非手术溶脂技术

doi:10.3760/cma.j.issn.0412-4030.2019.04.016

摘要/Abstract

摘要： 【摘要】近几十年来，无创技术显著发展，非侵入性的身体塑形是现代美学发展最快的领域。患者对手术的恐惧令微创及非创溶脂技术成为近年来的研究热点。目前临床主要有5种无创/微创技术用于减少局部皮下脂肪组织，包括注射去氧胆酸、冷冻溶脂、超声溶脂、射频溶脂和激光溶脂。本文主要综述近期相关的非侵入性减脂技术的作用原理、临床疗效及不良反应。

关键词: 脂肪切除术, 冷冻, 超声疗法, 激光疗法, 脉冲射频术, 溶脂技术

Abstract: 【Abstract】 In recent decades, non?invasive techniques have markedly developed. Non?invasive body contouring represents the fastest growing area of modern aesthetic medicine. Patients′ fear of surgery has made micro-invasive and non-invasive lipolysis technology a hot topic in recent years. There are currently five leading non?invasive or micro-invasive techniques for reducing localized subcutaneous adipose tissue, including deoxycholic acid injection, cryolipolysis, ultrasonic lipolysis, radiofrequency lipolysis and laser lipolysis. This review mainly summarizes the recent findings regarding the action mechanisms, clinical efficacy of and adverse reactions to non?invasive lipolysis techniques.

Key words: Lipectomy, Freezing, Ultrasonic therapy, Laser therapy, Pulsed radiofrequency treatment, Lipolysis techniques

刘子菁王小燕 Juliandri 张嘉文许阳. 非手术溶脂技术[J]. 中华皮肤科杂志, 2019, 52(4): 290-294.

Liu Zijing, Wang Xiaoyan, Juliandri, Zhang Jiawen, Xu Yang. Non-surgical lipolysis techniques[J]. Chinese Journal of Dermatology, 2019, 52(4): 290-294.

