IMPORTANCE Cryolipolysis is a popular, well-tolerated nonsurgical procedure that uses controlled cooling to selectively destroy fat cells. Central submental cryolipolysis has been reported to be safe and effective, but many patients would benefit from extending this treatment over the entire submental region.OBJECTIVE To investigate the safety and efficacy of cryolipolysis for reduction of lateral and central submental fat. DESIGN, SETTING, AND PARTICIPANTSThe study population consisted of 14 participants who were treated from January 22 to June 30, 2016, in the lateral and central submental area to reduce unwanted subcutaneous fat. A small-volume cup applicator was used to administer 2 cryolipolysis treatments, delivered in 45-minute treatment cycles in 2 sessions. For the first treatment session, all participants received bilateral treatments with approximately 20% overlap of the treatment area. At the 6-week follow-up visit, participants were reassessed to determine whether they would benefit from a second treatment and to determine the number of cycles needed to achieve the optimal aesthetic result, and then they were treated a second time. MAIN OUTCOMES AND MEASURESParticipant surveys assessed tolerability and treatment satisfaction at 12 weeks following the second treatment. Clinicians monitored adverse events to assess safety. Caliper measurements were recorded to assess fat thickness reduction. Treatment efficacy was objectively evaluated using 2-dimensional and 3-dimensional imaging.RESULTS Among the 14 participants (12 women and 2 men; mean [SD] age, 50.5 [10.4] years), the adverse effects of the procedure were typically mild and included numbness and tingling, which resolved without intervention by the final 12-week follow-up visit. An independent review of digital photographs revealed an 81.0% (95% CI, 65.9%-91.4%; P = .02) correct identification rate (34 of 42 images) of the pretreatment and posttreatment images. Caliper measurements demonstrated a mean (SD) fat layer reduction of 2.3 (0.8) mm (range, 0.7-3.5 mm). Three-dimensional imaging revealed a mean (SD) reduction in fat volume of 4.82 (11.42) cm 3 (from a reduction of 32.69 cm 3 to an increase of 13.85 cm 3 ), in skin surface area of 1.29 (1.42) cm 2 (from a reduction of 3.18 cm 2 to an increase of 0.99 cm 2 ), and in fat thickness of 3.77 (3.59) mm (from of reduction of 13.10 mm to an increase of 0.47 mm). Results of participant surveys indicated that 13 participants (93%) were satisfied with the cryolipolysis treatment. CONCLUSIONS AND RELEVANCEAlthough safe and efficacious central submental cryolipolysis has been reported, this is the first clinical study of cryolipolysis for treatment of the entire submental area using overlapping bilateral treatments and a shorter treatment duration. The study demonstrates that bilateral submental cryolipolysis is well tolerated and produces visible and significant fat layer reduction.LEVEL OF EVIDENCE 4.

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Background and ObjectivesA sharply contoured cryolipolysis vacuum applicator was developed to improve fit and tissue draw in the abdomen and flanks to better accommodate a range of body types and a variety of treatment sites. This study was carried out to evaluate the safety and efficacy of the new applicator for treatment of flank fat (“love handles”).Study Design/Materials and MethodsA cryolipolysis vacuum applicator with a sharply contoured cup and curved cooling plates was used to treat 20 flanks. Two treatment cycles were delivered sequentially to each flank (60-minute cycle at a Cooling Intensity Factor of 41.6). Efficacy was evaluated 12 weeks post-treatment by physicians performing blinded, independent review of clinical photographs. Safety was assessed by the treating physician monitoring subjects for side effects and adverse events.ResultsFour blinded, independent physician reviewers properly identified the pre- and post-treatment photographs 94.4% of the time. Improvement was scored from 0 (none) to 10 (complete) and showed an average 4.3 point (43%) improvement. Side-effects were limited to erythema, edema, bruising, and numbness or tingling at the treatment site, and resolved without treatment.ConclusionsMultiple treatment cycles from a new improved-fit cryolipolysis applicator are safe and effective for reduction of flank fat bulges. A high degree of improvement was reported by blinded, physician evaluation of standardized photographs. Laser Surg. Med. 46:731–735, 2014. © 2014 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Endoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and a shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection.