Received: 13 January 2018 | Revised: 24 June 2018 | Accepted: 19 July 2018

DOI: 10.1111/jocd.12785

MASTER CASE PRESENTATION

Effects of contrast cryolipolysis on flank region adiposity:

Case study

Patrícia Froes Meyer PhD1,2 | Márcia Cristina Dias Consulin MSc3 | Thais Rodrigues
PT4 | Aline Marques Pereira PT5 | Patrícia Carolina Martinez Lopes PT6 | Rodrigo Marcel
Valentim da Silva MSc1,6,7 | Liliane Santos de Vasconcellos MSc1

1
Federal University of Rio Grande do
Norte, Natal, Brazil Summary
2
Potiguar University‐UNP, Natal, Brazil Background: The Contrast Cryolipolysis is a non‐invasive technique that aims to
3
University of Piracicaba – UNIMEP, reduce localized adiposity with its heating‐cooling‐heating method, resulting in a
Piracicaba, Brazil
45% fat loss in the treated area, with no damage to the skin.
4
Centro Universitário Amparense – UNIFIA,
Amparo, Brazil Objective: To investigate the effects of contrast cryolipolysis compared to conven-
5
Gama Filho University‐ UGF, Rio de tional cryolipolysis on localized adiposity.
Janeiro, Brazil
6
Materials and Methods: This is a case study was carried out with two volunteers.
Estácio de Sá University, Rio de Janeiro,
Brazil The cirtometry, ultrasonography, and the anthropometric characteristics’ analyses of
7
Maurício de Nassau University, Natal, volunteers were performed before and after the intervention. The right flank region
Brazil
underwent conventional cryolipolysis, and the left flank underwent contrast cry-
Correspondence olipolysis.
Patricia Froes Meyer, Federal University of
Results: The procedures performed in both volunteers had positive results. How-
Rio Grande do Norte, Natal, Brazil.
Email: [email protected] ever, the use of Contrast Cryolipolysis promoted greater loss of adipose tissue,
reducing perimetry and cirtometry measurements, as well as the adipose tissue
thickness, acknowledged via ultrasonography.
Conclusion: The contrast cryolipolysis promotes greater localized adiposity reduc-
tion than the conventional cryolipolysis.

KEYWORDS
adiposity, body mass, contrast cryolipolysis, cryolipolysis

1 | INTRODUCTION destruction with the rupture of the cells’ membranes through the
induction of a cellular apoptosis mechanism. Another mechanism
The cryolipolysis is a non‐invasive method of fat layer reduction,
that is modified by the cooling is the fat cell metabolic activity,
which significantly decreases the fat layer thickness with no damage
inducing hormonal and biochemical adaptations that favor the
to the skin or other surrounding tissues.1
metabolization of the fat reserves present in the tissue.3,4
Recently, the esthetic industry has developed a new method, the
The contrast cryolipolysis allows a reduction of the discomfort
contrast cryolipolysis. The cryolipolysis is a non‐surgical procedure
generated by the low temperatures produced by the conventional
that promotes localized adiposity reduction, presenting high patient
method, considering it promotes lower irritability of nerve endings.
and physician satisfaction indexes.2
In contrast, the heating promotes a blood flow increase that favors
The lipolysis occurs through a mechanism of adipocyte crystal-
reperfusion, modulating the inflammatory response in adipose tissue
lization associated with a local inflammatory response. This inflam-
after cryolipolysis.5,6 Therefore, the objective of this study was to
mation triggers a mechanism of progressive and continuous fat cells

J Cosmet Dermatol. 2018;17:1059–1062. wileyonlinelibrary.com/journal/jocd © 2018 Wiley Periodicals, Inc. | 1059

1060 | MEYER ET AL.

