Body contouring for fat and muscle in aesthetics: Review and debate


      The recent demand for noninvasive fat reduction and muscle toning has generated the need for a variety of noninvasive body contouring devices, including cryolipolysis, radiofrequency, focused ultrasound, laser energy, and high intensity focused electromagnetic energy. Many of the recent technologies are still relatively new, and clinical trials are limited. There is also a lack of comparison between modalities, which makes it difficult for practitioners to select the best treatment option for patients. We review the currently available treatment modalities and offer relevant insights.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kruger J
        • Lee CD
        • Ainsworth BE
        • Macera CA.
        Body size satisfaction and physical activity levels among men and women.
        Obesity (Silver Spring). 2008; 16: 1976-1979
        • Al Dujaili Z
        • Karcher C
        • Henry M
        • Sadick N
        Fat reduction: pathophysiology and treatment strategies.
        J Am Acad Dermatol. 2018; 79: 183-195
        • Matarasso A
        • Swift RW
        • Rankin M.
        Abdominoplasty and abdominal contour surgery: a national plastic surgery survey.
        Plast Reconstr Surg. 2006; 117: 1797-1808
        • Jalian HR
        • Avram MM.
        Body contouring: the skinny on noninvasive fat removal.
        Semin Cutan Med Surg. 2012; 31: 121-125
        • Epstein Jr, EH
        • Oren ME
        Popsicle panniculitis.
        N Engl J Med. 1970; 282: 966-967
        • Beacham BE
        • Cooper PH
        • Buchanan CS
        • Weary PE.
        Equestrian cold panniculitis in women.
        Arch Dermatol. 1980; 116: 1025-1027
        • Manstein D
        • Laubach H
        • Watanabe K
        • Farinelli W
        • Zurakowski D
        • Anderson RR.
        Selective cryolysis: a novel method of non-invasive fat removal.
        Lasers Surg Med. 2008; 40: 595-604
        • Klein KB
        • Zelickson B
        • Riopelle JG
        • et al.
        Non-invasive cryolipolysis for subcutaneous fat reduction does not affect serum lipid levels or liver function tests.
        Lasers Surg Med. 2009; 41: 785-790
        • Avram MM
        • Harry RS.
        Cryolipolysis for subcutaneous fat layer reduction.
        Lasers Surg Med. 2009; 41: 703-708
        • Dierickx CC
        • Mazer JM
        • Sand M
        • Koenig S
        • Arigon V.
        Safety, tolerance, and patient satisfaction with noninvasive cryolipolysis.
        Dermatol Surg. 2013; 39: 1209-1216
        • Stevens WG
        • Pietrzak LK
        • Spring MA
        Broad overview of a clinical and commercial experience with CoolSculpting.
        Aesthet Surg J. 2013; 33: 835-846
        • Ho D
        • Jagdeo J.
        A systematic review of paradoxical adipose hyperplasia (PAH) post-cryolipolysis.
        J Drugs Dermatol. 2017; 16: 62-67
        • Krueger N
        • Mai SV
        • Luebberding S
        • Sadick NS.
        Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction.
        Clin Cosmet Investig Dermatol. 2014; 7: 201-205
        • Morton L
        • Weiss RA.
        Radiofrequency treatment: fat reduction.
        in: Orringer J Dover J Alam M Body Shaping, Skin Fat and Cellulite E-Book: Procedures in Cosmetic Dermatology Series. Elsevier Health Sciences, New York2014: 51
        • Dierickx CC.
        The role of deep heating for noninvasive skin rejuvenation.
        Lasers Surg Med. 2006; 38: 799-807
        • Carruthers J
        • Fabi S
        • Weiss R.
        Monopolar radiofrequency for skin tightening: our experience and a review of the literature.
        Dermatol Surg. 2014; 40: S168-S173
        • Weiss RA.
        Noninvasive radio frequency for skin tightening and body contouring.
        Semin Cutan Med Surg. 2013; 32: 9-17
        • Franco W
        • Kothare A
        • Ronan SJ
        • Grekin RC
        • McCalmont TH.
        Hyperthermic injury to adipocyte cells by selective heating of subcutaneous fat with a novel radiofrequency device: feasibility studies.
        Lasers Surg Med. 2010; 42: 361-370
        • Hantash BM
        • Ubeid AA
        • Chang H
        • Kafi R
        • Renton B.
        Bipolar fractional radiofrequency treatment induces neoelastogenesis and neocollagenesis.
        Lasers Surg Med. 2009; 41: 1-9
        • Beasley K
        • Weiss R
        • Weiss M.
        Dynamic monopolar reduction of arm fat by duplex ultrasound imaging and 3D imaging.
