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Criolipolise
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FUNDAMENTOS
DE CRIOLIPOacuteLISEFAacuteBIO BORGES
CRIOLIPOacuteLISE
2CONCEITO
Eacute o resfriamento localizado do tecido adiposo subcutacircneo com
temperatura em torno de -5 a -15 ordmC (medidas externamente)
causando paniculite fria e morte adipocitaacuteria por apoptose
- Estaacute indicada para gordura localizada (Celulite)
(Natildeo eacute adequado para grande volume de gordura ou gordura
visceral)
CRIOLIPOacuteLISE
3EFEITOS FISIOLOacuteGICOS
1) Apoptose adipocitaacuteria
- O termo apoptose se traduz por morte celular programadardquo
- Eacute um tipo de auto-destruiccedilatildeo celularrdquo
- Exemplo disso satildeo os queratinoacutecitos ceacutelulas da camada mais
externa da pele Durante o processo natural de ldquorenovaccedilatildeo da
pelerdquo ao migrarem das camadas mais profundas para a superfiacutecie
da pele morrem por apoptose Assim a camada mais externa da
pele eacute feita de ceacutelulas apoptoacuteticas
CRIOLIPOacuteLISE
4CRIOLIPOacuteLISE PANICULITE APOPTOSE
PERIODO PROCESSO Fonte
- Imediatamente apoacutes a
criolipoacutelise
Natildeo haacute nenhum dano nos adipoacutecitos Preciado et al 2008
- Apoacutes 24 a ateacute 72 horas A reaccedilatildeo inflamatoacuteria pode iniciar-se Jewell et al 2011 Farraro et al 2012 Zelickson et
al 2009
- Em 7 dias - Uma paniculite intensa se desenvolve e
atinge seu pico em aproximadamente 14
dias
Manstenin et al 2009
- Do 14ordm ateacute o 30ordm dia Macroacutefagos comeccedilam a envolver e
digerir os adipoacutecitos apoptoacuteticosManstenin et al 2009 Rocha 2013 Boey amp
Wasilenchuk 2014
- A partir dos 30 dias A inflamaccedilatildeo diminui (a atividade
fagocitaacuteria continua) mas os resultados
cliacutenicos comeccedilam a ficar mais evidentes
Manstenin et al 2009 Rocha 2013
- De 60 a 120 dias Haacute eliminaccedilatildeo efetiva dos adipoacutecitos -
ocorre lentamente (Durante 90 dias pelo
menos)
Manstenin et al (Lasers Surg Med 40595-604) 2009 Jalian e Avram 2013
CRIOLIPOacuteLISE
5EFEITOS FISIOLOacuteGICOS
2) Fenocircmento da Reperfusatildeo
Restabelecimento do sangue numa aacuterea antes isquecircmica (Bulkley 1987
Evora 1996)
- A restauraccedilatildeo de sangue poacutes-criolipoacutelise eacute capaz
a) Levar a uma inflamaccedilatildeo
b) Produzir uma matriz de radicais livres de oxigeacutenio (Espeacutecies reativas de
oxigecircnio)
c) Ativaccedilatildeo de enzimas proteoliacuteticas (Caspases)
d) ldquoMorterdquo celular adipocitaacuteria
(Preciado e Allison 2008 Manstein et al 2009 Sasaki et al 2014)
CRIOLIPOacuteLISE
6EQUIPAMENTO
Constituiccedilatildeo
1) Central de controle ou Console (o equipamento propriamente
dito)
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
2CONCEITO
Eacute o resfriamento localizado do tecido adiposo subcutacircneo com
temperatura em torno de -5 a -15 ordmC (medidas externamente)
causando paniculite fria e morte adipocitaacuteria por apoptose
- Estaacute indicada para gordura localizada (Celulite)
(Natildeo eacute adequado para grande volume de gordura ou gordura
visceral)
CRIOLIPOacuteLISE
3EFEITOS FISIOLOacuteGICOS
1) Apoptose adipocitaacuteria
- O termo apoptose se traduz por morte celular programadardquo
- Eacute um tipo de auto-destruiccedilatildeo celularrdquo
- Exemplo disso satildeo os queratinoacutecitos ceacutelulas da camada mais
externa da pele Durante o processo natural de ldquorenovaccedilatildeo da
pelerdquo ao migrarem das camadas mais profundas para a superfiacutecie
da pele morrem por apoptose Assim a camada mais externa da
pele eacute feita de ceacutelulas apoptoacuteticas
CRIOLIPOacuteLISE
4CRIOLIPOacuteLISE PANICULITE APOPTOSE
PERIODO PROCESSO Fonte
- Imediatamente apoacutes a
criolipoacutelise
Natildeo haacute nenhum dano nos adipoacutecitos Preciado et al 2008
- Apoacutes 24 a ateacute 72 horas A reaccedilatildeo inflamatoacuteria pode iniciar-se Jewell et al 2011 Farraro et al 2012 Zelickson et
al 2009
- Em 7 dias - Uma paniculite intensa se desenvolve e
atinge seu pico em aproximadamente 14
dias
Manstenin et al 2009
- Do 14ordm ateacute o 30ordm dia Macroacutefagos comeccedilam a envolver e
digerir os adipoacutecitos apoptoacuteticosManstenin et al 2009 Rocha 2013 Boey amp
Wasilenchuk 2014
- A partir dos 30 dias A inflamaccedilatildeo diminui (a atividade
fagocitaacuteria continua) mas os resultados
cliacutenicos comeccedilam a ficar mais evidentes
Manstenin et al 2009 Rocha 2013
