying something. Um, and I feel like it didn't do anything, and it also took a long time for me to get like those, like nerve endings, but I don't know if you had that feeling too numbness.

Yeah, the numbness took a long time to wear off, but um, yeah, it, I'm not a huge fan. Yeah.

Heather: I think the. There's still risks too. I mean, there's mm-hmm. Um, the risk of destroying the skin or harming the skin. I've seen that before where it's not quite targeting the fat as well as it should.

Crystal: And the paradoxical mm-hmm.

Um, adipose hyperplasia where you could, yeah. There's been lawsuits on that. Oh, yeah. Where it basically, it's more common than you think. Yeah. And that's where it's. Doing the opposite of what it's intended, where it's creating more fat. So, um, you know, [00:03:00] obviously no one wants that, who's a model

Dr. Zane: that had it like last year.

Like, and she really went on social and letting people know, oh,

Crystal: I didn't, I didn't know who she was. Yeah, yeah, because she, she did the jaw area. Yeah. And she said she had like the fattening effect too. Yeah.

Heather: Yeah. And it's like, I mean. It's not covered by insurance. It's obviously cosmetic. Yeah. And so putting, investing a lot of that money and not really getting the result or even getting a worse result.

Mm-hmm. Yeah.

Dr. Zane: I mean, I think the concept is really cool. Um, Rox Sanderson, who's a rock star in the dermatology world, you know, he's the father of many of the lasers that we have today. Um, he thought of this concept of freezing fat and using it for aesthetic applications for body contouring. So in theory, um, it's a pretty cool concept.

Mm-hmm. However, in practice I find that the results are disappointing. Um, you really have to be selective about the right patient. And even so with that. Minimal result. So [00:04:00] I really do think that, you know, for something that costs thousands of dollars, multiple cycles mm-hmm. And you also have to make sure that you keep up with your nutrition.

You can't be like eating like, you know, like crap all the time and expecting for those results to last. So, um, I just feel like it's a, it's a waste of money.

Crystal: Yeah. I a hundred percent agree. Mm-hmm. Um, I did not see. I think any difference, um, and I know you are supposed to have a few sessions, but I think the pain was so unbearable for me that I could not stomach another session.

Mm-hmm.

Dr. Zane: And I will totally agree with you. That was one of the most painful experiences I've had. But that's not the norm. Yeah. There's a lot of patients who have absolutely no pain with this procedure. Um, but I just don't think it's effective.

Crystal: Yeah. And there can be some, you know. Candidates that are not, you know, people who have like the cold urticaria were, you know, 'cause it is freezing that area.

So if you're having, um, like hives essentially from, you know, coldness, you definitely wanna do it. People who have like ray nods, I'm sure you [00:05:00] know, certain conditions that I think would probably disqualify people from being an ideal candidate

Dr. Zane: and if they ever had like other surgical procedures mm-hmm.

Their scar tissue scar. Yeah. Um, prior liposuction too, like that's not normal skin anymore. So you have to be careful about that.

Crystal: Yeah.

Dr. Zane: Um, so I guess we're all pretty unanimous. I mean, crystal, what are, have you experienced CoolSculpting on it? I

Crystal: haven't, and I don't like the way it looks. It looks super painful.

Hmm. I'm good.

Dr. Zane: Yeah. At your former med spa, did you guys offer that?

Crystal: We did. Um, but there were so many complaints and issues that they actually got rid of it altogether. Mm-hmm. Yeah, at my previous practice, they got rid of it. In fact, that's why, why I got my plan, they were free. Mm-hmm. Um, and we were actually like trying to get people in to do it and we couldn't get anyone.

Wow. So it lost a lot of money on it.

Dr. Zane: So Cryolipolysis obviously is probably one of the most well-known [00:06:00] treatments for body contouring. But there are a lot of other technologies on the market now. Um, and. Like CoolSculpting, I don't think that they're great. There are no slam dunks. So we're looking at devices that use laser light therapy that use radiofrequency ultrasound, and I feel like, you know, you can get some good results.

They're not. You know, very long lasting. And we may actually see, you know, patients who, you know, after a couple years with an aging process. I mean, it's really not working as effective anymore. Um, because, you know, we're hoping that that collagen production and. That fat loss will be the same, but we're also aging at the same time.

