Can one hour in a dermatologist’s office do more than eons at the
gym? Here, a report on the new wave of extreme-temperature fat blasters
I’ve always assumed that if I ever bit the bullet and went in for
liposuction, or even one of its newer, nonsurgical body-slimming
cousins, it would be a last resort, reached after months of unsuccessful
dieting and heinous workouts, that I would justify to myself (and my
husband, mother, etc.) with the knowledge that “there was no other way”
and “it had to be done.” As it turned out, last summer I celebrated my
impending metamorphosis with a cheeseburger and yet another canceled
training session. Lying in the Upper East Side office of dermatologist
Macrene Alexiades-Armenakas, MD, PhD, waiting for Zeltiq CoolSculpting
(a process about which I had bothered to learn exactly nothing ahead of
time) to erase—or at least significantly downsize—the gentle hillock
below my belly button, I thought, Huh. How did I come to the decision to permanently deep-freeze a
chunk of my own cells? It went something like this: Alexiades said,
“So, I have this fat-freezing device….” I’m not sure I even let her
finish the sentence.
In the age of stem cell–derived supercreams
and radio-frequency skin-tightening gizmos, tackling beauty woes with
the use of heat and cold seems downright Paleolithic, like asking Wilma
Flintstone for hairstyle advice. But extreme temperatures, heat in
particular, have long been the bedrock of all sorts of cosmetic
tinkering. These days, most of the plumping, smoothing, and tightening
that is not delivered via needle is executed with lasers, and these, by
and large, work by heating skin, thus damaging old collagen and
stimulating new collagen growth. Now, though, ever more high-tech
applications of hot and cold are working below the neck (and below the
skin, for that matter), blasting away belly bulge and slimming limbs.
“When you’re dealing with fat,” says Alexiades, “it turns out you can
accomplish the destruction of fat cells using either heat or cold.”
Zeltiq
CoolSculpting, for example, is a one-hour, no-fuss, no-muss
fat-cell-destroyer that requires neither healing time nor a single
stitch—or even, say, the formality of alerting one’s spouse to the fact
that you are “having something done.”
Alexiades says the impetus
for using cold to defat has its roots in the early ’70s, when some
papers were published about a condition dubbed “equestrian cold
panniculitis.” A handful of female horseback riders found that after
long rides in the cold, “their thighs would freeze and their fat would
become inflamed and, ultimately, disappear,” she says. This wasn’t just
weight loss resulting from a good, hard workout—it occurred because fat
cells, it seems, die off at temperatures that muscle and skin are able
to withstand. But there’s a reason it took decades for science to
harness that revelation. “It has to be done in a very controlled
fashion, at certain temperatures, to a point where you’re going to get
destruction of the fat without destruction of the surrounding tissue,”
says New York City dermatologist Roy Geronemus, MD, who was involved in
several rounds of Zeltiq trials.
During a Zeltiq session, a molded
cup is placed over the lower stomach or love handles; heavy-duty
suction pulls pudge inside the cup, where it’s chilled to 5˚C (41˚F).
Some of the fat cells in the selected area are destroyed and ultimately
disposed of by the liver, a process that, in all, can take four to six
months. “Zeltiq was able to definitively demonstrate a minimum of 25
percent reduction in the fat that fits in the cup for treatment,” says
Alexiades. “That’s a very high level of efficacy.”
At Alexiades’
office, her friendly, unflappable technician Malisa applied a cold,
slimy sheet of protective gel across my lower stomach to shield the
surface of my skin; lined up the machine’s oblong handpiece on top of
this, about an inch below my belly button; and turned on the device.
Suction? Well, for a touch-and-go moment, I feared that my, er, roll
wasn’t the only thing that would be sucked into the device—it seemed
entirely feasible that the rest of my body, and Malisa along with it,
would somehow follow suit. After about seven minutes, though, we were
both still there, and my stomach had grown numb. I felt next to nothing
for the next 53 minutes and clicked calmly away on my BlackBerry until
Malisa reappeared, powered down the machine, and popped off the suction
cup. Horror: My flesh, embarrassingly malleable, had behaved like Jell-O
in the mold of the device, and it was now frozen in the shape of a
cold, pink, lifeless brick, distinct from the rest of my abdomen. Malisa
briskly set about massaging this new topographical feature, and within a
few seconds my body had meekly reaccepted it. Minutes later, I was back
on the hot summer sidewalk, with a still-numb belly lying cold and
surreal beneath my thin skirt and a mind ringing with Malisa’s parting
words: “Wait till you see it in three or four months,” she said. “You’re
going to love it.”
Cold Front
The Germans have a word for people like me: Warmduscher.
Translation: “man who takes hot showers,” or, in other words, a wimp.
This is one insult to which I’ll proudly answer. Polar bear swims, icy
plunge pools, even tepid showers—these are forms of masochism, in my
opinion. So Whole-Body Cryotherapy, which is not a life-after-death
experience but rather a freestanding cylinder you step inside for a
rapid, head-to-toe ice-down? Sounds like a bad idea to me. Developed in
Japan in 1978, WBC has been used for years in Europe to treat chronic
aches and pains by reducing inflammation. Now it’s making its way into
American spas and medical centers, as well as the locker room of the
NBA’s Minnesota Timberwolves. Sessions last only two and a half to three
minutes, during which time liquid nitrogen gas plunges the temperature
to between -200 and -250˚F. (Consider that Antarctica’s record low, set
in 1983, is a comparatively balmy -129˚F.) But the rapid chill
penetrates only half a millimeter deep, causing vasoconstriction but
not, say, frostbite; it reduces soreness and swelling, promoting what
its practitioners call “parasympathetic rebound”—i.e., it takes the edge
off postgame fatigue.