- De 60 a 120 dias Haacute eliminaccedilatildeo efetiva dos adipoacutecitos -
ocorre lentamente (Durante 90 dias pelo
menos)
Manstenin et al (Lasers Surg Med 40595-604) 2009 Jalian e Avram 2013
CRIOLIPOacuteLISE
5EFEITOS FISIOLOacuteGICOS
2) Fenocircmento da Reperfusatildeo
Restabelecimento do sangue numa aacuterea antes isquecircmica (Bulkley 1987
Evora 1996)
- A restauraccedilatildeo de sangue poacutes-criolipoacutelise eacute capaz
a) Levar a uma inflamaccedilatildeo
b) Produzir uma matriz de radicais livres de oxigeacutenio (Espeacutecies reativas de
oxigecircnio)
c) Ativaccedilatildeo de enzimas proteoliacuteticas (Caspases)
d) ldquoMorterdquo celular adipocitaacuteria
(Preciado e Allison 2008 Manstein et al 2009 Sasaki et al 2014)
CRIOLIPOacuteLISE
6EQUIPAMENTO
Constituiccedilatildeo
1) Central de controle ou Console (o equipamento propriamente
dito)
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
3EFEITOS FISIOLOacuteGICOS
1) Apoptose adipocitaacuteria
- O termo apoptose se traduz por morte celular programadardquo
- Eacute um tipo de auto-destruiccedilatildeo celularrdquo
- Exemplo disso satildeo os queratinoacutecitos ceacutelulas da camada mais
externa da pele Durante o processo natural de ldquorenovaccedilatildeo da
pelerdquo ao migrarem das camadas mais profundas para a superfiacutecie
da pele morrem por apoptose Assim a camada mais externa da
pele eacute feita de ceacutelulas apoptoacuteticas
CRIOLIPOacuteLISE
4CRIOLIPOacuteLISE PANICULITE APOPTOSE
PERIODO PROCESSO Fonte
- Imediatamente apoacutes a
criolipoacutelise
Natildeo haacute nenhum dano nos adipoacutecitos Preciado et al 2008
- Apoacutes 24 a ateacute 72 horas A reaccedilatildeo inflamatoacuteria pode iniciar-se Jewell et al 2011 Farraro et al 2012 Zelickson et
al 2009
- Em 7 dias - Uma paniculite intensa se desenvolve e
atinge seu pico em aproximadamente 14
dias
Manstenin et al 2009
- Do 14ordm ateacute o 30ordm dia Macroacutefagos comeccedilam a envolver e
digerir os adipoacutecitos apoptoacuteticosManstenin et al 2009 Rocha 2013 Boey amp
Wasilenchuk 2014
- A partir dos 30 dias A inflamaccedilatildeo diminui (a atividade
fagocitaacuteria continua) mas os resultados
cliacutenicos comeccedilam a ficar mais evidentes
Manstenin et al 2009 Rocha 2013
- De 60 a 120 dias Haacute eliminaccedilatildeo efetiva dos adipoacutecitos -
ocorre lentamente (Durante 90 dias pelo
menos)
Manstenin et al (Lasers Surg Med 40595-604) 2009 Jalian e Avram 2013
CRIOLIPOacuteLISE
5EFEITOS FISIOLOacuteGICOS
2) Fenocircmento da Reperfusatildeo
Restabelecimento do sangue numa aacuterea antes isquecircmica (Bulkley 1987
Evora 1996)
- A restauraccedilatildeo de sangue poacutes-criolipoacutelise eacute capaz
a) Levar a uma inflamaccedilatildeo
b) Produzir uma matriz de radicais livres de oxigeacutenio (Espeacutecies reativas de
oxigecircnio)
c) Ativaccedilatildeo de enzimas proteoliacuteticas (Caspases)
d) ldquoMorterdquo celular adipocitaacuteria
(Preciado e Allison 2008 Manstein et al 2009 Sasaki et al 2014)
CRIOLIPOacuteLISE
6EQUIPAMENTO
Constituiccedilatildeo
1) Central de controle ou Console (o equipamento propriamente
dito)
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
4CRIOLIPOacuteLISE PANICULITE APOPTOSE
PERIODO PROCESSO Fonte
- Imediatamente apoacutes a
criolipoacutelise
Natildeo haacute nenhum dano nos adipoacutecitos Preciado et al 2008
- Apoacutes 24 a ateacute 72 horas A reaccedilatildeo inflamatoacuteria pode iniciar-se Jewell et al 2011 Farraro et al 2012 Zelickson et
al 2009
- Em 7 dias - Uma paniculite intensa se desenvolve e
atinge seu pico em aproximadamente 14
dias
Manstenin et al 2009
- Do 14ordm ateacute o 30ordm dia Macroacutefagos comeccedilam a envolver e
digerir os adipoacutecitos apoptoacuteticosManstenin et al 2009 Rocha 2013 Boey amp
Wasilenchuk 2014
- A partir dos 30 dias A inflamaccedilatildeo diminui (a atividade
fagocitaacuteria continua) mas os resultados
cliacutenicos comeccedilam a ficar mais evidentes
Manstenin et al 2009 Rocha 2013
- De 60 a 120 dias Haacute eliminaccedilatildeo efetiva dos adipoacutecitos -
ocorre lentamente (Durante 90 dias pelo
menos)
Manstenin et al (Lasers Surg Med 40595-604) 2009 Jalian e Avram 2013
CRIOLIPOacuteLISE
5EFEITOS FISIOLOacuteGICOS
2) Fenocircmento da Reperfusatildeo
Restabelecimento do sangue numa aacuterea antes isquecircmica (Bulkley 1987
Evora 1996)
- A restauraccedilatildeo de sangue poacutes-criolipoacutelise eacute capaz
a) Levar a uma inflamaccedilatildeo