Crystal: Yeah. And I think they've been marketed for so long as truly like to treat fat, but in my experience I find it more to be that it really is like a body contouring treatment. Like you're not gonna have someone who [00:07:00] has too high of A BMI come in and treat them. Um, the candidates for a lot of these procedures, you really have to meet certain qualifications and.

Again, it's not gonna be this overnight change. It's usually very subtle and very, um, you know, particular, I guess, yeah,

Heather: it's best for if you just have like a little bit of like a love handle that you wanna, or like a little muffin topic you wanna try to minimize. Like

Crystal: me, I'm pretty, I'm pretty thin. Um, and I've done it before and, um, I feel like it just.

Almost gave the effect of losing a little bit of water weight, but nothing had really changed. Mm-hmm. Mm-hmm. And um, every time you go back, they are, they measure you. And they would half measured me, like in the beginning they did it really? Like really loose? Loose. Yeah. And then they got really tight each time.

Ah, shady. Yeah. Yeah, exactly. [00:08:00] Wow. And I did several treatments, so no change. Hmm.

Dr. Zane: I mean there are some, you know, technologies that do have some merit though. Um, I mean, I feel like, like Courtney was saying though, it's more body contouring than fat reduction. Mm-hmm. Um, and I know that, you know, some people, um, you know, are doing localized injections of Kybella mm-hmm.

The oxy colic acid for targeted areas and have had success. But I think it's for really small areas.

Joe Woolworth: Mm-hmm.

Dr. Zane: And you know, like the other treatments, it may take multiple treatments and minimal results sometimes.

Crystal: Yeah. Well, and it's important to keep in mind, a lot of these are treating the subcu subcutaneous fat and not like that deeper fat.

Mm-hmm. So, again, if you're not. Living like a healthy lifestyle. You have that visceral fat, like around your organs, and that's not gonna treat that. That's, you know, coming from exercise, eating well, um, those types of, you know. Method, so. Mm-hmm. It really isn't, again, like the targeted obesity, you know, treatment.

And [00:09:00] I think sometimes people mistaken fat for loose skin.

Dr. Zane: Mm-hmm.

Crystal: Like it'll give the appearance that it's fat, but they just need some skin tightening. Yeah. Mm-hmm.

Dr. Zane: And that's what we're seeing with a lot with these GLP one patients. Mm-hmm. They have lost a tremendous amount of fat weight. Now they're skin sagging.

Joe Woolworth: Mm-hmm. Mm-hmm. So they

Dr. Zane: come to us for, you know, improving the skin quality by using technology to tighten the skin and induce collagen synthesis.

Crystal: Yeah. I think expectations are incredibly important to set beforehand because you're spending so much money on those and, um, you know, there's a lot of shady practices out there and, oh, just do this, it works, and

Joe Woolworth: mm-hmm.

Crystal: You know, and like Crystal said, I mean, they'll kind of make you, you know, the pictures are a little different. Mm-hmm. Each, the shadowing the light. I know it, they kind of, um, I don't know. You just need another one. You just need two more. Yeah. Yeah. Okay. Maybe, maybe more. Here's my wallet. Yeah.

Dr. Zane: Um, another.

Technology and [00:10:00] concept is the electromagnetic, um, radiation, um, for muscle contraction and toning. Mm-hmm. Um, as well as fat loss. Um, so sculp is, you know, the name of that device. And, you know, I think patients were really excited about it because, hey, I can get muscle toning and strengthening without having to do any exercise.

I just, you know, get hooked up to this machine and simultaneously lose fat. So. I don't think it's really played out that way in, you know, the real world. Um, and I think patients were disappointed, um, but I think clever marketing, um, but.

Crystal: It's like that shake weight. Do you guys remember the shake weight or like, oh yeah.

You just like hold it and it's like

Courtney: doing the work for you. What about those like the belt machines? Like belt and then they like, they give you like little top, to

Crystal: be honest, that how, how the em sculptors very used Miller

Heather: to that. Um, but it's so frustrating. I just think. [00:11:00] Us every, everybody in America is just so lazy, like just word out America's gonna come for you.

