CoolSculpting is the name of a device put out by a company called Zeltiq. CoolSculpting involves a new approach to removing stubborn fat called “cryolipolysis”. A localized bulge of fat – such as the flank or bra strap roll – is placed in an applicator for 1 hour. The machine cools the fat cells which are more sensitive to the cold than the surrounding skin, nerves, or blood vessels. Some of the fat cells are altered, stimulating the release of natural signaling chemicals in the body called cytokines. These cytokines trigger the natural self-destruction of your own fat cells by a process known as apoptosis. Your body then clears these destroyed fat cells using the same mechanisms it uses to clear dietary fats.Studies show that clearance of these fat cell remnants does not elevate your natural blood fat levels.
Results from CoolSculpting, which is FDA-approved, are noticeable within 2 months of treatment and further improvement occurs over 6 months. Provided that you maintain your current weight, diet, and exercise routine, results are long-term since the affected fat cells are eliminated. CoolSculpting can be repeated for more dramatic results.
CoolSculpting can cause tingling, sensitivity, redness, and numbness to the treated area but none of these require time off or anesthesia. All of these symptoms resolve within days or weeks. You can exercise or go back to work immediately after CoolSculpting. CoolSculpting will remove 15-30% of the fat cells within the treatment area and provides an effective alternative for people who do not want to undergo a surgical procedure, such as liposuction, to remove an area of stubborn fat.
In March of this year the FDA approved a new breast implant in the United States. Sientra (Silimed in Brazil) received approval to begin marketing and selling their highly cohesive, form stable breast implants. The two breast implant companies in this country are Mentor and Allegan. Both companies manufacture highly cohesive, form stable implants but they have not yet been approved by the FDA. Mentor’s CPG implant and Allergan’s 410 implant are both anatomic shaped (tear-drop) textured implants. Conversely, Sietnra offers smooth and textured round as well as anatomic textured implants. Sientra’s current business model restricts their use to board-certified and board-eligible plastic surgeons unlike Mentor and Allergan.
So, what does this mean for women desiring breast augmentation?? The current silicone gel breast implants available are Mentor’s Memory gel and Allergan’s Natrelle. These implants are cohesive but not “highly-cohesive” or form-stable. What does that mean? I usually describe to patients the difference in feel when the implant is cut open. The cohesive implants have the consistency of soft jello and the highly cohesive are more like a gummy bear. In fact, gummy bear implants are often used to describe these implants.
Does it matter? These form-stable, highly cohesive devices have advantages over the current silicone gel implants. The two biggest advantages seen in clinical trials are a decreased rate of capsular contracture and visible rippling and a decreased rupture rate. The shaped implants may also offer advantages in certain patients looking for a certain natural feel to the implant as well.
The decision to have breast augmentation surgery is exciting. However, there are several factors to consider and choices to make. One of those choices is silicone or saline implants. Silicone implants had been “off the market” for the general population for many years (1992-2006) and within the last several years have now become available for cosmetic breast augmentation. While the moratorium was in place, silicone implants were being utilized for breast reconstruction and were extensively studied. The FDA determined that they were, in fact, safe and allowed the use of silicone for cosmetic augmentation as well in 2006.
So how do you choose? What are the differences and what is right for you? Saline implants have a silicone elastomer shell and are placed in the body deflated. Once placed, they are filled with saline (salt water). If and when they deflate, the saline is readily reabsorbed into your body. Typically the deflation is readily noticeable. The rupture rate for saline implants is around 10% at 10 years. That means that at 10 years 9 out of 10 breast implants are still intact. Silicone implants have a cohesive gel filler. This means that the silicone gel is more like a soft solid rather than a liquid. If you were to cut an implant in half, the silicone would remain intact and not run out as a liquid. This means that a rupture of this type of implant may not be noticeable as it would still remain cohesive. The rupture rate for silicone gel implants is 1% at 4 years and 8% at 11 years after surgery.
Silicone is generally considered softer and feels more “natural” that saline. Some women complain about a “water bag” feel with saline implants. Most plastic surgeons will have implants available for you to feel in their office.
Complications of any breast augmentation include, rupture or deflation and capsular contracture. This is a scar capsule that forms around the implant. In a small subset of patients, this scar can become hardened and may even distort the breast or be painful. For silicone breast implants the risk of capsular contracture after 4 years is 13% and with saline implants at 5 years is 11%
A final consideration may be the incision size. Because the saline implant can be placed deflated it requires a smaller incision (2-3 centimeters) than the silicone implant(5 centimeters).
Both saline and silicone breast implants are available and safe. The decision is one that you should make with your plastic surgeon based on your goals, your tissue and your comfort level. We look forward to responding to your questions and comments on this and many future topics in cosmetic surgery! Sincerely, Drs. Marissa Tenenbaum and Terence Myckatyn
If you are thinking about a cosmetic surgery procedure — whether it’s facial rejuvenation, liposuction, a tummy tuck or breast surgery — we’re here to help you learn more about what to expect.
As cosmetic and reconstructive surgeons, we are often asked about questions about the pre- and post-operative experience, recovery times and other issues important to those considering cosmetic procedures.
We look forward to sharing our professional insights with you!
-Terry Myckatyn, MD and Marissa Tenenbaum, MD