investigate the effects of contrast cryolipolysis compared to conven- made. An analysis of the percentage difference between the first
tional cryolipolysis on localized adiposity. and second measurements was also performed, to find a loss per-
centage value.
Volunteer 1 received contrast cryolipolysis session on the right
2 | MATERIALS AND METHODS
side, with initial heating application (40°C for 5 min), followed by a
low‐temperature positive cooling (8°C for 30 minutes) and by
2.1 | Drawing of study
another heating application (38°C for 10 min).2,5 Then, the left side
This case study was approved by the Research Ethics Committee flank underwent a Conventional cryolipolysis session, which consists
of the Federal University of Rio Grande do Norte—UFRN, under of the cooling with negative temperature at −7°C for 60 minutes.7
registration number 2.326.871. Two volunteers were selected, one Only on the left side flank, upon session end, the volunteer received
male (volunteer 1) and one female (volunteer 2). Inclusion criteria a vigorous massage in the region for 3 minutes to facilitate blood
were: presence of localized adiposity in the flanks, with a mini- reperfusion. Volunteer 2 underwent contrast cryolipolysis on the
mum fold of 2.0 cm and no history of anterior esthetic treatment right‐side flank, with initial heating (40°C for 5 minutes), followed by
in the region. Exclusion criteria were: previous esthetic and/or sur- low‐temperature positive cooling (8°C for 30 minutes) and heating
gical procedures in the flanks, positive rheumatoid factor, rheuma- (38°C for 10 minutes). The left side flank received contrast cryolipol-
toid arthritis, cryoglobulinemia, cold paroxysmal hemoglobinuria, ysis with initial heating (40°C for 5 minutes), followed by a low neg-
Sjogren's syndrome, systemic lupus erythematosus, peripheral circu- ative cooling application (−7°C for 60 minutes) then heating (38°C
latory commitment, Reynaud's disease, hepatitis C, autoimmune for 10 minutes).
disease, acquired immunodeficiency syndrome (AIDS), cold urticaria,
open or infected wounds, recent bleeding area, acute or chronic
2.4 | Treatment sequence
infections, pregnancy, lactation, scarring in the region, hernia in
the region, dermatitis and eczema, post herpetic neuralgia, neo-
plasia or tumor, obesity, excessive visceral fat, hepatic steatosis,  With the patient in a standing position, demarcation of the
skin flaccidity after considerable weight loss, hypovitaminosis D, anatomical regions of treatment (Right flank and Left flank) was
infertility drug treatment, use of steroids or corticosteroids, Cush- made with a dermographic pen. The flank: the region between
ing's syndrome. the anterior and posterior axillary line of the sixth intercostal to
the iliac crest.
 With the patient lying in right lateral decubitus, the region was
2.2 | Experimental protocol evaluation
protected with an antifreeze membrane.
The volunteers underwent a previous evaluation immediately before  The medium‐sized applicator was selected, (250 mL volumetric
and 8 weeks after the cirtometry and the photographs, and before capacity).
and 11 weeks after the ultrasonography. In the physical therapy  The applicator was positioned in the region to be treated with
evaluation, body mass (kg) and cirtometry (cm) were measured at vacuum suction onset to 70 KPA, decreasing to 30 KPA after the
umbilical scar level, 5 cm above and 5 cm below.7 All evaluations skin fold was adjusted to the applicator.
were performed by a single individual, who was responsible for the  The blanket was inspected to check for any bendings or
photograph, body weight, and perimetry evaluations, before and irregularities.
after the applications. The medical evaluation was performed by  The experimental protocol was performed.
ultrasonography, the examination was performed with a high‐resolu-  The applicator and the antifreeze membrane were removed.
tion multifrequency transducer (5‐12 MHz) GE Logiq P7 USA, in  A manual massage was made on the treated spot (3 minutes).
panoramic image, to visualize subcutaneous thickness from the ante-
rior to the posterior sciatic spine. After the procedure, the patients were reassessed under the ini-
tial evaluation criteria.

2.3 | Procedure
3 | RESULTS AND DISCUSSION
The volunteers underwent a single application protocol on each
flank, which consisted of the cryolipolysis technique and its varia- Volunteers 1 and 2 had a reduction in total body mass. Volunteer 1
tions, with HTM Electronics' Beauty Shape equipment (Registered reduced 3.3 kg, and volunteer 2 reduced 1.5 kg. Measurements of
with ANVISA (Brazilian Health Surveillance Agency) under number the cirtometry reduced from 3 to 6 cm, with the umbilical scar as
80212480025). reference (Table 1). Tables 3 and 4 describe the cirtometry and ultra-
Before the initial intervention, an assessment of body weight, sonography of the adipose tissue thickness.
perimetry, cirtometry, and ultrasonography measuring was per- It was observed that the procedures performed in both volun-
formed. In addition to the analysis of the measurement of the adi- teers had positive results, with Volunteer 1 presenting 58% mean
pose tissue thickness of the, a fat percentage loss analysis was total reduction of right side subcutaneous thickness voluntary 2 with
MEYER ET AL. | 1061