I know. It's so frustrating though because yes, we have all these great technologies and everything and I mean, it might get you a little bit of a sculpt. But it's not that hard to work out. I'll

Crystal: counter you, Heather, and I'll say, I'll play devil's advocate. Yeah, I think time. I think for a lot of people too, I think time is hard.

I think people are trying to find shortcuts. People who, yeah, maybe have kids, people who work long hours, and so I think, but if you're also

Heather: spending the time doing this.

Crystal: Yeah. Yeah. Well maybe they're doing the shake weight, you know, while they're, while they're walking their kid. Yeah, yeah.

Heather: At work. Yeah.

Yeah. At the playground.

Dr. Zane: I agree. Everyone's looking for a fast solution, quick fix. Um, and unfortunately, there's really nothing besides doing hard work. Yeah. [00:12:00] Tried and

Crystal: true. Yeah. And sometimes the people that are offering these services. Aren't even qualified or know what they're doing. I've personally been somewhere where they've done so and burned people 'cause they didn't put enough lubricant on there, you know, and,

Dr. Zane: and people think that these are, you know, risk-free non-invasive procedures.

But yeah, things can go wrong with any procedure. Yeah.

Crystal: Yeah. I had a rash after my CoolSculpting, like I had like a Hy-Vee kind of like reaction, um, that, I mean, it only lasted a day or two, but. Even then, they're like, what do we do? I'm like, well, I'm just gonna throw some steroid on. I actually, I actually scabbed up.

I got burnt. Yeah, I

Heather: heard that too. Yeah. Yeah. There are some lawsuits too. Yeah, it's crazy.

Crystal: I do. Um, we used to use Thermage, um, which is the, um, ultrasound therapy. But we used it more for skin tightening rather than like a true fat loss. Um. And it had some okay responses, but again, the pain, um, we would give [00:13:00] people like a Percocet before they did it.

Or like a what, like a Ativan? Yeah. Which she

Heather: feels more painful that the cold skull.

Crystal: I've never had Thermage. Oh, you haven't. But from every person I've ever talked to. That's done it. That's one paper. Yeah. They say it hurts. Um, so I don't know. And it's different. 'cause I guess mostly you're treating the face.

Mm-hmm.

Dr. Zane: Um, all therapy is also kind of like that too. Mm-hmm.

Crystal: Yeah. Yeah.

Dr. Zane: Um, so I guess the consensus is that these fat loss treatments really don't work. These devices aren't, um, as effective as they claim to be. And you'd be better off. Saving your money, maybe hitting the gym. But the other alternative is an invasive procedure, um, tumescent liposuction.

Mm-hmm. So let's get into that. So tumescent liposuction is considered the gold standard for body contouring. It's been around for decades. And interestingly, um, a dermatologist, Jeffrey Klein, um, had introduced tumescent. [00:14:00] Liposuction, which made it a lot more comfortable and safer for patients. So what it is, is we use a dilute, um, anesthetic that we inject into the skin, and that helps to not only numb the area, but it also like, kind of separates the layers of the skin and the fat so that it's easier for us to remove.

Um, fat, um, in an effective manner. Um, there's different flavors of liposuction. There's traditional liposuction. There is power assisted liposuction. There is laser assisted liposuction and some are paired with radio frequency energy. So there are variety of different options available, but the concept is the same.

We're targeting. Areas of fat and we're literally going to town and removing large quantities of fat.

Crystal: Mm-hmm. Yeah, I mean, the nice thing is definitely, I think, more noticeable results. Mm-hmm. Obviously, um, of course there is gonna be a longer recovery because it is invasive. [00:15:00] Um, and with that comes its own risk, just like any invasive procedure, you know, risk of infection.

Mm-hmm. Risk of, you know, um. Adverse events, I guess. But that's why, you know, of course you wanna go to someone who knows what they're doing.

Heather: Yeah. More successful results, but also faster results too, I think. Yeah.

Dr. Zane: But you do have to realize like it's not, you know, complication free.

Joe Woolworth: Mm-hmm.

Dr. Zane: Um, there's a lot of bruising involved.

Um, there is some discomfort after there's a lot of swelling. And, um, you do have to be compliant after the procedure. You have to wear those compression garments. That is huge. Patients hate it. Mm-hmm. But it is a must for getting like a really smooth contours afterwards. You don't wanna be lumpy, bumpy mm-hmm.

