實證醫學看冷凍溶脂 EBM of Cryolipolysis

這幾年醫美市場新興的塑身整形技術：冷凍溶脂(cryolipolysis)，最近在各家期刊中正反意見開始被炒得火熱。

作用機轉

其原理是利用儀器導入低溫造成脂肪細胞凍傷壞死。其作用詳細機轉尚未被完全了解，一理論認為是低溫時細胞結晶(crystallization)並影響細胞內代謝及自由基釋放造成細胞破壞^(1,2)，而另一派理論則認為是結晶後重新灌流傷害(re-perfusion injury)活化細胞凋亡(apoptosis)路徑⁽³⁾。

相對於傳統抽脂手術

較少疼痛、無麻醉風險是冷凍溶脂的相對優勢，不過與傳統抽脂手術一樣有水腫(edema)、瘀青(bruising)、紅腫(erythema)與短暫神經異常(transient neuralgia)之副作用。極低的比率會發生反向脂肪增生(paradoxical adipose hyperplasia)^(4-6) ，目前猜測是與多次冷凍溶脂治療後相關^(5,6)。

EBM

就實證醫學的角度而言，冷凍溶脂成效如何? 除了零星幾篇cases series之外^(3,4,9)，多數關於cryolipolysis的論文皆是小樣本數的研究，直到2015年才有2篇review articles^(8,9)。就目前paper review的信度與效度而言，cryolipolysis確實是可以減少脂肪組織，但減少之比率從<2%到25.5%不等^(10,11)。

小結 

以實務而言，冷凍溶脂在非侵入性治療中有其成效。但須經多次治療，才可能達到傳統抽脂手術一次即可達到的效果，目前其價格亦不斐，是否符合經濟效益與需求仍有討論空間。

Reference:

1.     Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: A novel method of non-invasive fat removal. Lasers Surg Med. 2008;40:595–604.

2.     Pinto H, Arredondo E, Ricart-Jane D. Evaluation of adipo-cytic changes after a simil-lipocryolysis stimulus. Cryo Letters 2013;34:100–105.

3.     Sasaki GH, Abelev N, Tevez-Ortiz A. Noninvasive selective cryolipolysis and reperfusion recovery for localized natural fat reduction and contouring. Aesthet Surg J. 2014;34:420–431.

4.     Dierick CC, Mazer JM, Sand M, Koenig S, Arigon V. Safety, tolerance, and patient satisfaction with noninvasive cryolipolysis. Dermatol Surg. 2013;39:1209-1216.

5.     Stefani W. Adipose Hypertrophy Following Cryolipolysis. Aesthet Surg J. 2015;35(7):NP218-NP220.

6.     Seaman SA, Tannan SC, Cao Y, et al. Paradoxical Adipose Hyperplasia and Cellular Effects After Cryolipolysis: A Case Report. Aesthet Surg J 2016;36(1):NP6–NP13.

7.     Stevens WG, Pietrzak LK, Spring MA. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthet Surg J. 2013;33(6):835-846.

8.     Derrick CD, Shridharani SM, Broyles JM. The Safety and Efficacy of Cryolipolysis: A Systematic Review of Available Literature. Aesthet Surg J 2015;35(7):830–6.

9.     Ingargiola MJ, Motakef S, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plast. Reconstr. Surg. 2015;135(6):1581–90.

10.  Swanson E. Prospective outcome study of 360 patients treated with liposuction, lipoabdominoplasty, and abdominoplasty. Plast Reconstr Surg. 2012;129:965-978, discussion. 979–980.

11.  Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesth Plast Surg. 2009;33:482-488.