July 27, 2022
Dr Ivan Puah, Medical Director at Amaris B. Clinic, has been performing modern liposuction and corrective surgeries for patients who have experienced less than satisfactory results from non-surgical treatments and those who suffer from PAH, a rare side effect of cryolipolysis.
SINGAPORE, July 2022 — Advancement in technology has led to the development of many fat reduction treatment options and modalities. Non-invasive treatments, in particular, have become the preferred choice as they are affordable and come with minimal downtime, among others.
One of the most popular and readily available is fat freezing or Cryolipolysis, which operates on the basis that adipocytes, compared to other skin cells, are more susceptible to cooling. An applicator is used on the targeted areas to initiate the apoptosis of the adipocytes, which leads to the digestion of dead cells by the surrounding macrophages. The variety of the applicator's head can be used to suit the needs. Before the treated fat cells are completely digested, an inflammatory process is triggered, and over the course of a few weeks, the adipocyte volume decreases as the inflammation subsides. Two to three months post-treatment, the fat volume in the treated area gradually reduces.
Liposuction, the gold standard for body contouring, has been facing stiff competition due to the rise of non-invasive treatments in the last ten years. In recent years, however, Dr Ivan Puah has seen a dramatic rise in the number of patients who have tried non-invasive fat reduction treatments turning to liposuction, largely due to unsatisfactory results. Data collected by Amaris B. Clinic, where Dr Ivan Puah practises, showed that eight in ten patients had done various types of non-surgical fat loss treatments, including fat freezing.
Another reason could be that more patients suffering from paradoxical adipose hyperplasia (PAH), a rare but permanent side effect of fat freezing, are now more aware of their condition and are actively seeking help to rectify this issue.
Supermodel Linda Evangelista spoke out about her adverse experience with fat freezing in 2020. She developed PAH and according to her, the treatment "permanently deformed and brutally disfigured her", and she had turned to liposuction to treat PAH. According to reports, Ms Evangelista has even filed a lawsuit seeking compensation for damages.
PAH is a condition where fatty tissues on the treated area develop, thicken and expand. This typically develops around three to six months post-treatment. "Patients were told that PAH is rare. However, I am seeing more patients coming forward to seek a second opinion," says Dr Ivan Puah.
Dr Puah observed that patients who suffer from PAH are generally unaware that the cause of the deformity is a result of fat freezing. "When the area continues to grow, causing soreness and swelling resembling the shape of the applicator head, only then do they realise it is unusual and decide to seek help. Once PAH develops, the condition is unfortunately permanent and will require surgical correction," he added.
There are merits and advantages associated with different non-surgical fat reduction modalities and technologies. The most common ones are cost, convenience, minimal downtime and the perception that results are equivalent to liposuction. However, the differences are not to be ignored, including response rate, level of discomfort/pain, side effects and the number of treatment sessions needed. The responsibility falls on the service providers to explain and discuss in detail so the patient can make an informed decision.
In 2021, the U.S. Food and Drug Administration (FDA) issued an FDA Class 2 recalls (Medical Device Recall) on certain cryolipolysis devices.
"Non-invasive treatments rest on the principle of either inducing fat cell necrosis or apoptosis, without the risks associated with surgical fat removal. However, non-surgical solutions often require individuals to incorporate weight loss management in order to achieve a tangible and quantifiable result over a longer period. Without which, the results may not be comparable to liposuction, which is more dramatic, as it involves immediate fat removal and contouring," explains Dr Ivan Puah.
According to Dr Ivan Puah, Liposuction has evolved with technological advancements. The risks and complications associated with traditional liposuction have significantly reduced with the use of technologies in the hands of an experienced and skilled doctor. "Results are immediate and predictable. The performing surgeons also have tools at their disposal to contour and sculpt the area into shape. Downtime and pain have minimised, and patients can recover faster with little disruption to their daily activities," says Dr Ivan Puah.
Both surgical and non-surgical fat reduction treatments have their pros and cons. In this new era where social media heavily influences one's decision to try new treatments, it is not hard to fathom why non-invasive treatments are popular. However, we must caution patients that it is unwise to jump into the latest in-trend treatment blindly without understanding the implications, side effects, and possible complications that could affect their lives.