Afterwards. And, um, you know, just making sure that you're also staying consistent with a well-balanced diet, um, and you're exercising, things like that.

Crystal: Yeah. I, I had a patient that, um, she had gotten. Done about three separate [00:16:00] times and it's 'cause she just thinks it's like a quick fix and it'll remain that way and doesn't change her eating habits.

So the weight just comes back on rather quickly. Yeah.

Dr. Zane: Yeah. I think, um, what's been really, um, trending in the media is like that 3D lipo sculpture, um, the vaser, getting those really high definition, um, you know, results and like the etching. Um, and I feel like. Although they look great, like immediately after, like for a year or two, um, they're kind of etching the subcutaneous tissue, so that's leaving pockets of fat.

So you kind of see them that look like ab Yeah. Yeah. Oh,

Crystal: they said Drake got that. Yeah. They accused Drake of getting that.

Dr. Zane: And

Crystal: that, I mean, it looks, I believe that it looks like as nice. Yeah, let's get a photo. It does look nice. No, but

Dr. Zane: what happens? What happens later on when you gain weight and like, or like, you know, you're aging and your skin's also not the same.

Like it's gonna be all [00:17:00] funky.

Joe Woolworth: Oh my gosh. I'm literal, legit. Gonna get a

Dr. Zane: cheese

Crystal: and desist. But it's true. I mean, it's true. Um, and. Like, I think more and more men are doing this. I mean, women have been doing this for a long ti, you know, just all of the body contouring and, but I think, yeah, as more men are doing this, they've kind of catered these treatments more towards them and um, yeah, it does make you think about And like bodybuilders.

Yeah. The bo Yeah. Interesting. Um, I do feel like in some instances you could, like, it's like the last result, you know, like they'll exercise and they'll have a good diet and just they can't get rid of that fat. Yeah, yeah, yeah.

Dr. Zane: No, I'm not hating that. I think liposuction is a phenomenal procedure. You can transform lives.

Mm-hmm. Um, in the right hands you can get beautiful results. Um, but you know, some of the trends that we're seeing now, I mean, I just don't know what these people are gonna look like in five, 10 years. Um, you know, yeah. Also like leaving, you know, areas of fat mm-hmm. Just for the [00:18:00] illusion of having high definition, but,

Crystal: and the dad bot is in.

I love a dad. But

Dr. Zane: tell that to though.

Crystal: Yeah, it's, um, I don't know. I will like never wanna be like the first one that tries anything. You know? It's like, I don't know. It's so risky. Um, you see some of these complications and. Yeah.

Courtney: Well, I mean, liposuction has been around for decades. I would do lipo and a heartbeat,

Crystal: but I don't need all the fake abs, you know?

Yeah. Just get it out like,

Dr. Zane: um, and then, you know, like other complications you can get, like you can be too aggressive with your lipo and lose fat and it looks really weird. You almost get like a skeleton and like, it's like rippled and weird. Oh. 'cause

Crystal: like, you know, it's kind of like an arm workout right?

When you're, I don't know if any like. I've watched videos of the lipo and I think it is before I ever saw the videos, I had this like image in my head and then I was like, oh my God, I don't, oh, I would, [00:19:00]

Dr. Zane: when I was in fellowship and in practice, like when I was doing those cases, like I was like literally dying, like my arms were like literally it is a workout.

Yeah. Because you're going back and forth. Yeah, and moving in different, you know, vectors and you know, we have to just keep going until we get enough of the fat and making sure that it's all even. It is a workout, like yeah, you definitely have to be in shape to be

Crystal: Yeah. You don't want, um, a fat surgeon. It doesn't work out.

Gives up halfway through.

Dr. Zane: Yeah. Wouldn't that be ironic? A fat surgeon would?

Heather: Yeah. Yeah. Could you use liposuction to like, if somebody wanted like wider hips, if they have like fat Yeah. That transfer if there, yeah. Yeah, just so basically

Dr. Zane: what you can do is with the fat that you're taking out with liposuction, you essentially like filter it and process it so that it's actually an injectable that you can transfer and inject into other areas.

So you can do it on the [00:20:00] face, you know, the buttock area, you can do it on the hips. Some people are doing the breasts. So

Heather: yeah,

Dr. Zane: this is a way that you can actually use what you're actually sucking out and repurpose it.