b) Produzir uma matriz de radicais livres de oxigeacutenio (Espeacutecies reativas de
oxigecircnio)
c) Ativaccedilatildeo de enzimas proteoliacuteticas (Caspases)
d) ldquoMorterdquo celular adipocitaacuteria
(Preciado e Allison 2008 Manstein et al 2009 Sasaki et al 2014)
CRIOLIPOacuteLISE
6EQUIPAMENTO
Constituiccedilatildeo
1) Central de controle ou Console (o equipamento propriamente
dito)
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
5EFEITOS FISIOLOacuteGICOS
2) Fenocircmento da Reperfusatildeo
Restabelecimento do sangue numa aacuterea antes isquecircmica (Bulkley 1987
Evora 1996)
- A restauraccedilatildeo de sangue poacutes-criolipoacutelise eacute capaz
a) Levar a uma inflamaccedilatildeo
b) Produzir uma matriz de radicais livres de oxigeacutenio (Espeacutecies reativas de
oxigecircnio)
c) Ativaccedilatildeo de enzimas proteoliacuteticas (Caspases)
d) ldquoMorterdquo celular adipocitaacuteria
(Preciado e Allison 2008 Manstein et al 2009 Sasaki et al 2014)
CRIOLIPOacuteLISE
6EQUIPAMENTO
Constituiccedilatildeo
1) Central de controle ou Console (o equipamento propriamente
dito)
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
6EQUIPAMENTO
Constituiccedilatildeo
1) Central de controle ou Console (o equipamento propriamente
dito)
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
7EQUIPAMENTO - Aplicador
2) Aplicador de tratamento (ligado ao console
por um cabo)
Tambeacutem chamado Maniacutepulo Manopla ou
- Alccedila de tratamento
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
8EQUIPAMENTO
3) VAacuteCUO
- A forccedila do vaacutecuo 80 a 100 Kpa (Kilopascals) (650 a 750 mmHg)
- A pressatildeo deve ser moderada (ldquoDESENHAR SUAVEMENTErdquo a prega
no ldquocopordquo do aplicador)
- Alguns equipamentos possuem um controle automaacutetico do
vacuo (a pressatildeo inicia-se com um niacutevel mais alto e a medida que
o tempo de tratamento avanccedila a pressatildeo diminui
automaticamente)
- Isso pode ser feito manualmente
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
9Formaccedilatildeo da ldquopregardquo
- Durante a aplicaccedilatildeo os
tecidos da aacuterea alvo (pele
e gordura) satildeo ldquosugadosrdquo
para dentro do aplicador
por meio de um vaacutecuo
moderado para entatildeo
posicionaacute-los entre as duas
placas de resfriamento
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
10TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Natildeo haacute uma regra
- Em meacutedia de 1 a 3 APLICACcedilOtildeES para bons resultados
Obs 1 Dependendo espessura da gordura (Interface gordura-derme)
precisaremos de mais de 1 sessatildeo para atingirmos niacuteveis subcutacircneos
mais profundos (Manstein et al 2009)
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
11TECNICA DE APLICACcedilAtildeO
Quantidade de aplicaccedilotildees
- Segundo Dierickx et al (2013) a taxa de satisfaccedilatildeo dos clientes
pode chegar a 73 apoacutes 1 sessatildeo
- Num estudo com 528 clientes apenas 6 ficaram insatisfeitos com 1
sessatildeo mas 4 desses seis clientes mostraram satisfaccedilatildeo tratados
pela segunda vez (Stevens et al 2013)
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
12TECNICA DE APLICACcedilAtildeO
Periodicidade
INTERVALO
- 2 meses tem respaldo na literatura (Shek et al 2012 Coleman et al 2009 Stevens et al 2013
Garibyan 2014)
- Pratica cliacutenica 30 dias (Aspecto comercial onde se ldquovenderiardquo mais
atendimentos alem do ldquoagradordquo aos clientes que acreditam que quanto mais aplicaccedilotildees
melhores seriam os resultados)
Obs 2 EFEITOS A partir de 1 semana ou 10 dias (incomum)
ldquoResultado definitivordquo a partir de 30 a 60 dias (90 dias)
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
13TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Coleman et al (2009) Os resultados podem continuar evoluindo
ateacute 6 meses apoacutes o tratamento (verificaram reduccedilatildeo de 255 neste
periacuteodo)
-Nelson et al (2009) relataram reduccedilotildees significativas na gordura
subcutacircnea (20 a 80) ao longo dos primeiros 3 meses apoacutes o
tratamento
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
14TECNICA DE APLICACcedilAtildeO
ANAacuteLISE FINAL DOS RESULTADOS POacuteS-TRATAMENTO
ldquoPode ocorrer alem dos 2 meses poacutes-tratamentordquo
- Brightman amp Geronemus (2011) apoacutes 4 meses do tratamento uma
reduccedilatildeo meacutedia de 20 de gordura nas aacutereas tratadas
- Sasaki et al (2014) 45 dias apoacutes o tratamento (Fotos) resultados
