Emmy M. Graber

Guest Editor for the following articles:

Vol. 28. No. 4

Overview of Ultrasound-Assisted Liposuction, and Body Contouring With Cellulite Reduction

Neil S. Sadick, MD, FAAD, FAACS, FACP, FACPh

Body contouring is a rapidly growing sector of esthetic procedures and dermatologic
surgery. Currently, liposuction is one of the most popular cosmetic procedures with
considerable research being conducted into devices that would facilitate fat emulsification.
The advent of ultrasound-assisted liposuction presented physicians with a great tool in
approaching more superficial as well as fibrous adipose irregularities. Additionally, our
increasing understanding of laser, light, and radiofrequency interaction with adipose tissue
is allowing for these energy sources to be used noninvasively to improve body contours.
This article will provide an overview of the vibration amplification of sound energy at
resonance third-generation ultrasound device for liposuction as well as the VelaShape
platform for noninvasive adipose and cellulite reduction. As body contouring technology
and coinciding experience grow, so will the ability to achieve the aims of more efficient,
safer, and cosmetically pleasing body sculpting.
Semin Cutan Med Surg 28:250-256 © 2009 Elsevier Inc. All rights reserved

Vol. 28. No. 4

High-Intensity Focused Ultrasound Effectively Reduces Adipose Tissue

Afschin Fatemi, MD

Liposonix is considered to be a nonsurgical treatment for body contouring that uses
high-intensity focused ultrasound (HIFU) to disrupt adipocytes percutaneously. We wanted
to find out about its efficacy, effectiveness, and so forth. The technique delivers energy
across the skin surface at a relatively low intensity, but brings this energy to a sharp focus
in the subcutaneous fat. At the skin surface, the intensity of the ultrasound energy is low
enough so that no damage occurs. The focusing of the ultrasound beam at specific depths
beneath the epidermis, combined with proprietary application techniques, results in adipose
tissue disruption. Once adipocytes have been disrupted, chemotactic signals activate
the body’s inflammatory response mechanisms. Macrophage cells are attracted to the area
to engulf and transport the lipids and cell debris. This results in an overall reduction in local
adipose tissue volume. Our clinical and histologic studies will show exactly what happens
under the skin. We did a series of studies on gross pathology and histology, and we tried
to correlate these with the clinical results. The histologies show clearly that adipocytes are
disrupted by HIFU. The pathologies show the lesions, but they are always at a safe distance
from dermis or the epidermis. The correlation between focal depth, energy levels, and
clinical results is evident. The average circumference reduction after treatment of the
abdomen and waist is 4-5 cm. Liposonix turns out to be a safe and effective technique for
nonsurgical body sculpting by reduction of fat deposits.
Semin Cutan Med Surg 28:257-262 © 2009 Elsevier Inc. All rights reserved.

Vol. 35. No. 2

Over-the-counter treatments for acne and rosacea

Lorraine Larsen Rosamilia, MD

Acne and rosacea are common inflammatory processes historically classified in the same disease category, but evolving understanding of their disparate pathophysiology and exacerbating factors have generated an enormous armamentarium of therapeutic possibilities. Patients seek over-the-counter therapies first when managing cutaneous disease; therefore, this review defines ingredients considered to be effective over-the-counter acne and rosacea products, their mechanisms, and safe formulations, including botanical components, oral supplements, and other anecdotal options in this vast skin care domain.

Semin Cutan Med Surg 35:87-95 © 2016 Frontline Medical Communications

Vol. 28. No. 4

Non-Invasive, External Ultrasonic Lipolysis

Arie Benchetrit, MD, FRCS(C) | Kyle M. Coleman, MD | William P. Coleman, III, MD

Numerous nonsurgical techniques and devices have sought to reproduce the effectiveness
of liposuction. Unfortunately, the vast majority of these has fallen short of adequate results
or has been plagued with complications. UltraShape (UltraShape; Yoqneam, Israel) is a
device that is able to accomplish the reduction of the subcutaneous fat with a procedure
that is both comfortable and leads to good patient satisfaction. Its design of a nonthermal
ultrasonic energy is able to produce cavitation leading to fat cell lysis while sparing
adjacent blood vessels and nerves. Although the results are not equivalent to surgical
results, this device will offer a safe and effective alternative for patients who are apprehensive
about undergoing liposuction.
Semin Cutan Med Surg 28:263-267 © 2009 Elsevier Inc. All rights reserved.

Vol. 35. No. 2

Physical modalities for treating acne and rosacea

H Ray Jalian, MD | Molly Wanner, MD | Yakir Levin, MD, PhD

Physical modalities provide an important adjunct to medical treatment of acne and rosacea. In patients who cannot tolerate or fail medical treatments, physical modalities offer an alternative approach. For cases of acne scarring, phymatous changes of rosacea, and rosacea-associated telangiectasia, physical modalities such as laser and light treatments represent the treatment of choice. We will review the use of laser and light treatments, photodynamic therapy, and other physical modalities such as targeted therapies for the treatment of acne and rosacea.

Semin Cutan Med Surg 35:96-102 © 2016 Frontline Medical Communications