        Lasers Surg Med. 2013; 45: 20-21
        • Weiss R
        • Weiss M
        • Beasley K
        • Vrba J
        • Bernardy J.
        Operator independent focused high frequency ISM band for fat reduction: porcine model.
        Lasers Surg Med. 2013; 45: 235-239
        • Beasley KL
        • Weiss RA.
        Radiofrequency in cosmetic dermatology.
        Dermatol Clin. 2014; 32: 79-90
        • Nassab R.
        The evidence behind noninvasive body contouring devices.
        Aesthet Surg J. 2015; 35: 279-293
        • Brown SA
        • Greenbaum L
        • Shtukmaster S
        • Zadok Y
        • Ben-Ezra S
        • Kushkuley L.
        Characterization of nonthermal focused ultrasound for noninvasive selective fat cell disruption (lysis): technical and preclinical assessment.
        Plast Reconstr Surg. 2009; 124: 92-101
        • Moreno-Moraga J
        • Valero-Altés T
        • Riquelme AM
        • Isarria-Marcosy MI
        • de la Torre JR.
        Body contouring by non-invasive transdermal focused ultrasound.
        Lasers Surg Med. 2007; 39: 315-323
        • Schilling L
        • Saedi N
        • Weiss R.
        1060 nm Diode hyperthermic laser lipolysis: the latest in non-invasive body contouring.
        J Drugs Dermatol. 2017; 16: 48-52
        • Chilukuri S
        • Mueller G.
        Hands-free” noninvasive body contouring devices: review of effectiveness and patient satisfaction.
        J Drugs Dermatol. 2016; 15: 1402-1406
        • Decorato JW
        • Chen B
        • Sierra R.
        Subcutaneous adipose tissue response to a non-invasive hyperthermic treatment using a 1,060 nm laser.
        Lasers Surg Med. 2017; 49: 480-489
        • Katz B
        • Doherty S.
        A multicenter study of the safety and efficacy of a non-invasive 1060nm diode laser for fat reduction of the flanks.
        Lasers Surg Med. 2015; 47: 378-379
        • Bass L
        • Doherty S.
        Non-invasive fat reduction of the abdomen: a multicenter study with a 1060nm diode laser.
        Lasers Surg Med. 2015; : 47
        • Katz B
        • Bass L
        • Doherty S.
        Objective evaluation of a non-invasive fat reduction with a 1060nm diode laser for treatment of the thighs and back.
        Lasers Surg Med. 2016; : 48
        • Decorato J
        • Sierra R
        • Chen B.
        Clinical evaluations of a 1060nm laser device for non-invasive fat reduction as compared to cryolipolysis.
        Lasers Surg Med. 2014; 46: 19-20
        • Chen B
        • Sierra R
        • Katz B
        • Doherty ST
        • Bass L.
        Objective evaluation of fat reduction treatment with a non-invasive 1060nm diode laser.
        Lasers Surg Med. 2015; 47: 5-6
        • Weiss R
        • McDaniel D
        • Doherty S
        • et al.
        Clinical evaluation of fat reduction treatment of the flanks and abdomen with a non-invasive 1060nm diode laser: a multicenter study.
        Lasers Surg Med. 2016; 48: 18-19
        • Katz B
        • Doherty S.
        Safety and efficacy of a noninvasive 1,060-nm diode laser for fat reduction of the flanks.
        Dermatol Surg. 2018; 44: 388-396
        • Duncan D
        • Dinev I.
        Noninvasive induction of muscle fiber hypertrophy and hyperplasia: effects of high-intensity focused electromagnetic field evaluated in an in-vivo porcine model: a pilot study.
        Aesthet Surg J. 2020; 40: 568-574
        • Weiss RA
        • Bernardy J.
        Induction of fat apoptosis by a non-thermal device: mechanism of action of non-invasive high-intensity electromagnetic technology in a porcine model.
        Lasers Surg Med. 2019; 51: 47-53
        • Jacob CI
        • Paskova K.
        Safety and efficacy of a novel high-intensity focused electromagnetic technology device for noninvasive abdominal body shaping.
        J Cosmet Dermatol. 2018; 17: 783-787
        • Kinney BM
        • Kent DE.
        MRI and CT assessment of abdominal tissue composition in patients after high-intensity focused electromagnetic therapy treatments: one-year follow-up.
        Aesthet Surg J. 2020; 40 (NP686-NP693)
        • Samuels JB
        • Pezzella A
        • Berenholz J
        • Alinsod R.
        Safety and efficacy of a non-invasive high-intensity focused electromagnetic field (HIFEM) device for treatment of urinary incontinence and enhancement of quality of life.
        Lasers Surg Med. 2019; 51: 760-766