discretos
- Entretanto 6 meses apoacutes o procedimento mostraram resultados
mais significativos (reduccedilatildeo de 196 - Ultrassonogrfia) especialmente
no abdocircmen e flancos
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
15Temperatura de tratamento
- Segundo alguns autores (Manstein et al 2009 Nelson et al 2009) o grau de
paniculite depende da temperatura utilizada = quanto menor a
temperatura maior a inflamaccedilatildeo e consequentemente melhores
satildeo os resultados
Mercado
-5ordmC -10ordmC ou -15ordmC
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
16TECNICA DE APLICACcedilAtildeO
Tempo de aplicaccedilatildeo
- Pode variar de 45 (Brightman amp Geronemus 2011) a 60 min (Boey amp Wasilenchuk 2014 Boey et al 2012 Stevens et
al 2013)
- Na praacutetica cliacutenica o tempo mais utilizado eacute 60 minutos
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
17TECNICA DE APLICACcedilAtildeO
AVALIACcedilAtildeO
- Demarca-se a regiatildeo a ser tratada a fim de direcionar o
posicionamento do aplicador
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
18AVALIACcedilAtildeO
- Peso IMC
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
19AVALIACcedilAtildeO
- Mensuraccedilatildeo
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
20AVALIACcedilAtildeO
- Anaacutelise ultrassonograacutefica
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
21TECNICA DE APLICACcedilAtildeO
ASSOCIACcedilOtildeES TERAPEcircUTICAS
- Pratica clinica Associaccedilatildeo de vaacuterios recuros terapecircuticos
- ANTES
- Imediatamente APOacuteS a aplicaccedilatildeo
- Nas SEMANAS (meses) que se seguem (intervalo entre as sessotildees)
- QUAL O OBJETIVO Aumentar a inflamaccedilatildeo eou tratar possiveis
adipoacutecitos natildeo atingidos pelo frio ou estimular reperfusatildeo
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
22Associaccedilotildees terapecircuticas
Protocolos de ASSOCIACcedilAtildeO comuns no ldquomercadordquo
- Massoterapia ultrassomultracavitaccedilatildeo radiofrequecircncia e ateacute
carboxiterapia logo apoacutes (ou natildeo) a criolipoacutelise
Obs Com exceccedilatildeo da massoterapia (e Ondas de Choque) natildeo
encontramos respaldo na literatura para o uso desses recursos
termoteraacutepicos poacutes-criolipoacutelise
ldquoMAIORIA DOS PROTOCOLOS SEM COMPROVACcedilAtildeOrdquo(Resultados questionaacuteveis e com grande apelo cormercial)
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
23Associaccedilotildees terapecircuticas
- Recomenda-se CAUTELA nas ldquoassociaccedilotildeesrdquo ateacute que
haja mais base em estudos cientiacuteficos
- OPCcedilAtildeO Dependendo do recurso muitos profissionais
tem feito as associaccedilotildees somente a partir de 30 dias apoacutes
a criolipoacutelise onde o quadro de paniculite se reduz
bastante
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
24TECNICA DE APLICACcedilAtildeO
Associaccedilotildees terapecircuticas
Massoterapia
- Facilita a homogeneidade da cristalizaccedilatildeo no local de tratamento
- Diminui a ldquodeformaccedilatildeordquo tecidual (ldquopregardquo)
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
25Estudo Boey amp Wasilenchuk 2014
- Objetivo Avaliar o uso da massagem imediatamente apoacutes a
criolipoacutelise no abdomem
- Protocolo Um dos lados recebeu massagem vigorosa por 1 minuto
(amassamento) + 1 minuto de massagem circular usando as pontas
dos dedos
- Resultados 4 Meses apoacutes A reduccedilatildeo da gordura foi 44 maior no
lado massageado (Ultrassonografia)
- Conclusatildeo A massagem pode ter causado um mecanismo adicional
de dano celular imediatamente apoacutes o tratamento
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
26MASSOTERAPIA X REPERFUSAtildeO
- Apoacutes a criolipoacutelise a massagem local restabeleceu a
temperatura mais raacutepido do que indiviacuteduos que natildeo receberam
massagem (Sasaki et al 2014)
- Este efeito foi hipotetizado como potencializador da apoptose
adipocitaacuteria em virtude do fenocircmeno da reperfusatildeo (Sasaki et al 2014)
(Liberaccedilatildeo de espeacutecies reativas de oxigecircnio e ativaccedilatildeo de outros eventos
intracelulares deleteacuterios)
Obs Bernstein et al (2014) recomendaram massagem por 5 minutos
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
27PROTOCOLOS MERCADOLOacuteGICOSSUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE RECURSOS
- Imediatamente apoacutes a criolipoacutelise Recursos que aceleram o aumento