参考文献 39

［1］	International Society of Aesthetic Plastic Surgery. Demand for cosmetic surgery procedures around the world continues to skyrocket—USA, Brazil, Japan, Italy and Mexico ranked ［DB/OL］. （2017⁃06⁃27）［2018⁃4⁃16］. https://www.isaps.org/wp⁃content/uploads/2017/10/GlobalStatistics.PressRelease2016⁃1.pdf.
［2］	Arner P, Bernard S, Salehpour M, et al. Dynamics of human adipose lipid turnover in health and metabolic disease［J］. Nature, 2011,478（7367）:110⁃113. doi: 10.1038/nature10426.
［3］	Kennedy J, Verne S, Griffith R, et al. Non⁃invasive subcutaneous fat reduction: a review［J］. J Eur Acad Dermatol Venereol, 2015,29（9）:1679⁃1688. doi: 10.1111/jdv.12994.
［4］	Reeds DN, Mohammed BS, Klein S, et al. Metabolic and structural effects of phosphatidylcholine and deoxycholate injections on subcutaneous fat: a randomized, controlled trial［J］. Aesthet Surg J, 2013,33（3）:400⁃408. doi: 10.1177/1090820X13478630.
［5］	Rotunda AM. Commentary on overview of ATX⁃101 （deoxycholic acid injection）［J］. Dermatol Surg, 2016,42 Suppl 1:S271⁃S274. doi: 10.1097/DSS.0000000000000813.
［6］	Dayan SH, Humphrey S, Jones DH, et al. Overview of ATX⁃101 （deoxycholic acid injection）: a nonsurgical approach for reduction of submental fat［J］. Dermatol Surg, 2016,42 Suppl 1:S263⁃S270. doi: 10.1097/DSS.0000000000000870.
［7］	Georgesen C, Lipner SR. The development, evidence, and current use of ATX⁃101 for the treatment of submental fat［J］. J Cosmet Dermatol, 2017,16（2）:174⁃179. doi: 10.1111/jocd.12347.
［8］	Shridharani SM. Early experience in 100 consecutive patients with injection adipocytolysis for neck contouring with ATX⁃101 （deoxycholic acid）［J］. Dermatol Surg, 2017,43（7）:950⁃958. doi: 10.1097/DSS.0000000000001133.
［9］	Shridharani SM, Behr KL. ATX⁃101 （deoxycholic acid injection） treatment in men: insights from our clinical experience［J］. Dermatol Surg, 2017,43 Suppl 2:S225⁃S230. doi: 10.1097/DSS. 0000000000001306.
［10］	Souyoul S, Gioe O, Emerson A, et al. Alopecia after injection of ATX⁃101 for reduction of submental fat［J］. JAAD Case Rep, 2017,3（3）:250⁃252. doi: 10.1016/j.jdcr.2017.02.021.
［11］	Ward CE, Li JY, Friedman PM. ATX⁃101 （deoxycholic acid injection） for paradoxical adipose hyperplasia secondary to cryolipolysis［J］. Dermatol Surg, 2018,44（5）:752⁃754. doi: 10. 1097/DSS.0000000000001317.
［12］	Manstein D, Laubach H, Watanabe K, et al. Selective cryolysis: a novel method of non⁃invasive fat removal［J］. Lasers Surg Med, 2008,40（9）:595⁃604. doi: 10.1002/lsm.20719.
［13］	Naouri M. Fat removal using a new cryolipolysis device: a retrospective study of 418 procedures［J］. J Eur Acad Dermatol Venereol, 2017,31（3）:e158⁃e160. doi: 10.1111/jdv.13899.
［14］	Adjadj L, SidAhmed⁃Mezi M, Mondoloni M, et al. Assessment of the efficacy of cryolipolysis on saddlebags: a prospective study of 53 patients［J］. Plast Reconstr Surg, 2017,140（1）:50⁃57. doi: 10.1097/PRS.0000000000003433.
［15］	Carruthers JD, Humphrey S, Rivers JK. Cryolipolysis for reduction of arm fat: safety and efficacy of a prototype CoolCup applicator with flat contour［J］. Dermatol Surg, 2017,43（7）:940⁃949. doi: 10.1097/DSS.0000000000001134.
［16］	Klein KB, Bachelor EP, Becker EV, et al. Multiple same day cryolipolysis treatments for the reduction of subcutaneous fat are safe and do not affect serum lipid levels or liver function tests［J］. Lasers Surg Med, 2017,49（7）:640⁃644. doi: 10.1002/lsm. 22674.
［17］	Suh DH, Park JH, Jung HK, et al. Cryolipolysis for submental fat reduction in Asians［J］. J Cosmet Laser Ther, 2018,20（1）:24⁃27. doi: 10.1080/14764172.2017.1368564.
［18］	Bernstein EF, Bloom JD. Safety and efficacy of bilateral submental cryolipolysis with quantified 3⁃dimensional imaging of fat reduction and skin tightening［J］. JAMA Facial Plast Surg, 2017,19（5）:350⁃357. doi: 10.1001/jamafacial.2017.0102.
［19］	Lam SM. A cautious but optimistic opinion of submental cryolipolysis［J］. JAMA Facial Plast Surg, 2017,19（5）:358⁃359. doi: 10.1001/jamafacial.2017.0112.
［20］	Harrington JL, Capizzi PJ. Cryolipolysis for nonsurgical reduction of fat in the lateral chest wall post⁃mastectomy［J］. Aesthet Surg J, 2017,37（6）:715⁃722. doi: 10.1093/asj/sjw250.
［21］	Karcher C, Katz B, Sadick N. Paradoxical hyperplasia post cryolipolysis and management［J］. Dermatol Surg, 2017,43（3）:467⁃470. doi: 10.1097/DSS.0000000000000941.
［22］	Choong WL, Wohlgemut HS, Hallam MJ. Frostbite following cryolipolysis treatment in a beauty salon: a case study［J］. J Wound Care, 2017,26（4）:188⁃190. doi: 10.12968/jowc.2017.26. 4.188.
［23］	Nseir I, Lievain L, Benazech D, et al. Skin necrosis of the thigh after a cryolipolysis session: a case report［J］. Aesthet Surg J, 2018,38（4）:NP73⁃NP75. doi: 10.1093/asj/sjx028.
［24］	Fatemi A. High⁃intensity focused ultrasound effectively reduces adipose tissue［J］. Semin Cutan Med Surg, 2009,28（4）:257⁃262. doi: 10.1016/j.sder.2009.11.005.
［25］	Coleman WP, Coleman W, Weiss RA, et al. A multicenter controlled study to evaluate multiple treatments with nonthermal focused ultrasound for noninvasive fat reduction［J］. Dermatol Surg, 2017,43（1）:50⁃57. doi: 10.1097/DSS.0000000000000918.
［26］	Kwon TR, Im S, Jang YJ, et al. Improved methods for evaluating pre⁃clinical and histological effects of subcutaneous fat reduction using high⁃intensity focused ultrasound in a porcine model［J］. Skin Res Technol, 2017,23（2）:194⁃201. doi: 10.1111/ srt.12319.
［27］	Choi SY, No YA, Kim SY, et al. Tightening effects of high⁃intensity focused ultrasound on body skin and subdermal tissue: a pilot study［J］. J Eur Acad Dermatol Venereol, 2016,30（9）:1599⁃1602. doi: 10.1111/jdv.13713.
［28］	Zhou B, BYK L, Sun L. The effects of low⁃intensity ultrasound on fat reduction of rat model［J］. Biomed Res Int, 2017,2017:4701481. doi: 10.1155/2017/4701481.
［29］	Alizadeh Z, Halabchi F, Mazaheri R, et al. Review of the mechanisms and effects of noninvasive body contouring devices on cellulite and subcutaneous fat［J］. Int J Endocrinol Metab, 2016,14（4）:e36727. doi: 10.5812/ijem.36727.
［30］	Franco W, Kothare A, Ronan SJ, et al. Hyperthermic injury to adipocyte cells by selective heating of subcutaneous fat with a novel radiofrequency device: feasibility studies［J］. Lasers Surg Med, 2010,42（5）:361⁃370. doi: 10.1002/lsm.20925.
［31］	Kwon TR, Kim JH, Joon S, et al. Assessment of equivalence of adipose tissue treatment with a noncontact field RF system delivering 200 W for 30 min and 300 W for 20 min: An in vivo porcine study［J］. Laser Ther, 2017,26（1）:39⁃52. doi: 10.5978/islsm.17⁃OR⁃5.
［32］	Suh DH, Kim CM, Lee SJ, et al. Safety and efficacy of a non⁃contact radiofrequency device for body contouring in Asians［J］. J Cosmet Laser Ther, 2017,19（2）:89⁃92. doi: 10.1080/14764172. 2016.1256486.
［33］	Fritz K, Salavastru C. Long⁃term follow⁃up on patients treated for abdominal fat using a selective contactless radiofrequency device［J］. J Cosmet Dermatol, 2017,16（4）:471⁃475. doi: 10.1111/jocd. 12429.
［34］	Kapoor R, Shome D, Ranjan A. Use of a novel combined radiofrequency and ultrasound device for lipolysis, skin tightening and cellulite treatment［J］. J Cosmet Laser Ther, 2017,19（5）:266⁃274. doi: 10.1080/14764172.2017.1303169.
［35］	Chilukuri S, Denjean D, Fouque L. Treating multiple body parts for skin laxity and fat deposits using a novel focused radiofrequency device with an ultrasound component: safety and efficacy study［J］. J Cosmet Dermatol, 2017,16（4）:476⁃479. doi: 10.1111/jocd.12448.
［36］	Ichikawa K, Miyasaka M, Tanaka R, et al. Histologic evaluation of the pulsed Nd:YAG laser for laser lipolysis［J］. Lasers Surg Med, 2005,36（1）:43⁃46. doi: 10.1002/lsm.20118.
［37］	Caruso⁃Davis MK, Guillot TS, Podichetty VK, et al. Efficacy of low⁃level laser therapy for body contouring and spot fat reduction［J］. Obes Surg, 2011,21（6）:722⁃729. doi: 10.1007/s11695⁃010⁃0126⁃y.
［38］	Jankowski M, Gawrych M, Adamska U, et al. Low⁃level laser therapy （LLLT） does not reduce subcutaneous adipose tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism［J］. Lasers Med Sci, 2017,32（2）:475⁃479. doi: 10.1007/s10103⁃016⁃2021⁃9.
［39］	Decorato JW, Chen B, Sierra R. Subcutaneous adipose tissue response to a non⁃invasive hyperthermic treatment using a 1,060 nm laser［J］. Lasers Surg Med, 2017,49（5）:480⁃489. doi: 10.1002/lsm.22625.

