While GLP-1s have changed the way we think about nonsurgical body contouring, they haven’t made those treatments obsolete. In fact, one recent case from Delray Beach, FL dermatologist Dr. Janet Allenby shows how the two can go hand in hand. On a recent episode of The Beauty Authority, Dr. Allenby shared the results of a patient on tirzepatide who also underwent an extensive nonsurgical body sculpting treatment plan. Rather than focus on weight loss alone, the goal was to use CoolSculpting to help shape the areas that remained resistant as her body changed. “She got that body that was something that she couldn’t have gotten without contouring with the weight loss,” says Dr. Allenby. “She got her dream body.”
A Chin-to-Knees Treatment Plan
The patient, who was in her 40s, wanted to lose about 20 pounds, but Dr. Allenby didn’t wait for her to reach her goal before starting body contouring. “We started her on GLP-1s and at the same time, because she wanted pretty quick changes, we started her immediately on CoolSculpting,” she says.
Over the next 18 weeks, the patient came in for four CoolSculpting sessions spaced about six weeks apart. “We treated her from the chin to the knees,” says Dr. Allenby, who continued to reassess her shape as the weight came off. That was important because what bothers a patient at the beginning may change along the way. “When you look at yourself in the mirror and you think it’s all in your abdomen, once you get rolling and you see that maybe it’s the flanks and the back, there are more things,” she says. Spacing out the sessions also meant “you could target an area that just was more stubborn.”
The Joys of No Downtime
An extensive plan like this doesn’t mean coming in for every individual application. Dr. Allenby has multiple CoolSculpting devices and can perform four applications at once. In this case, the patient spent four eight-hour days in her office over the 18-week period. For the patient, one of the benefits of going the nonsurgical route was being able to return to her routine between sessions. “She was back at work every eight-hour day that she’s been in here,” says Dr. Allenby. “She went right back to work the next day.”
What About PAH?
Any discussion of CoolSculpting also has to address paradoxical adipose hyperplasia, or PAH, a known complication in which the opposite of the intended effect occurs: Instead of shrinking, fat in the treated area grows. “It’s something people have to know that it’s a potential,” says Dr. Allenby, who describes true PAH as having a distinctive appearance. “It matches the shape of the applicator where the fat grew.”
Dr. Allenby believes PAH may have been underdiagnosed before awareness of the complication grew but says the pendulum has since swung in the other direction. “It is now way over diagnosed because everybody who thinks they didn’t have [a result], especially because of the old applicators, people didn’t do enough treatments,” she says. In other words, she believes some patients who suspect PAH may simply have had an inadequate response or been undertreated, something she says can be addressed with additional cycles when true PAH has been ruled out. “Everybody’s fat does respond a little bit different,” she says. “Some people don’t need much treatment. Some people you do have to do multiple treatments to get them there.”
A Combination Approach
When it comes to getting these types of results, Dr. Allenby says it’s really about knowing the right approach. While her patient underwent a significant number of CoolSculpting cycles, she was also taking tirzepatide and lost about 20 pounds during that time. Both were working at once, and Dr. Allenby says patients don’t necessarily have to wait until they’ve reached their goal weight to start contouring. “You can probably do it about 15, 20 pounds before your ideal weight is hit,” she says.
Her approach is also about avoiding weight loss at the expense of overall body composition. “We want you to have some muscle mass,” she says. “You have to keep all those other pieces together.”
Watch the full episode of The Beauty Authority above to hear more from Dr. Allenby about this case, CoolSculpting, PAH and the other nonsurgical body treatments she’s using now.