da temperatura local podem estimular a reperfusatildeo Manstein et al 2008 Preciado JA Allison
2009 Sasaki et al 2014
a) Massoterapia (comprovado) Boey amp Wasilenchuk 2014 Sasaki et al 2014
b) Ondas de choque (comprovado) Hunt e Stork 2013 Fe rraro et al 2012
c) RadiofrequecircnciaRonzio e Meyer 2010 (Ponteira monopolar ndash temperatura de 37ordm a
38ordmC por 5 a 7 minutos por aacuterea)
d) Ultrassom terapecircutico Borges 2010 (Dose de 15Wcm2 modo contiacutenuo)
e) Talvez a Carboxiterapia Scorza e Jahara 2010 (caso haja toleracircncia a dor fluxo de
50 a 60 mlmin teacutecnica hipodeacutermica
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
28PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 30 dias apoacutes a criolipoacutelise Carboxiterapia (fluxo 50 a 60 mlmin) para
aumentar o fluxo sanguiacuteneo e favorecer o aporte de elementos
fagocitaacuterios na aacuterea tratada
Obs Outros recuros que estimulam a circulaccedilatildeo tambeacutem pode ser
utilizados
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
29PROTOCOLOS MERCADOLOacuteGICOS
SUGESTAtildeO DE ASSOCIACcedilAtildeO CONSCIENTE DE OUTROS RECURSOS
- 45 dias (em diante) apoacutes a criolipoacutelise Objetiva-se atingir
adipoacutecitos que provavelmente natildeo foram afetados pelo frio
a) Ultrassom (Dose de 25 a 30Wcm2 modo contiacutenuo)Borges 2010
b) Ultracavitaccedilatildeo Jewell et al 2011 Weiss et al 2013
c) Radiofrequecircncia Trelles et al 2009 Franco et al 2010 (Ponteira monopolar ndash temperatura de 42ordm
a 43ordmC por 10 a 12 minutos por aacuterea)
d) Carboxiterapia Balik et al 2011 Costa et al 2011 (Carbolipoacutelise ndash Fluxo de 150 a 200 mlmin
teacutecnica hipodeacutermica profunda)
e) Ondas de choque Hunt e Stork 2013 Ferraro et al 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
30RESULTADOS
- Mulher de 57 anos
- Tratamento de ldquodobras
em naacutedegas
- (B D) Cinco meses apoacutes
2 sessotildees em cada lado
STEVENS ET AL BROAD OVERVIEW OF A CLINICAL AND COMMERCIAL EXPERIENCE WITH COOLSCULPTING AESTHETIC SURGERY JOURNAL AUGUST 2013 - VOL 33 (6)
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
31RESULTADOS
Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009 Dec28(4)244-9
Quatro meses apoacutes a 1ordf sessatildeo (Paciente engordou 16 Kg)
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
32
APLICACcedilAtildeO DE MULTIPLAS AacuteREAS
Eacute comum a sobreposiccedilatildeo de aplicaccedilotildees numa mesma regiatildeo
ANTES 12 SEMANAS APOacuteS 1deg TRATAMENTO
15 Kg acima do peso normal
reg
Poroduzido por Flor A Mayoral (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
12 SEMANAS APOacuteS 2deg TRATAMENTO
Volta ao peso normal
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
33
ANTES 20 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Kathleen Welsh (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
4 SEMANAS APOacuteS 2deg TRATAMENTOreg reg
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
34
ANTES 8 SEMANAS APOacuteS 1deg TRATAMENTOreg
Poroduzido por Edward Becker (CoolSculpting ndash Zeltiq)
reg
2deg TRATAMENTO1deg TRATAMENTO
9 SEMANAS APOacuteS 2deg TRATAMENTO
(Natildeo houve mudanccedila de peso)
reg reg
reg reg
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
35
TECNICA DE APLICACcedilAtildeO
IMPORTANTE
Em virtude de natildeo ser invasiva e de natildeo necessitar de
anesteacutesicos ou qualquer outro medicamento a
criolipoacutelsie pode ser realizada por qualquer profissional
da aacuterea de esteacutetica
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
36EFEITOS ADVERSOS
- NOacuteDULOS (Fibrose) (Dierickx et al 2013)
-Podem aparecer noacutedulos (infiltraccedilatildeo
inflamatoacuteria) em poucos dias apoacutes
-Todos os casos (12) tiveram resoluccedilatildeo
espontacircnea com regressatildeo completa
- Os pacientes tiveram maior eficaacutecia
do que aqueles que natildeo tiveram a
infiltraccedilatildeo
(Hipoacutetese maior resposta inflamatoacuteria =
melhor resposta terapecircutica)
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
37EFEITOS ADVERSOS
- HIPERPLASIA ADIPOSA PARADOXAL POacuteS-CRIOLIPOacuteLISE (Jalian et al 2014)
- O episoacutedio eacute raro (incidecircncia 1 em 20000 casos) parece acometer
mais os homens (+ 65 casos Zeltiq)
- Seu iniacutecio ocorre 2 a 3 meses apoacutes o tratamento
- Muitas vezes ocorre apoacutes uma reduccedilatildeo inicial da gordura
subcutacircnea
