Fat Freezing Helps Doctors Enhance Physiques, and Their Revenue

“Great read if you’re considering CoolSculpting!”

— Dr. Dale

From Fat Freezing Helps Doctors Enhance Physiques, and Their Revenue

FAYETTEVILLE, Ark. — Fat freezing, a treatment that can eliminate people’s fat cells, is becoming a hot new revenue opportunity for doctors’ offices and spas looking to capitalize on Americans’ willingness to open their wallets for a trimmer physique.

Dermatology clinics and medical spas are increasingly offering a procedure called CoolSculpting to shrink love handles, flabby tummies and jiggly arms. Doctors’ offices are eager to offer the treatment because it represents a way to meet the fast-growing demand for fat-reduction services that don’t require surgery. It is also, they say, a way to get new types of customers in the door, including men.

Revive Medical Spa, the cosmetic arm of a dermatology practice in Fayetteville, Ark., began offering CoolSculpting almost two years ago, after its owner, Dr. Lance Henry, decided it would meet his patients’ demand for nonsurgical fat reduction.

Revive began with one CoolSculpting machine and added a second so clients could have two target areas treated at once. Anne Scott, Revive’s spa director, said it stays busy with fat-freezing clients. “CoolSculpting has allowed our business to grow both in reaching new clients and in revenue,” she said, although she would not give specifics.

Suzanne Kilmer, founder of the Laser & Skin Surgery Center of Northern California, which participated in early testing of the treatment, said her center has four CoolSculpting machines and does 300 to 400 treatments a month. “The four machines go all the time,” said Dr. Kilmer, who is on the advisory board of Zeltiq Aesthetics, the company that developed the treatment. (Zeltiq was acquired in April for $2.4 billion by the pharmaceutical behemoth Allergan.)

CoolSculpting, promoted heavily on television, uses a technique known as cryolipolysis — fat freezing, or “controlled cooling” — to eliminate fat cells without the risk and time out of work required by surgery. During the treatment, clients recline while a clinician affixes a plastic suction cup — sort of like an upholstery attachment to a vacuum cleaner — to the targeted area. The cup — its size and shape vary, depending on the part of the body being treated — is attached by a hose to a machine that hums as it sucks the tissue into the cup and cools it.

Treatment lasts 35 minutes to an hour, depending on the targeted area. The effects are seen over a period of weeks after treatment, as the body eliminates the dead fat cells. It can take two to four months to see full results.

CoolSculpting was initially cleared by the Food and Drug Administration in 2010, based on a 2007 study that found “clinically meaningful” changes in 60 patients after treatment for the reduction of love handles. Six months after treatment, ultrasound measurements found an average 19 percent reduction of the targeted fat layer. Zeltiq said in regulatory filings it has improved its systems since then.

The procedure is not covered by insurance, and costs an average of $625 per treatment, according to Zeltiq. A course of procedures, typically treating different areas of the body, can run $2,000 to $4,000. An investor presentation in January estimated that a practice averaging two patients a week, with four treatments each, could expect “gross profit” of $200,000 a year.

Anne Scott, Revive’s spa director, said it stays busy with fat-freezing clients. “CoolSculpting has allowed our business to grow both in reaching new clients and in revenue,” she said, although she would not give specifics.

Zeltiq sells its machines and a set of attachments for about $150,000. Zeltiq says it performed nearly 4 million treatment cycles on about one million patients as of the end of last year, and had more than 5,600 machines installed worldwide.

The procedure is marketed to doctors and spas as a “gateway” treatment that can help grow a clientele of people who might otherwise not get cosmetic treatments. The idea is that when people arrive to get their fat iced, they can also hear about Botox (another Allergan product) and other aesthetic options.

CoolSculpting isn’t alone in marketing noninvasive fat reduction machines to doctors, and some practices offer multiple products to clients. Other options include radio-frequency and laser-based treatments. Fat freezing, however, is the market leader, according to the American Society for Dermatologic Surgery, which found CoolSculpting made up almost half of all body-sculpting treatments in 2016.