Question is, will WBC make you skinnier? Don’t rule it out. A study published earlier this year in The Journal of Clinical Investigation found
that brown fat—that is, the good kind—can be activated by, yes, cold.
Brown fat was long thought to exist only in mice and human newborns (as
they can’t shiver, it’s what keeps them warm), but, beginning in 2009,
it was detected in human adults as well. Unlike its lazy, energy-storing
white counterpart, the brown stuff is located in small, oddly placed
patches—a few ounces in the upper back, on the side of the neck, between
collarbone and shoulder, along the spine—and it burns calories like a
Jillian Michaels devotee, especially when we’re chilly. In the study,
male subjects who were held in a room that was cool, but not cold enough
to cause shivering, burned an average of 250 calories over three
hours—80 percent more than they would have normally.
Rather unfairly, people who don’t have
weight problems tend to be the ones with the most brown fat, and until
recently we had little idea of how one could gain more of it.
(McDonald’s fries, sadly, don’t help in this arena.) Now scientists at
the Dana-Farber Cancer Institute in Boston have discovered a new
hormone, irisin, which converts white fat cells into brown fat cells.
And it seems that the same thing that helps banish white fat is what
also helps make more brown: Exercise tells the body to release more
irisin, which in turn causes more fat cells to be transformed. So far,
the effect has been documented only in rodents, but human irisin is
identical to that of mice, so there’s a good chance our bodies do the
same thing. Notably, the irisin-generated brown fat was of a different
type from the cold-activated kind targeted in the JCI study.
Nevertheless, it might be reason enough to book next winter’s ski
getaway now—increasingly, it appears that exercise in the cold could
prove to be the best fat-blaster of all.
Heat Wave
On the opposite end of the thermometer, dermatologists have set
their dials to 62˚C (143.6˚F). This, according to Alexiades, is the
temperature at which optimal collagen injury occurs—and skin improvement
can begin. “Until now, everything we were doing for skin tightening and
wrinkle reduction was guesswork,” she says. “We were guessing that
we were putting enough heat into the dermis.” The skin-firming device
du jour, ePrime, is changing all that: Its handpiece is studded with
five pairs of hair-thin needles, which bypass the skin’s superficial
layers to go directly into the dermis and deliver heat at a steady,
measurable temperature. A recent convert, Manhattanite Susan D., whose
defined cheekbones and taut jawline speak to both her genetics and the
subtle ministrations of “Dr. A,” was thrilled with her ePrime tune-up
and reported that the device’s benefits outweigh its bite. “Most of it
didn’t hurt at all,” she says. “But when it hits an area that’s not
fully anesthetized, you definitely feel the heat.”
ePrime has been
proven safe for the face and neck, “but the next horizon is the body,”
says Alexiades, who sees it shoring up sagging knees and loosey-goosey
elbow skin in the not-too-distant future. On those telltale areas, “I’ve
tried Thermage. I’ve tried Titan,” she says. “The results are
okay—they’re not terrific.”
For now, though, the hot competitor to
fat-freezer Zeltiq is the new Liposonix, a gadget that liquefies fat
using high-intensity, focused ultrasound (a different version of the
technology used in the face-firming Ulthera). The manufacturers of
Liposonix don’t make claims about specific weight loss, but they do have
a catchy tagline: “One treatment, one hour, one size smaller.” On
average, patients lose an inch around the waistline after one session.
Liposonix heats fat to 55˚C, the temperature at which it melts (and the
same temperature that “smart lipo” procedures use to assist fat
extraction with a cannula), which “stimulates our immune system to come
in and eat up the damaged fat cells and take that damaged fat to the
liver,” says dermatologist Anne Chapas, MD. “Then the body gets rid of
it.” She says some patients see results within four to six weeks; most
require seven to 12.
“I’ve had people call me up and say, ‘Can I
get Liposonix on my full body?’ ” Chapas says. In a word, no. Liposonix
was FDA-approved in November for the abdomen and flanks. To get what you
want out of it, “you have to be able to pinch an inch,” she says, but
you can’t have a BMI of more than 30, the cutoff for obesity. “Neither
[Zeltiq or Liposonix] is for someone who is obese and wants to lose
weight,” says Chapas, who performs both procedures. “You have to be
pretty happy in the skin you’re in, and really just trying to lose, you
know, little problem areas.”
As for my own Zeltiq zapping, nearly a
year later, the jury is still out. Sometimes I’m convinced it worked.
But fat is fickle—as are hormonal shifts and bewitching slivers of
chocolate cake. You’re up, you’re down; the jeans fit, they don’t.
Unless you’re a slim woman with a specific drives-you-nuts problem area
(and I’m more of a curvy-all-over type), you’re looking for a relatively
subtle change in the one area of a woman’s body where it would be the
most difficult to observe. For many people, a 25 percent loss with
Zeltiq or the one-inch subtraction of Liposonix equals a skirt size,
maybe a belt loop or two; for others, it’s negligible.
Which is
not to say that I’ve ruled out miracles, even slightly scary-sounding
ones. “It’s not heat, it’s not cold—it’s chemical!” says Alexiades of
the new magic bullet that she’s investigating: injections of something
called ATX101, or deoxycholate, a natural substance found in the human
body, which works on the metabolism of fat cells to dissolve fat. As of
yet, it’s only in phase-II clinical trials, but Alexiades has high
hopes. “Now that we’re moving at such a rapid pace, liposuction, in my
view, is going to be obsolete. All you’re going to have to do is inject a
solution to dissolve fat. That’s the future.”