Heather: I've seen fat transfers for like, um. Under eyes. Mm-hmm. Um, but I know that if it's placed to superficially, you can really tell.

Yeah. Can it move? Like if you were to do it in the hips, is there a possibility? It could. I think a poss but the

Dr. Zane: thing that I've seen with other patients who've had, um, fat transfer is that you're transferring a biological tissue. It has metabolism, right? And in a different area. So it's not necessarily gonna behave the same way in other areas.

And I had this one lady who got fat transfer from over the sea and she started developing these inflammatory nodules wherever it was injected. So she looked awful. And she had that for months and months and months. And you couldn't do anything about it. 'cause in skin, her skin now.

Joe Woolworth: Mm-hmm.

Dr. Zane: So, and it [00:21:00] was just kind of, you know, behaving differently than other places.

She had an objective

Crystal: right. Is that kind of like, so I've seen, um, some women that they have really nice bun buns after getting liposuction and the fat transfer, but then I've also, but then I've also seen those that their butt looks so lumpy. Yeah. That's also part of it like, like it looks like their entire butt is just covered in cellulite.

Yeah.

Dr. Zane: Yeah. So I mean, I think that if they had like fat transfer to the buttock area. Like, it certainly can be uneven. Okay. Um,

Heather: is it a depth thing too? Like, I think

Dr. Zane: so, yeah. I think depth, um, surgical technique.

Joe Woolworth: Mm-hmm.

Dr. Zane: Um, also the inherent biological like characteristics of the fat. Mm-hmm. And you know, it may not be even on one side versus the other.

Um, so I'm always a little wary about it, but I mean, I like the idea you're using your own fat. Yeah. Right. Um, [00:22:00] and it's natural.

Heather: Yeah. How long is a procedure typically for liposuction?

Dr. Zane: It depends on the area, right? So we're using liposuction in a variety of different areas. So it could be, you know, an area like small, like the submental area under, you know, the chin, the double chin, um, or large areas like abdomen, um, eyes, AOC area.

So it really depends on how big the case is.

Crystal: And there's also ideal candidates for lipo as well. Mm-hmm. Which I think is worth mentioning, I think, you know. Mm-hmm. You don't, you're not gonna take a case where someone is like obese. Um, you know, you obviously wanna get down to a reasonable weight. Um, 'cause that itself will hold its own complications.

Dr. Zane: Yeah. I think there's a role like for, you know, morbidly obese patients to seek some intervention either like doing like bariatric surgery Yeah. Mm-hmm. Or, you know, going on those GLP ones mm-hmm. Losing enough weight. Mm-hmm. Where, you know, it's still. [00:23:00] Sustainable for them. But if they need a little help, I mean, I think that's where the liposuction

Crystal: can come in.

Yeah. Mm-hmm.

Dr. Zane: Any other questions or thoughts on lipo?

Crystal: It's definitely more, um, you know, adherence. Patients really need to adhere more to that procedure, but obviously I think the results are. Phenomenal. Mm-hmm. Um, when done correctly and when Yeah. The patients are able to stick to their part of the, you know, treatment.

Heather: Yeah. And like the commitment to, um, recovery. Mm-hmm. And just knowing, especially with the liposuction, liposuction, there's gonna be more downtime, more healing process. Um, so kind of depends on how much you're willing to Yeah. You know, take off. Work or your daily life to heal or go

Crystal: to work looking crazy.

Heather: Yeah.

Dr. Zane: All right. So body contouring definitely is a hot topic in cosmetic [00:24:00] dermatology. It is an option that people can definitely look into, but remember, um, seeking the advice of a cosmetic. Physician who is well versed in this can give you the best guidance. You know, like we had all discussed, I don't think like the non-invasive, you know, procedures really help most patients.

So I'd be weary about those kind of treatments. I do think that there is a role for liposuction and good candidates. Nothing really beats having a healthy lifestyle. And there is no substitute for good old exercise, good nutrition. And we'll talk about that in our next episode of how, um, a healthy lifestyle can influence our skin.

Um, but I think that wraps up our episode. Hopefully you enjoyed our discussion. Please like, follow, leave us a review. But until next time.

Skin side. Out. Out.

[00:25:00]