On a recent weekday morning, Ms. Scott, Revive’s spa director, showed a visitor the room where CoolSculpting clients pose for “before” and “after” photographs. Calming music played in the halls, as clients arrived for massages and other treatments.

Clients often read, work or even nap during a treatment, Ms. Scott said. Once the treatment is started, the doctors or clinicians administering it don’t have to remain in the room, freeing them to tend to other clients — another way to enhance revenue.

Patients like Krystal Willhite, 40, of Stillwater, Okla., say they are pleased with the treatment. At 5 feet 9 inches and 135 pounds, she said, she isn’t concerned about her weight. “I’m already pretty skinny,” Ms. Willhite, the general manager of a car dealership, said in a telephone interview. But she felt self-conscious about a double chin. She considered a treatment that involved injections, but opted for CoolSculpting instead, and visited Revive a year ago for her first treatment. “There’s no pain to it,” she said. Her chin was red afterward, she said, but she was able to return to work.

She said she noticed a slight difference a few weeks after her first treatment, but saw a bigger change after a second treatment. “It’s gone,” she said of her double chin. She said the results justified the cost of about $1,300.

Others say there can be some discomfort. Steve Kizzar, 49, who said he keeps in shape and teaches fitness classes, said that after his first treatments at Revive, on his abdomen and flanks, he found it difficult to button his pants for a week or so because of swelling. And his skin had some numbness and tingling, which subsided over a couple of weeks. During a subsequent treatment, he said, he felt the suction cup didn’t attach properly, so he had the procedure repeated at no charge.

“It’s not immediate,” Mr. Kizzar said. “It’s kind of a slow process.”

Still, Mr. Kizzar said he is satisfied with the end result. “I think it made a lot of difference,” he said.

W. Grant Stevens, a clinical professor of plastic surgery at the University of Southern California’s medical school and an early tester of fat freezing, said he maintains more than two dozen machines at his network of clinics near Los Angeles. The procedure may be especially appealing to men, he said, as a discreet nonsurgical treatment.

11 Things to Know If You're Thinking About Trying Dermal Fillers

“Great read if you’ve been thinking about getting fillers! Contact us for a consultation.”

— Dr. Dale

From 11 Things to Know If You're Thinking About Trying Dermal Fillers

Full cheeks, smooth skin, plump lips: Some people have them naturally, while others get a little help from their dermatologists with dermal fillers. If you can't quite tell which category a celebrity or someone you know fits into, well, that's the point. The latest injectable treatments are easy to get (if not cheap), long lasting, and designed for subtlety. They're also perfectly safe, provided you've done your homework and go to a reputable doctor. If you're curious about fillers, these are the things to know before getting pumped up.

1. Fillers made from hyaluronic acid, which is naturally found in the skin, are derm favorites.

First things first: Dermal fillers aren't the same as neurotoxins like Botox and Dysport. The latter type "freezes" muscles to reduce wrinkles, while fillers smooth out skin by filling wrinkles. Collagen used to be a common filler, but these days most fillers, such as Restylane and Juvéderm, use hyaluronic acid. Thanks to its ability to store moisture, hyaluronic acid is responsible for giving skin a plump, hydrated look. It's used topically to moisturize, but a cream or serum can't restore lost volume—only injectable hyaluronic acid can. Once injected it can add to the natural plumping action, or replenish your body's natural production of hyaluronic acid, which diminishes as you age.

2. One injection can make skin look plumper and smoother for several months, and maybe longer.

One of the reasons injectable hyaluronic acid-based dermal fillers are increasingly popular is their ability to add volume and decrease wrinkles with a single visit to the doctor. Results typically last for three to six months, depending on the location of the injection. Research suggests that HA injections may stimulate collagen production, leading to fresher-looking skin in the long run.

