Fat Reduction with Cryolipolysis and HIFU


Understanding how fat is deposited

Fat cells are reciprocals for excess lipids that aren’t needed for immediate energy consumption. There are differences in types of fat cells.  You either have visceral fat around your organs or you have subcutaneous fat that lies below your skin.  This second type of skin is the one that is being targeted by the energy based procedures that we’re talking about in this lecture.


This procedure destroys fat cells through selective cooling of lipid rich tissues.  It’s a non invasive treatment that is FDA approved for fat bulges in the submentum (double chin), thigh, abdomen, flank, and bra fat.    Patients receive a precise energy extraction that injures only a specific fat cells.  This spares skin, nerves and muscles of the patients.  The patients fat cells die due to cold exposure that causes an inflammatory response.  The lipids are then slowly released over time through urination, which can take four to six weeks.



Ideal patients for the procedure according to Dr. Narukar are those with “visable bulges, with noticeable, pinchable fat that can be pulled from the body with a healthy layer of skin.”

This process has been refined over the last five years, and doctors have learned a process called treatment to transformation.  “This means six to eight weeks after the first series of cycles you repeat the treatment again.” Says Dr Narukar,  “It’s not always necessary, but it usually produces the best outcomes.”  Patients will see lower returns after the second treatment and Dr. Narukar recommends just the two treatments. 

Dr Narukar says that there are some promising long term results over the treatments five year lifespan.  Even with modest weight gain after the procedure, patients still see some reduced fatty areas where the procedure was applied.

HIFU (High Intensity Focused Ultrasound)

High intensity focused ultrasound done through actually killing the fat cells through necrosis. FDA cleared for circumferential reduction of abdomen and flanks.   A patients fat cells are worked on in a dual tissue response.  There is a thermal disruption followed by a contraction and thickening of collagen in the mid-lamellar matrix. 



Doctors can apply this treatment through transducers.  They initially were used at very high frequencies, which was very painful to patients.   Patients now receive the treatment with a multi-pass technique at a lower energy level.  With this new technique, patients feel much less pain. It is still less popular than other procedures due to patient discomfort.

The optimal patient for HIFU is someone with a body mass index less than thirty.  Doctors should only apply the treatment to patients with good skin quality, with low excess laxity.  Also important, doctors should apply only to localized areas of adiposity. 

Doctor Narukar has some other practical considerations for practitioners.

DesireJonathan McClung