Busting fat without liposuction

SINGAPORE - For years, Thomas (not his real name) worked out five days a week in the gym and cut his rice intake by half to get rid of his flanks (love handles). He even had liposuction, which trimmed 2.5cm from his waist.

But still, pockets of fat clung stubbornly to his waistline. Said Thomas, 49: "For a while, I felt there was probably nothing much I could do - Asian body types like mine probably collect more fat around these areas."

Then, in February, he went to his general practitioner Benjamin Yim and underwent a non- invasive procedure with a machine called Liposonix.

This treatment uses high-intensity focused ultrasound and promises to permanently destroy the fat which lies just under the skin, known as subcutaneous fat.

When Thomas returned to his doctor's clinic 12 weeks later, he was pleasantly surprised to learn that he had shaved 5cm off his waist circumference.

He now has a 30.5-inch (77.5cm) waistline.

During that time, Thomas said, he did not alter his diet or exercise, except for the month or so after the procedure when he could not exercise.

Such non-invasive alternatives are rapidly gaining favour over liposuction, a surgical procedure in which solid fat is sucked out of the body. Thomas was able to have the hour-long procedure done during his lunch hour and return to work immediately afterwards. After the procedure, he had to avoid exercise for over a month and wear a special garment for six months.

He said: "I'm open to more of such non-invasive methods to improve my body."

Liposuction is done here thousands of times every year, though no official figure is available.

But it is not without risk. In the past four years, two people have died here during liposuction.

One was Mr Franklin Heng, 44, the head of a property firm, who died of complications from anaesthesia in December 2009. In June this year, Madam Mandy Yeung, also 44, collapsed while on the operating table.

The coroner's inquiry has yet to be held. Such cases have made patients wary, pushing them towards non-invasive methods, said Dr Joseph Yang, a GP at Aesthetic & Medical Clinic in Wisma Atria.


Liposuction and non-invasive machines target subcutaneous fat, which acts as a tissue padding to protect the skin above and muscles, bones and joints beneath, and serves as energy storage, said Dr Martin Huang, a plastic surgeon at The Cosmetic Surgery Clinic in Paragon.

He added that non-invasive procedures are incapable of removing too much subcutaneous fat from our bodies. Doctors agreed that removing it confers no health benefits.

No procedure can remove the deeper layer of fat in the abdomen that surrounds the organs, called visceral fat, which increases the risk of heart disease when there is too much of it.

Dr David Loh, vice-president of the Society of Aesthetic Medicine (Singapore), said 25 of the doctors in the society who offer liposuction now have at least one non-invasive body-sculpting machine in their clinics. Dr Yim said demand for liposuction has halved in the last five years. Nine out of 10 of his patients opt for the Liposonix.

Five other GPs told Mind Your Body they have stopped offering liposuction and are focusing on non-invasive body-sculpting methods instead.

Demand has fallen as patients choose not to put themselves through the surgical and anaesthesia risks associated with liposuction.

Doctors are also more convinced of the efficacy of newer machines.

They work in several ways: by application of cold to freeze fat cells to death, low-level laser to create holes in cell membranes so their contents leak out, non-thermal ultrasound to mechanically disrupt fat cells and high-intensity focused ultrasound that produces heat to destroy fat cells.

Dr Dennis Kwan, the medical director at Dermacare Aesthetic & Laser Clinic in Ion Orchard, said the resulting fat and cellular debris are engulfed by white blood cells called macrophages and transported through the lymphatic system to the liver. He added: "The liver treats the fat from the macrophages just like fat you have eaten. The liver takes it and metabolises it normally."

This sequence of events may take months, so the manufacturers of fat-busting machines say results are typically seen up to three months later.

Doctors stressed these machines should not be seen as weight-loss solutions for people who are obese. Instead, they are used to get rid of stubborn pockets of fat that are resistant to exercise and diet, such as those on the arms, abdomen, flanks, thighs, back and buttocks.

Dr Calvin Chan, a GP at Wheelock Place who stopped doing liposuction last year, estimated that for every patient who chooses liposuction, another 10 would opt for machines that promise a slimmer silhouette after one or several sessions. Since 2009, he has bought five machines to do that, offering treatments according to patients' expectations, time constraints and budgets.

The costs are either less than or comparable to that of liposuction. Dr Loh said liposuction for the abdomen costs $7,000 if done in a clinic and up to $12,000 if done in an operating theatre.


Dr Chew Khek Kah, who runs NU.U Aesthetics and Wellness Clinic in Paragon, who also stopped offering liposuction this year and now has four body-sculpting machines, said the technology has improved. Dr Huang and dermatologist Joyce Lim have also jumped on the bandwagon.

Dr Huang said when he tried out some machines years ago, he was not convinced that they were worth the money. But they are better today, he said.

This year, he started offering patients non-invasive body-sculpting treatments with Liposonix and another machine called Vaser Shape, which uses ultrasound and massage therapy.

Dr Huang acknowledged that liposuction remains the "gold standard" for body contouring and skin tightening, which is why patients are able to see more drastic results. He added that both his non-invasive machines are able to achieve an average reduction of 2.5cm, but liposuction can trim up to 12cm from the waist circumference, which is equivalent to removing two to four litres of fat.

Dr Lim from Joyce Lim Skin and Laser Clinic in Paragon said patients who have had face treatment have shown interest in improving their body shape afterwards. She has put "a hundred or so" patients on a fat-freezing machine called CoolSculpting since 2010 and another 50 to 60 patients on Liposonix since July last year.

Checks with 10 doctors showed that both these machines appear to be the most popular among doctors and patients now.

CoolSculpting promises a 20 to 25 per cent reduction in fat layer in the treated area, while Liposonix purportedly can result in an average waistline reduction of one inch, which is about one dress or pant size. Dr Lim has priced both procedures at the same rate of about $3,000 for the abdomen and $5,000 if flanks are included.

When Mind Your Body first reported on CoolSculpting in October 2011, its distributor NeoAsia said 19 clinics had bought the machine. This has now increased to 28.

Liposonix received approval from the Health Sciences Authority (HSA) just three months ago, but is already being used by 16 clinics. In fact, seven of these 16 offer both Liposonix and CoolSculpting.

A spokesman for HSA said the "safe and effective use of medical devices is largely dependent on the skills and expertise of the device users".

Both machines are regarded as "professional use only" medical devices. This means that they can be operated only by qualified practitioners, such as doctors and dentists registered with the Ministry of Health, as well as by people under their supervision.

He said: "Qualified practitioners are in a position to manage the clinical needs and well-being of the patients and also provide the appropriate aftercare following the procedure."

Doctors say that prior to putting patients through non-invasive procedures, they talk to them to understand their lifestyle and expectations.

Patients who have no intention to eat healthily or exercise and others who expect immediate results are sometimes turned away.

Dr Dylan Chau, the medical director of CeleVenus Wellness & Aesthetic Clinic in Ngee Ann City, said: "If you have tried your best at losing the flab, then opt for such procedures. At the end of the day, weight management is about one's input and output. These procedures do not cure weight issues."


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