I've lost 7 pounds since June, probably from exercising more and eating a little less. Yet despite the fact that I'm at a healthy body weight, I've got a little stomach pouch right under my belly button that runs the length of my lower abdomen—a permanent remnant of my three pregnancies. While I'd love to have a tummy tuck like other moms I know, I don't want to undergo the risks and pain of surgery for something cosmetic. So I was excited to hear about two new body-contouring options that don't involve incisions and got approved by the Food and Drug Administration this week. The first, called CoolSculpting, freezes away fat cells, and the second, called Zerona, uses a laser to zap fat; both work above the skin.
"The best candidates are those who aren't significantly overweight but have some localized areas of fat that they'd like to get rid of on the abdomen, hips, or thighs," says Boston dermatologist Jeffrey Dover, chair of the scientific advisory board of Zeltiq, the company that makes CoolSculpting. He tells me some of his best results are in women like me who eat nutritiously and exercise but have a stubborn bulge of fat left over from previous pregnancies. The procedure involves sitting in a chair (no anesthesia necessary) while a technician applies a cooling suction device to the target area of fat; the cold temperature—above freezing—destroys fat cells while causing a numbing sensation. Results take two to four months to appear, and some people experience redness, mild pain, and bruising for a few days afterward. Each $700 treatment round takes about an hour, and most areas require two treatments to get a 20 percent reduction in fat, Dover says. So my belly pouch would set me back $1,400, while love handles or thigh reduction, which both require a separate treatment for each side, would cost $2,800.
Zerona, on the other hand, employs a laser to shrink fat cells, and costs about $1,500 to $1,700 for a package of six purportedly painless treatments performed over two weeks in a doctor's office. Each treatment takes roughly 40 minutes. Liposuction costs $4,000 on average, and a tummy tuck costs $5,000 to $9,000. Unlike CoolSculpting, Zerona has "absolutely no side effects, no allergic reactions, bruising, anything," says Steve Shanks, president of Erchnoia, Zerona's manufacturer. The company's clinical trial for FDA approval found that the procedure removed about 1 to 1.5 inches from each area treated including waist, hips, and thighs. (Neither device has been tested on other areas like the neck or upper arms.)
So, which one works better? That's tough to say, since one company measures inches of fat lost while the other measures the percentage of fat lost—and both argue that their measurement method is superior. What's more, each company submitted data on fewer than 75 patients, so it's hard to know if their results apply to everyone with love handles and pouches. It's also impossible to say how long results will last, since the trials followed patients for less than a year.
"FDA approval means the data collection is only beginning; we don't really know how effective either of these two procedures will be in clinical practice," says plastic surgeon Felmont Eaves, president of the American Society for Aesthetic Plastic Surgery. "These devices certainly are not as aggressive as liposuction and are really meant for small, isolated areas." In other words, they probably won't be making an appearance on the reality show Extreme Makeover anytime soon. Eaves says he worries that some physicians—driven by dollar signs—will open a body sculpting practice without knowing how to truly use these devices. "We could see a huge wild west of practitioners running in to stake their claims," he adds.
That isn't going to happen with CoolSculpting, says Gordie Nye, chief executive officer of Zeltiq. He insists his company only sells its machine to "selected board-certified aesthetic dermatologists and plastic surgeons" who have "expertise in judging the suitability of our treatment as it relates to each and every patient." Nye says the cooling device, which has so far been sold to slightly more than 100 U.S. medical practices, isn't as dramatic as liposuction and is only meant for discreet bulges of exercise-resistant fat.
The good news, says Jeff Kenkel, vice chair of the department of surgery at the University of Texas Southwestern Medical Center in Dallas: "We've got two new nonsurgical devices on the market, which is great for patients. But I think this is just the beginning; we're going to see a lot more devices come on the market in the next few years." Even though he's had success with Zerona in his practice, he says certain patients will get much better results from surgery—those with large bellies and loose skin, for example. (He takes no money from either device manufacturer.) Moreover, no procedure will produce permanent results if it's not accompanied by a sensible diet and exercise. "How well a patient embraces lifestyle changes," he says, "is critical to the success of a technique, surgical or not."
Corrected on 9/20/10: A previous version of this piece incorrectly identified the American Society for Aesthetic Plastic Surgery.