- Ateacute entatildeo ainda natildeo verificaram evidecircncias de resoluccedilatildeo
espontacircnea da afecccedilatildeo
- Quando necessaacuterio o tratamento se daacute por meio da lipoaspiraccedilatildeo
ou abdominoplastia
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
38ldquoEFEITO CONTRALATERAL BENEacuteFICOrdquo ENRIJECIMENTO DA PELE
- Stevens (Ago2014) verificou em 2 clientes um enrijecimento substancial da
pele na aacuterea tratada Cryodermadstringo
- Carruthers et al (Dez2014) relataram que haacute melhora consistente na textura
da pele flacidez e ateacute na celulite apoacutes o tratamento com a criolipoacutelise
- Esta melhora TAMBEacuteM foi relatada por muitas pessoas (25 de todos que
receberam atendimentos - mais de 8000 atendimentos)
-Nenhum aumento de flacidez na pele foi relatado ou verificado apoacutes a
criolipoacutelise
- Os autores ainda natildeo descobriram o mecanismo exato disto mas suspeitam
que pode ser alguma produccedilatildeo estimulada de colaacutegeno elastina fibrose ou
uma compactaccedilatildeo do tecido
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
OBRIGADO
Email fabioborges2000gmailcom
Site wwwproffabioborgescombr
Instagram fabioborges2000
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
40REFERENCIASREFERENCIAS
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and SurgeryFrontline Medical Communications 2013 p1085-5629
- Manstein D Laubach H Watanabe K Anderson RR A novel cryotherapy method of non-invasive selective lipolysis Lasers
Surg Med 2008 20 104
- Zelickson B Egbert BM Preciado J Allison J Springer K Rhoades RW Manstein D Cryolipolysis for noninvasive fat cell
destruction initial results from a pig model Dermatol Surg 2009 35 1462-1470
- Stevens WG Pietrzak LK Spring MA Broad Overview of a Clinical and Commercial Experience With CoolSculpting
Aesthetic Surgery Journal August 2013 - vol 33 (6) p835-846
- Mayoral F Kaminer M Kilmer S et al Effect of multiple cryolipolysis treatments on the abdomen Annual Meeting of the
American Society for Laser Medicine and Surgery 2012 Kissimmee FL
- Shek SY Chan NPY Chan HH Non-invasive cryolipolysis for body contouring in Chinesemdasha first commercial experience
Lasers in Surgery and Medicine Vol44(2) p125ndash130 Feb 2012
- Jalian HR Avram MM Cryolipolysis Um histoacuterico perspectiva e praacutetica cliacutenica atual Seminars in Cutaneous Medicine
and Surgery Frontline Medical Communications 2013 p 1085-5629
- Brightman L Geronemus R Can second treatment enhance clinical results in cryolipolysis Cosmetic
Derm 2011 24(2)85ndash88
- Avram MM Harry RS Cryolipolysis for subcutaneous fat layer reduction Lasers Surg Med 200941703ndash708
- Hengartner MO The biochemistry of apoptosis Nature 2000 407770-76
- Cohen JJ Apoptosis Immunol Today v14 p126-130 1993
- Ziegler U Groscurth P Morphological features of cell death News Physiol Sci 2004 19124-28
- Hackeumlr G The morphology of apoptosis Cell Tissue Res v301 p5-17 2000
- Ranganath RM Nagashree NR Role of programmed cell death in development Int Rev Cytol 2001 202159-242
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
41REFERENCIAS- Lee K R Clinical Efficacy of Fat Reduction on the Thigh of Korean Women through Cryolipolysis J Obes Weight Loss Ther
2013 36
- Coleman SR Sachdeva K Egbert BM Preciado P Allison J Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on
Peripheral Nerves Aesth Plast Surg 19 Mar 2009 (online)
- Dierickx CC Mazer JM Areia M S Koenig Arigon V Safety tolerance and patient satisfaction with noninvasive
cryolipolysis Dermatologic Surgery 2013 39(8)1209-1216
- Manstein D Laubach H Watanabe K et al Selective cryolysis A novel method of non-invasive fat removal Lasers Surg
Med 40595-604 2009
- Rocha LO Criotermolipoacutelise Tecnologia natildeo invasiva para reduccedilatildeo de medidas remodelagem corporal tratamento de
cellulite e flacidez cutacircnea CampD-Revista Eletrocircnica da Fainor Vitoacuteria da Conquista v6 n1 p64-78 janjun 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg v35 (5) 2011
- Ferraro GA Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring Aesthetic Plast Surg
v36 (3) 2012
- Matos et al Hemoglobinuacuteria paroxiacutestica ao frio quando suspeitar Nascer e Crescer vol 21 (03) Porto Set 2012
- Nelson AA Wasserman D Avram MM Cryolipolysis for reduction of excess adipose tissue Semin Cutan Med Surg 2009
Dec28(4)244-9
- Boey GE Wasilenchuk JL Enhanced clinical outcome with manual massage following cryolipolysis treatment A 4-month