T A B L E 1 Result of perimetry before and after intervention, and data analysis, the total body mass change occurred, but it was not
body mass of volunteers considered a clinical transformation, since the cryolipolysis process is
Volunteer Volunteer Volunteer Volunteer local and does not interfere with this variable and this result corrob-
1 before 1 after 2 before 2 after orates with other studies.1,6,8 It is probable that weight reduction
5 cm above the 97.5 93.0 76.0 70.0 may have interfered with localized fat loss and contributed to a
umbilical scar (cm) reduction in total body mass.
Umbilical scar (cm) 103.5 98.2 89.0 79.0 Ferraro et al and Zelickson et al,1,6 in their studies with cryolipol-
5 cm above the 104.0 101.0 94.0 90.0 ysis, obtained positive results, with mentioned reduction of waist cir-
umbilical scar (cm) cumference. A similar result occurred in this study, in which the
Body mass (kg) 96.3 93.0 61.0 59.5 volunteers obtained reduction of the measurements varying from 3
to 6 cm difference after treatment. The ultrasonography could quan-

T A B L E 3 Results of cirtometry before and after intervention tify the percentage of fat loss. Zelickson,1 in this investigation, also
performed an ultrasonographical analysis and observed a reduction
Adipose tissue Volunteer Volunteer Volunteer Volunteer
thickness 1 before 1 after 2 before 2 after
of the fat layer after cryolipolysis application.9 The results of percent
loss, cirtometry, perimetry, ultrasonography and measures of circum-
Measure 1 (cm) 1.77 1.45 1.35 1.08
ference and body mass showed greater reduction in volunteer 1
Measure 2 (cm) 5.11 1.58 2.26 1.05
when compared to the values from volunteer 2. The difference in
Measure 3 (cm) 4.06 2.42 2.20 2.02
body composition, besides other factors such as physical activity,
age, diet, and metabolism6 could reinforce such results.
T A B L E 4 Percentage of adipose loss before and after treatment Contrast cryolipolysis promotes blood reperfusion after the cool-
ing application phase4. This response probably favors a regulation of
Percentage of loss Volunteer 1 Volunteer 2
the local inflammatory response, contributing to an increase in lipoly-
Left side (%) 56 28.5
sis, which is a possible factor for the greater adipose tissue loss, as
Right side (%) 58 50
seen in these works. Other methods that associate the cryolipolysis
with radiofrequency or shock wave therapy have also promoted a
a 50% reduction. On the left side, there were also reductions of response to reperfusion and modulation of the inflammatory
56% and 28.5%, respectively (Table 4). response. However, contrast cryolipolysis promotes an immediate
Figures 1 and 2 show the ultrasonography comparisons of before effect, which would accelerate the inflammatory response without
and after right‐sided treatment of both volunteers. the risk of cold caused by the cooling technique.10–12 Contrast cry-
During the research, it was possible to observe changes on the olipolysis favors the lipolysis process through adipocyte crystalliza-
individuals weight, waist circumference, and subcutaneous thickness tion, associated with a cellular lysis. This process consists of a
decrease, with changes in the contour of the treated region. In the complex network of metabolic reactions that reduce the quantity of

F I G U R E 1 Comparison of
ultrasonography before and after right‐
hand intervention—Volunteer 1 Before After

F I G U R E 2 Comparison of
ultrasonography before and after right‐
hand intervention—Volunteer 2 Before After
1062 | MEYER ET AL.

