Noninvasive Body Contouring

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Body contouring traditionally refers to surgical removal of fat and/or skin or surgical modification of the breast. While body contouring procedures are often highly successful, they are nonetheless associated with risk, downtime and scarring. Recently, noninvasive technology-based devices have been used in an effort to tighten skin and reduce the thickness of fat layers in the abdomen, flanks (“love handles”), back and thighs. While these treatments do not provide the same degree of correction as surgery, they may be well suited for a select group of individuals.


After introduction to the US market in 2002, Thermage remains one of the most reliable noninvasive skin tightening treatments available. The term Thermage refers to a device that heats the skin in a controlled manner, thus inducing tightening—it is useful to think of Thermage treatment as inducing a ‘shrink wrap” or contouring effect. Thermage treatments may be used on the face, neck, eyelids, abdomen, arms and thighs.

  • Before Treatment: Anesthesia, pain medications or injections are not required prior to Thermage treatment.
  • During Treatment: Thermage treatments are performed in the office and typically take 45-60 minutes to complete. Discomfort during treatment is mild and Thermage treatments are generally extremely well tolerated. Within a few minutes of completing a Thermage treatment there is no visible evidence (bruising, swelling, etc.) that a procedure has been performed.
  • After Treatment: Patients may resume their normal activities without restrictions or limitations immediately after undergoing a Thermage treatment. With regard to results, while some tightening of the treated skin is typically observed at the conclusion of a Thermage treatment, ongoing improvement occurs over a period of up to six months. If Thermage treatment is performed by a skilled and experienced operator, the associated risks are negligible. Dr. Biesman developed and directed initial testing of the Thermage eyelid treatment.

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Ultherapy is a noninvasive treatment that has been on the US market since 2009. It is a noninvasive treatment that uses focused ultrasound (sound waves) to selectively heat the skin at several depths to produce nonsurgical tightening and lifting. Ultherapy is the only nonsurgical treatment to be recognized by the FDA as producing a lifting effect. Ultherapy is currently FDA approved for noninvasive lifting of the eyebrows and the skin beneath the chin and on the neck and for improvement of lines and wrinkles in the decollete region.

  • Before Treatment: Ultherapy treatments can be somewhat uncomfortable. Some patients choose to take Tylenol or Ibuprofen prior to treatment while others take prescription drugs such as valium and/or Percocet. If you choose to take prescription medications you will need someone to drive you to and from your treatment.
  • During Treatment; Ultherapy treatments are performed in the office and take approximately an hour to complete. It is possible but relatively uncommon to develop bruising after Ultherapy treatment
  • After Treatment: Patients may resume their normal activities immediately after Ultherapy treatment unless they have taken prescription sedatives or pain medications in which case they must not drive, operate machinery, or make important decisions. Visible results of an Ultherapy treatment are typically apparent before a patient leaves the office while the maximum benefit is typically achieved 3-6 months after treatment.

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Noninvasive Fat Layer Reduction

Noninvasive fat layer reduction is the newest area of technology-based research. Several approaches have been used in an attempt to improve body contour without invasive procedures. These approaches include the use of:

  • Lasers
  • Radiofrequency and other devices which heat the fat
  • Low-energy light sources,
  • Cold therapy
  • Injectables

The latter, cold therapy, has proven over many years and millions of treatments to be the most dependable, reliable,  and safe method of noninvasively getting rid of unwanted, excess fat collections. The principle guiding cold treatment of fat, known commercially by the term CoolSculpting, is that fat is more susceptible to injury cold than skin, blood vessels, and other important structures.


CoolSculpting is a procedure developed by a company known as Zeltiq. CoolSculpting treatments use special applicators which freezes the fat while leaving surrounding structures uninjured. CoolSculpting may be performed to reduce unwanted fat on the abdomen (belly), flanks (love handles), inner and outer thighs, back (near the bra line), to treat the “puffs” that form in the location where the arm meets the chest, to reduce the size of male breasts, and, most recently, under the chin. After a single CoolSculpting treatment the treated fat layer is reduced in thickness by 20-25%. The affected fat is broken down and  and excreted via the body’s natural processes. There is no measurable elevation of cholesterol, triglycerides or other harmful substances following CoolSculpting treatment. Multiple CoolSculpting treatments may be performed to achieve additional benefits if necessary. Maximum outcomes are generally seen after three months. Results from CoolSculpting treatment are permanent.

  • Before Treatment: CoolSculpting treatment does not require advance preparation, sedation or anesthesia.
  • During treatment: CoolSculpting treatments can take from 1 to several hours to complete, depending on the number of areas being treated. During your treatment you  may relax, watch television, read, use our secure wireless wi-fi for work or entertainment purposes, listen to your favorite music or pass the time any way you like.
  • After Treatment: There are no limitations of activity after CoolSculpting treatment. Maximum benefit is typically seen 3 months after treatment. While some patients will experience bruising in the treated area, as most treated areas are covered by clothing bruising rarely is a problem. Despite several years of testing and millions of treatments performed worldwide,  there have been no serious complications of CoolSculpting treatment.

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Kybella, is a trade name given to a naturally occurring product used by our bodies to break down fats that we eat.  When injected into unwanted fat collections, Kybella breaks down the fat leading to improvement in contour. Kybella was first studied in the area under the chin.  Dr. Biesman and his clinical research team were part of the initial clinical trials performed with Kybella (then known by its experimental name ATX-101) and thus has extensive experience using this product. Kybella received FDA clearance in 2015 and has become an important addition to our noninvasive body contouring options. Two or more Kybella treatments are typically required to achieve best outcomes.

  • Before treatment: As bruising can occur following Kybella treatment, it is ideal to discontinue the use of aspirin, ibuprofen, and other blood thinners 1-2 weeks prior to treatment.  If blood thinners have been prescribed by a physician, do not discontinue their use without first obtaining your doctor’s permission to do so.  Kybella treatments are performed in the office and do not require sedation.  Most patients choose to have local anesthetic injected into the treated area.
  • During treatment. Kybella injections are delivered through a tiny needle and take just a few minutes to administer. Cold compresses are applied immediately after treatment to help reduce swelling.
  • After treatment; Swelling does occur after Kybella treatment; the amount of swelling varies from mild to marked. Using cold compresses intermittently for the first day after treatment helps minimize swelling. There is minimal discomfort after Kybella treatment which may or may not require ibuprofen. Results of Kybella injections are typically seen as early as 1 month after injection with maximum improvement achieved approximately 3 months after treatment.

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