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For decades there has been a relentless search for effortless weight loss and painless cosmetic surgery. We might call these goals the "holy grail" of plastic surgery. Last year Americans spent over $11 billion on surgical and non-surgical cosmetic procedures and the potential market is likely much, much larger. The only thing that holds many of us back is the effort, pain and recovery typically required to improve/reshape our bodies. Without a doubt, there are tremendous profits to be made by anyone that can produce consistent results with minimal effort, pain and downtime. And wherever there are big profits to be made there will invariably be snake-oil salesmen trying to get a piece of the action. I cannot stress too strongly that it is a "buyer beware" market out there. Remember what your mother always said: "If it sounds too good to be probably is."

With that warning out of the way, let's look at where the search stands today.

I think the hottest area of research right now is the search for a non-invasive technique or technology that will remove fat without the need for surgery or anesthesia. There are several companies currently touting such technologies...and ALL are fiercely competing for our hard-earned dollars with big promises and multi-million dollar marketing campaigns. Let's take a look at a few of them one at a time:

1. Cold lasers: This technology, most prominently marketed as Zerona and Lipo-Light, uses non-invasive low-level laser therapy(LLLT), or "cold laser" therapy, to purportedly disrupt the cell membranes of fat cells, essentially deflating them. Your body then eliminates the fat cell contents. Zerona has been modestly successful marketing their laser technology in conjunction with diet and exercise programs making it difficult to determine the true cause of any positive results.

2. Cryolipolysis: This technology, most widely marketed as Coolsculpting by Zeltiq, uses targeted cooling of the fat tissue, sparing injury to the overlying skin, in an attempt to kill fat cells. This technology, like Zerona, has been FDA approved for fat reduction, but experience to date is mixed. Our understanding is that patient satisfaction rates are in the 40-50% range. At $1000-3000/treatment, the challenge will be how to deal with the 50-60% of patients that are unhappy!

3. Ultrasound: Ultrasonic energy has been used for decades in medicine to treat various maladies such as solid tumors and kidney stones. Now it is being promoted as a way to break up fat cells without injury to the skin. The most promising and exciting technology is a type of focused ultrasonic energy called HIFU, or High Intensity Focused Ultrasound. Early studies seem to indicate modest success in carefully selected patients. While we have not yet committed to this technology, we believe it is exciting and are anxious to see results from second and third generation products.

4. Radiofrequency: While not marketed specifically for fat, I include this technology here because of its prevalence in the aesthetic marketplace. Most popularly known as Thermage, this technology is promoted as a way to tighten loose skin by transferring energy via radiofrequency waves to the deep layers of the skin. As with the other technologies listed above, results to date have been modest at best. I have seen many disappointed patients that have spent thousands on this technology only to end up in our office for a facelift.

So where does this leave us? As disappointing as it sounds, it's not all bad. Future generations of one or more of the technologies listed above may prove to be more promising. Currently, there is no shortage of research going on with all of these and more. Unfortunately the holy grail, though perhaps on the horizon, continues to elude us. So for now I must still warn: "Buyer Beware".

C. Cayce Rumsey III, M.D.

Doctor Rumsey is a founding partner of Ponte Vedra Plastic Surgery and is currently President of the Florida Society of Plastic Surgeons.

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