study of safety and efficacy Lasers in Surgery and Medicine Vol46(1) pag 20ndash26 Jan 2014
- Saltz R Cryolipolysis Treatment to Transformation One Year Safety and Efficacy Follow-up The Aesthetic Meeting 2014 ndash
Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Broyles J The Safety and Efficacy of Cryolipolysis A Systematic Review of Available Literature The Aesthetic Meeting 2014
ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
42REFERENCIAS
- Stevens WG Feasibility Study of a Cryolipolysis Surface Applicator for Non-Invasive Fat Reduction in the Outer Thigh The
Aesthetic Meeting 2014 ndash Building the bridge between science and art Moscone Center - San Francisco CA April 2014
- Dover J Burns J Coleman S et al A prospective clinical study of noninvasive Cryolipolysistrade for subcutaneous fat layer reduc-
tion Poster presented at 2009 ALSMS Annual Conference April 2009 National Harbor MD
- Dover J Saedi N Kaminer M et al Side effects and risks associated with cryolipolysis Annual Meeting of the American Society
for Laser Medicine and Surgery 2011 Grapevine TX
- Klein KB Zelickson B Riopelle JG Okamoto E Bachelor EP Harry RS Preciado JA Non-invasive cryolipolysistrade for
subcutaneous fat reduction does not affect serum lipid levels or liver function testsdagger Lasers in Surgery and Medicine Vol 41 Issue
10 p 785ndash790 Dec 2009
- Costa JV Duarte JS Tecido adiposo e adipocinas Acta Med Port 2006 19 251-256
- Santos LC Torrent IF O tecido adiposo e a produccedilatildeo de adipocinas SynThesis Revista Digital FAPAM Paraacute de Minas v2 n2
110-119 nov 2010
- Preciado JA Allison JW The effect of cold exposure on adipocytes Examining a novel method for the noninvasive removal of
fat Cryobiology 2008 57 315ndash340
- Evora PRB Pearson PJ Seccombe JF Schaff HV Lesatildeo de Isquemia-Reperfusatildeo Aspectos Fisiopatoloacutegicos e a Importacircncia da
Funccedilatildeo Endotelial Arq Bras Cardiol Vol 66 (nordm 4) 1996
- Boey G Wasilenchuk J Preciado J Effect of post-treatment manual massage on efficacy following a cryolipolysis procedure
Annual Meeting of the American Society for Laser Medicine and Surgery 2012 Kissimmee FL
-Nieda VK Michlovitz SL Cryotherapy In Michlovitz SL Thermal in Rehabilitation 3ordf ed Philadelphia FA Davis Company 1996
p83
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
43REFERENCIAS- Kitchen S Efeitos Teacutermicos In Kitchen S Eletroterapia ndash Praacutetica baseada em evidecircncias Satildeo Paulo Manole 2ordf ed bras 2003
109-10p
- Gregoacuterio OA Cavalheiro R Tirelli R Freacutez AR Ruaro MB Ruaro JA Influecircncia do tempo de aplicaccedilatildeo da crioterapia na
sensibilidade cutacircnea Rev dor15(1)12-12 Jan-Mar2014
-Knight KL Crioterapia no tratamento das lesotildees esportivas Satildeo Paulo Manole 2000 127-49p
- Weiss R Weiss M Beasley K Vrba J Bernardy J Operator Independent Focused High Frequency ISM Band for Fat
Reduction Porcine Model Lasers in Surgery and Medicine Vol 45(4) pages 235ndash239 Apr 2013
- Jewell ML Solish NJ Desilets CS Noninvasive body sculpting technologies with an emphasis on high-intensity focused
ultrasound Aesthetic Plast Surg 2011 Oct35(5)901-12
- Trelles et al Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system
Lasers Med Sci Mar 2009
- Shalom A et al Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects
Undergoing Abdominoplasty A Placebo-Control Pilot Study Dermatol Surg 2013 May39(5)744-51
- Jewell ML et al Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting 24-
Week Aesthetic Surgery Journal 2012 32 868
- Scorza FA Borges FS Carboxiterapia Uma revisatildeo Revista Fisioterapia Ser ndash Ano 3 ndash no 4 ndash OutNovDez ndash 2008
- Kaffer EN Carboxiterapia Infusatildeo Terapecircutica Dermatoloacutegica de CO2 em tratamentos capilares faciais e corporais ndash
Novas Praacuteticas em Carboxiterapia Capilar Facial e Corporal Produccedilatildeo Assista DVD 1 2009
- Worthington A Lopez JC Carboxiterapia ndash Utilizaccedilatildeo do CO2 para Fins Esteacuteticos In Yamaguchi C II Annual Meeting of
Aesthethic Procedures Satildeo Paulo Santos 2006567-71
- Vilos GA Vilos AG Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure J Am Assoc Gynecol
Laparosc 2003 Aug 10(3) 415-20
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
44REFERENCIAS- Spalding KL Arner E Westermark PO Bernard S Buchholz BA Bergmann O Blomqvist L Hoffstedt J Naslund E Britton T
Concha H Hassan M Ryden M Frisen J Arner P Dynamics of fat cell turnover in humans Nature 2008 453(7196)783ndash787