T A B L E 2 Cirtometry results before and after intervention 3. Pinto H. Local fat treatments: classification proposal. Adipocyte.
2016;5(1):22‐26.
Adipose tissue Volunteer Volunteer Volunteer Volunteer
4. Pinto H, Ricart‐Jane D, Pardina E. X‐ray diffraction study confirms
thickness 1 before 1 after 2 before 2 after
intra‐adipocitary lipid crystallization after lipocryolysis stimulus. Cryo
Measure 1 (cm) 4.82 2.05 1.05 0.93 Letters. 2013;34(6):619‐623.
Measure 2 (cm) 3.22 1.34 1.73 0.66 5. Sasaki GH, Abelev N, Tevez‐Ortiz A. Noninvasive selective cryolipol-
ysis and reperfusion recovery for localized natural fat reduction and
Measure 3 (cm) 1.38 0.74 2.01 0.44
contouring. Aesthet Surg J. 2014;34(3):420‐431.
6. Majdabadi A, Abazari M. Simulation of cryolipolysis as a novel
method for noninvasive fat layer reduction. Turk J Med Sci. 2016; 46
fat cells, which clinically promotes a reduction in measurements and (6):1682‐1687.
adipocyte volume.3,4,8,12 7. Meyer PF, Furtado A, Araújo MS, Neto LG, Valentim da Silva RM,
The inflammatory response arises after tissue cooling, promoting Queiroz C Effects of cryolipolysis on abdominal adiposity of women.
Cryo Letters. 2017;38(5):379‐386.
a soft and progressive reduction of the adipose tissue and presenting
8. Meyer PF, da Silva R, Oliveira G, et al. Effects of cryolipolysis on
fat volume reduction in the treated area, favoring the reduction of abdominal adiposity. Case Rep Dermatol Med. 2016;2016(5):1‐7.
the anthropometric measures related to body constitution.13,14 9. Stevens WG, Bachelor EP. Cryolipolysis conformable‐surface applica-
In this sense, the present investigation is relevant, even as a case tor for nonsurgical fat reduction in lateral thighs. Aesthetic Surg J.
2015;35(1):66‐71.
study, by analyzing, through different methodologies, the clinical
10. Wahrlich V, Luiz E, Anjos A. Validação de equações de predição da
evolution of two patients submitted to contrast cryolipolysis treat- taxa metabólica basal em mulheres residentes em Porto Alegre, RS,
ment. Since there are few articles about it, it is hard to explain the Brasil* Validation of predictive equations of basal metabolic rate of
results. More studies with more volunteers and more sessions are women living in Southern Brazil. Rev Saúde Pública. 2001;3935
(1):39‐39.
suggested.
11. Knobloch K, Kraemer R. Extracorporeal shock wave therapy (ESWT)
Therefore, this study allowed of the adipose panniculus reduc- for the treatment of cellulite–a current metaanalysis. Int J Surg.
tion, both with the use of conventional cryolipolysis and the contrast 2015;24:210‐217.
cryolipolysis in a single treatment session. A reduction in the concen- 12. Kim J, Kim DH, Ryu HJ. Clinical effectiveness of non‐invasive selec-
tration of adipose tissue occurred in the group who underwent the tive cryolipolysis. J Cosmet Laser Ther. 2014;16(5):209‐213.
13. Few J, Gold M, Sadick N. Prospective internally controlled blind
contrast technique. This result may be justified by the inflammatory
reviewed clinical evaluation of cryolipolysis combined with multipolar
modulation, which promotes fat concentration reduction.8,12 radiofrequency and varipulse technology for enhanced subject
results in circumferential fat reduction and skin laxity of the flanks. J
Drugs Dermatol. 2016;15(11):1354‐1358.
ORCID 14. Pereira JX, Cavalcante Y, deOliveira RW The role of inflammation in
adipocytolytic nonsurgical esthetic procedures for body contouring.
Patrícia Froes Meyer http://orcid.org/0000-0001-8530-8183 Clin Cosmet Investig Dermatol. 2017;10: 57.

REFERENCES
How to cite this article: Meyer PF, Consulin MCD, Rodrigues
1. Zelickson BD, Burns AJ, Kilmer SL. Cryolipolysis for safe and effec- T, et al. Effects of contrast cryolipolysis on flank region
tive inner thigh fat reduction. Lasers Surg Med. 2015;47(2):120‐127. adiposity: Case study. J Cosmet Dermatol. 2018;17:1059–
2. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH.
1062. https://doi.org/10.1111/jocd.12785
Cryolipolysis for fat reduction and body contouring. Plast Reconstr
Surg. 2015;135(6):1581‐1590.