[1]	门月华臧琳吴雯婷李薇薇张春雷. 皮肤镜毛孔检测方法在2 940 nm铒像素激光治疗毛孔粗大疗效观察中的应用[J]. 中华皮肤科杂志, 2019, 52(2): 111-114.
[2]	张丽丹林玲曾菁莘刘炜钰罗权. 黄金微针射频治疗面部痤疮瘢痕的疗效评估[J]. 中华皮肤科杂志, 2018, 51(9): 672-675.
[3]	陈明懿应川蓬罗东升吴冬梅杨镓宁戴耕武. 腔内激光消融术联合泡沫硬化剂注射及多磺酸黏多糖乳膏治疗淤积性皮炎的临床研究[J]. 中华皮肤科杂志, 2018, 51(12): 885-888.
[4]	仲少敏曹雅晶苑辰童欣云谢孟谚吴艳. 优化强脉冲光联合1 565 nm非剥脱点阵激光改善面部光老化随机半脸对照研究[J]. 中华皮肤科杂志, 2018, 51(11): 791-796.
[5]	孙占学,李元文,周志强,李纬. 液氮冷冻后化脓性肉芽肿一例[J]. 中华皮肤科杂志, 2009, 42(3): 159-159.
[6]	王爱平, 韩钢文, 王家璧, 孙建方, 姜祎群, 刘跃华, 朱学骏. 复方硝酸溶液治疗寻常疣多中心、随机开放、平行对照临床试验[J]. 中华皮肤科杂志, 2004, 37(9): 522-524.