3. Good filler is invisible.

Trout pout and duck lips are a surefire sign of filler. But when expertly injected, filler should look natural. "The changes we can make are so subtle that nobody would notice," says Ava Shamban, M.D., a dermatologist in Los Angeles. "Instead of seeing filler, they'd say, 'Oh, I never noticed your eyes were green.' " Imperceptibility is the goal.

4. That's in part because filler techniques have gotten better.

Take the lines around your mouth, for example. A decade or so ago, filler was often injected into the nasolabial folds, or laugh lines, to literally fill the wrinkles themselves. These days, the goal is to plump and lift in other parts of the face for a more natural-looking result. "As you age, your bones get thinner, and the overlying fat pads slide down," which makes the skin sag lower, causing deeper folds at the bottoms of your cheeks, Whitney Bowe, M.D., a dermatologist in New York City, tells SELF. Bowe often injects Restylane Lyft right near the cheekbone to restore fullness, which lifts the face, reducing the look of smile lines in the process.

5. It matters who does your filler.

"The fear [with injectables] is that someone is going to look like the product," Paul Jarrod Frank, M.D., a dermatologist in New York City, tells SELF. "But really, you're going to look like the injector." Injection is an art, so you want to find an artist whose work you like. That's why it pays to do more than a Yelp search for recommendations. "People are starting to be more open about injectables," Shamban says. "If you're in a group of women and someone has had it done, ask who she went to see." From there, she advises asking the doctor or nurse to see before-and-after photographs of real patients. Every practitioner has different philosophies, techniques, and levels of experience. Be sure you and your physician communicate about realistic results and your expectations—it's your face, after all.

Don't be afraid to ask about training and certification, too. Even though dermal fillers are available at Medspas, you should see only licensed and trained physicians for any injectable treatment. Just like any medical procedure, there are risks for infection, discoloration, and lumps if injections are done incorrectly.

6. Fillers can be used for prevention as well as to treat lines you already have.

Though there is absolutely no need to go running out for fillers before you even see your first wrinkle, people are starting treatments younger than ever before. According to the American Academy of Facial Plastic and Reconstructive Surgery, in 2015, the majority of member facial plastic surgeons saw an increase in cosmetic surgery or injectable treatments in patients under age 30. Many dermatologists say that starting relatively young may have benefits. "It depends on the person, but I think earlier is better," Shamban says. "Looking at my patient population, there's no question that those who started earlier with small amounts are aging differently than people who didn’t. It’s much better to play the game of prevention than the game of correction." But keep in mind, there are other—cheaper—ways to prevent aging, including wearing sunscreen and using retinols.

7. Different fillers do different things.

While the bulk of filler is made with hyaluronic acid, different particle sizes will deliver different results. "Restylane Lyft has larger particle sizes—think of them like the bricks of a foundation," Bowe says. Those larger particles have the heft to "rebuild" thinned cheekbones, while a smaller particle size, as in Restylane Silk, works better for addressing fine lines and plumping lips. A good dermatologist will explain the ideal treatment plan for you, but know that the most natural-looking results may require more than one weight of filler.

8. Bad filler can happen, but it doesn't have to stay that way.

If you're unhappy with the way filler looks, don't panic—in most cases, you can have it adjusted. A dermatologist might inject additional filler for balance, or she can dissolve it altogether. "The wonderful thing about hyaluronic acid fillers is that there's an enzyme that can be injected into the area to dissolve the product," Shamban says. "It just goes away."

9. If the price seems too good to be true, it probably is.

If you see a deal for inexpensive filler, be skeptical. Shamban says that doctors typically pay between $250 and $350 per syringe of Restylane, so if patients are paying less than that, something's off. "You have to be careful," she says, adding that counterfeit and diluted filler do exist. "Ask to see the box, and look for a safety seal on it." The price of these fillers varies depending on the amount of product needed—expect a treatment to run anywhere from $650 to $2,000.

10. There are some times you shouldn't get fillers injected.

Though fillers are considered safe, there are a few reasons to postpone an injection. If you're pregnant, breastfeeding, or you're battling a sinus infection, it's best to hold off, as any infection in the facial area could spread to the injection site. And here's one more you might not think about: Don't get filler right before a teeth cleaning or other dental treatment, Shamban says. These procedures require pressure and stretching of the face that could potentially misplace fillers. Waiting at least a few days, or preferably a week, is ideal.

