The 1060 nm diode laser SculpSure (Cynosure) is safe, effective and offers another option for noninvasive treatment of submental fat, according to research presented in April 2018 at the 38th Annual Conference of the American Society for Laser Medicine & Surgery (ASLMS), in Dallas.
“This is really the first laser that has been shown to work when removing fat in the submental area,” says Bruce E. Katz, M.D., clinical professor, Icahn School of Medicine at Mt. Sinai, and director of the director Juva Skin & Laser Center. “The great thing about it is it’s a quick treatment. It’s about 25 minutes. We found that in addition to removing fat, it actually tightens the skin.”
The SculpSure device, which is FDA cleared to treat the abdomen, flanks, back, inner and outer thighs and the submental area, includes changes to the device’s software, so the heat from the laser is more superficial under the chin than it is for treatment of other body areas, according to Dr. Katz, who presented on the topic at ASLMS.
David H. McDaniel, M.D., a dermatologist based in Virginia Beach, Va., presented clinical study findings on the safety and efficacy of the 1060 nm diode laser for treating the submental area. He and colleagues initially studied eight healthy male and female subjects between ages 20 and 65 years of age, with significant submental fat and body mass indexes of 45 or less. Each received two 25-minute treatments. Physicians graded patient outcomes on a 5-point scale at the 12-week followup. Subjects also completed a satisfaction questionnaire based on a 6-point scale. Physicians also used 2D and 3D digital images to do a subset analysis of three of the subjects.
The physicians’ assessments of the images were an average score of 4, which is much improved, for all eight participants. No subject scored less than 3. And subjects’ satisfaction scores were an average 2.5, which is between satisfied and extremely satisfied. In the subset analysis, researchers reported an average improvement of -21.5% in lift; -3.0% in skin tightening; -5.3% minor strain median measurements; and an average reduction of 5.6 cc in volume.
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SculpSure vs CoolSculpting vs Kybella
SculpSure uses heat to rid the body of fat. When used in the submental area, the device is placed under the chin.
“It looks a little like a bicycle helmet with a chin strap to hold the applicator in place. It has sensors that know if it’s in contact with the treatment area,” Dr. McDaniel says.
Other options for nonsurgical submental fat reduction include CoolSculpting’s CoolMini (Zeltiq). Its applicator is held in place with mild suction, according to Dr. McDaniel. And Kybella (deoxycholic acid, Allergan), which is chemical lipolysis and isn’t a device, requires injection into the fat. One big benefit for the cosmetic practice is that Kybella doesn’t require investment in a device, nor does it require the space needed for devices.
“We have special rooms set up for SculpSure and CoolSculpting, where we have wide-screen TVs and special spa-like beds,” Dr. McDaniel says.
Dr. McDaniel, who uses all three options, says the geometric shapes of the two devices are different and can sometimes limit potential candidates. CoolMini’s applicator is an oval, while SculpSure’s is a rectangle.
In people who have double chins that run east, west — or ear to ear — versus, north and south, there may be a difference in which applicator may fit the anatomy, according to Dr. McDaniel.
“Right now both devices are one-size-fits-all. In some patients CoolSculpting or SculpSure will fit and the other will not. Just quirks in your jaw and anatomy, and which direction your fat runs,” Dr. McDaniel says.
Kybella can be used on almost any shape or geometric pattern of submental fat, and it doesn’t depend on contact with suction or straps. But some patients and doctors hesitate to use Kybella because many patients experience significant temporary posttreatment edema.
“Patients can get anything from a very tiny bit of swelling to an extreme case, termed ‘bullfrog neck’. That can last for a long time. There’s research now on how to minimize or avoid that,” Dr. McDaniel says.
Dr. Katz, who did the FDA trials for Kybella, says the swelling associated with Kybella use is a big problem when one considers that Kybella requires three or four treatments.
“We do [Kybella] at one-month intervals, so it can take four months until you see results or longer,” Dr. Katz says. “Whereas, with the laser, it’s usually one or two treatments and you don’t get any swelling or discomfort after.”
Treatment Insights
Addressing double chins could result in patients wanting more.
“Once people aren’t fixated on their double chin, they notice other things,” Dr. McDaniel says.
For example: platysmal muscle bands might become more visible after submental fat treatment. Or patients might want more skin tightening after the noninvasive treatment, he says.
“Sometimes, we’ll use the CoolMini or SculpSure on the submental area and, if there’s a little residual fat left, touch up the area with Kybella,” Dr. McDaniel says.
Patient satisfaction is usually very high if you select the cases properly. The equipment is safe. SculpSure has the ability to sense if the patient moves during treatment, and so does CoolMini. The fat removal appears to be very enduring or permanent.
Physicians offering any of these treatments should be careful treating around the marginal mandibular nerve, according to Dr. McDaniel.
“The nerve can be fairly variable in location. You don’t want to treat that nerve. The “insulation” of the nerve is a lipid. If you damage it, you can have sensory or motor changes which typically resolve with time,” he says.