- Hunt AJ Stork H Cryolipolysis e Terapia Acoustic Onda Prime- International Journal of Aesthetic and Anti-Aging
Medicine - 19 September 2013
- Skolarikos A Mitsogiannis H Deliveliotis C Indications prediction of success and methods to improve outcome of
shock wave lithotripsy of renal and upper ureteral calculi (review) Arch Ital Urol Androl 2010 8256ndash63
- Jalian HR Avram MM Garibyan L Mihm MC Anderson RR Paradoxical adipose hyperplasia after cryolipolysis JAMA
Dermatol 2014150(3)317-319
- Bulkley GB Free radical-mediated reperfusion injury A selective review Br J Cancer Suppl 1987 866ndash73
- Kayser C Correcirca MJU Andrade LEC Fenocircmeno de Raynaud Rev Bras Reumatol 200949(1)48-63
- Garibyan L Sipprell WH Jalian HR Sakamoto FH Avram M Anderson RR Three-dimensional volumetric quantification of
fat loss following Cryolipolysis Lasers in Surgery and Medicine Vol46( 2) p 75ndash80 Feb 2014
-Stevens WG Does Cryolipolysis Lead to Skin Tightening A First Report of Cryodermadstringo Aesthetic Surgery Journal -
August 2014 34 NP32-34
-Bacci PA Leibaschoff G La Celulitis Medical Books Gascoacuten2000 p19-196
- Bartoletti Medicina Esteacutetica ndash Metodologie Diagnostiche Preventive e Corretive Editrice Salus Internazionale 1998
p405-423
- Bernstein EF Longitudinal evaluation of cryolipolysis efficacy two case studies J Cosmet Dermatol 201312(2)149ndash152
- Levy RA Cryoglobulinemia and Cryofibrinogenemia Fitzpatricks Dermatology MedGenMed 5ordf ed Nova York
McGrawHill 1999
- Silveira DWS Boery EN Boery RNSO Reflexotildees acerca da crioterapia na fase aguda da artrite reumatoacuteide e suas
correlaccedilotildees com a crioglobulinemia RevSauacutedeCom 2006 2(2) 153-160
- Knight KL Crioterapia no Tratamento das Lesotildees Esportivas 1 ed Satildeo Paulo Manole 2000
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
45REFERENCIAS
-Sidhu HK Dukes GD Goldenberg D Dermatopathology of Rheumatologic Diseases Expert Rev Dermatol 20127(2)137-
148
- Shachafa S Yaira M Correlaccedilatildeo entre a siacutendrome antifosfolipiacutedica e acrioglobulinemia seacuterie de quatro casos e revisatildeo da
literatura RBR 2014153
-Coelho MC Melo E Albuquerque A Saraiva JP Pimentel A Siacutendrome de Sjogren Primaacuteria - revisatildeo teoacuterica Rev Soc Port
Med Int 2002 9(3)156
-- Freitas T MC Medeiros AMC Oliveira PT Lima KC Siacutendrome de Sjoumlgren revisatildeo de literatura e acompanhamento de um
caso cliacutenico Rev Bras Otorrinolaringol [online] 2004 vol70 n2 pp 283-288
- Goeldner I Skare TL Reason ITM Utiyama SCR Artrite reumatoide uma visatildeo atual J Bras Patol Med Lab 2011
47(5)495-503
-Wener MH Hutchinson K Morishima C Gretch DR Absence of Antibodies to Cyclic Citrullinated Peptide in Sera of
Patients With Hepatitis C Virus Infection and Cryoglobulinemia Arthritis amp Rheumatism 2004 50(7)2305ndash08
- Shumaker PR et al Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model Part 2
Lasers in Surgery and Medicine 2006 38(3) 211ndash217
- Franco W Kothare A Ronan SJ Grekin RC McCalmont TH Hyperthermic injury to adipocyte cells by selective heating
of subcutaneous fat with a novel radiofrequency device feasibility studies Lasers Surg Med 2010 Jul 42 (5) 361-70
- Boisnic S Divaris M Nelson AA Gharavi NM Lask GP A Clinical and Biological Evaluation of a Novel Noninvasive
Radiofrequency Device for the Long-Term Reduction of Adipose Tissue Lasers in Surgery and Medicine 2014 4694ndash103
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
CRIOLIPOacuteLISE
46REFERENCIAS
- Brandi C DrsquoAniello C Grimaldi L Bosi B Dei I Lattarulo P Alessandrini C Carbon Dioxide therapy in the treatment of
localized adiposities clinical study and histopathological correlations Aesthetic Plast Surg 2001 May-Jun 25(3)170-4
- Balik O Yilmaz M Bagriyanik ADoes carbon dioxide therapy really diminish localized adiposities Experimental study
with rats Aesthetic Plast Surg 2011 35(4)470-4
-Costa CS Otoch JP Seelaender MCL Neves RX Martinez CAR Margarido NF Avaliaccedilatildeo citomeacutetrica dos adipoacutecitos
localizados no tecido subcutacircneo da parede anterior do abdome apoacutes infiltraccedilatildeo percutacircnea de CO2 Rev Col Bras
Cir 2011 38(1)15-23
- Munavalli G Cryolipolysis for the treatment of male pseudogynecomastia Lasers Surg Med 201345(S25)16
- Garcia PN Shockwave therapy to treat cellulite Prime- International Journal of Aesthetic and Anti-Aging Medicine -
June 2012