11. If you love the look of your fillers, you'll have to keep going back for more.

After about six months, the hyaluronic acid fillers are naturally broken down by the body. So, you have to get touchups once or twice a year to maintain the look. However, this is good news if you're just want to try fillers once or twice, since the effects will fade away without any long-term risks. It's important to note that getting filler doesn't stop your skin from aging completely, so you could need more filler to get the same results over time.

Obesity in Teen Years Tied to Colon Cancer Risk in Adulthood

“Maintain healthy eating and exercising habits to decrease the risk of colon cancer. Questions? Book an appointment today. ”

— Dr. Dale

From Obesity in Teen Years Tied to Colon Cancer Risk in Adulthood

MONDAY, July 24, 2017 (HealthDay News) -- Obesity even in adolescence may raise the odds for colon cancer in adulthood, a large new study finds.

Overweight and obese teens in Israel had about a 53 percent higher risk for colon cancer as adults, researchers found.

And for rectal cancer, obesity -- but not overweight --was tied to more than double the risk for girls, and 71 percent higher odds for boys, compared to normal-weight teens.

"This study is additional evidence that risk factors for colon cancer operate through the life course," said Dr. Andrew Chan, an associate professor of medicine at Harvard Medical School.

The findings "highlight the importance of maintaining a healthy body weight even in childhood," added Chan, who wasn't involved in the study.

According to the American Cancer Society, colon cancer is the third most common cancer diagnosis in U.S. men and women, excluding skin cancer.

About 95,500 new cases of colon cancer, and nearly 40,000 new cases of rectal cancer will be diagnosed in the United States this year, the society says.

With so many young Americans overweight or obese, concerns have been growing about the effect of excess weight on chronic disease, including cancer, later in life.

"When you are young, obesity is a disease that puts you at risk for many medical problems," said Dr. David Bernstein, chief of hepatology at Northwell Health's Center for Liver Diseases in Manhasset, N.Y.

"We know about diabetes, we know about arthritis, and now we know about colon cancer," said Bernstein, who had no role in the research.

"There is a well-documented link between obesity and colon cancer in adults," said Bernstein. "It makes sense that if you are obese when you are young, then you are going to have more problems when you are older."

Bernstein said it takes years to develop cancers, so it's not surprising that the effects of obesity in adolescents are seen in adulthood.

The new study was led by Dr. Zohar Levi, of Rabin Medical Center in Petah Tikva, Israel. Levi's team collected data on nearly 1.1 million Israeli men and more than 707,000 Israeli women. They had weight assessments at ages 16 to 19 between 1967 and 2002. Follow-up continued until 2012.

The final sample included almost 1.8 million participants, according to the study. The results were published online July 24 in the journal Cancer.

Over an average follow-up of 23 years, nearly 3,000 participants developed colon cancer, the researchers found.

Among men, about 1,400 had colon cancer, and nearly 600 had cancer of the rectum. Among women, more than 760 had colon cancer, and more than 220 had rectal cancer.

"This is a huge cohort with a minimum follow-up of 10 years, and all individuals had measured BMI [body mass index], not just reported or recalled," Levi said in a journal news release.

One limitation of the study is that participants were only an average age of 49 when their cancer was diagnosed, well before most colon cancer develops, the researchers said.

Also, while the study found a link between teenage obesity and adult colon cancer, it doesn't show a direct causal relationship.

In addition, the researchers had no data on diet, physical activity and smoking, which might have affected risk estimates. Nor did they have family medical histories, which might have shown a predisposition to colon cancer.

Bernstein said it hasn't been shown scientifically that losing weight can help reduce the risk. Still, "one should treat obesity," he said. "If obesity is a risk, then the only way to modify that risk is to lose weight. I don't know if it will help; it certainly can't hurt."