Ultrasound and cavitation

The HIFU technique originates in medicine and is used for kidney stone fragmentation for instance. Ultrasound creates high and low pressure waves (2 MHz, energy density 1,000-3,000 W/cm²) which oscillate the body tissue. Several sound probes are focused on a particular area of the subcutaneous fat tissue and the applied high ultrasound and pressure energies stretch the fat cells until the cell membranes crack and the cell content runs into the interstitium. There, the triglycerides and phospholipids are emulsified through ultrasound and then removed with the lymph fluid. Depending on the intensity of the ultrasound there even occur bleeding lesions in the fat tissue. The following healing process shrinks the tissue which results in a reduced body circumference. The procedure is painful and may lead to fibrotisations and lump formation in the lipid and connective tissue. The health authorities (FDA) in the United States have not approbated the HIFU technique for the treatment of fat tissue. The initially improved body shape may then end up with a lumpy and wavy skin appearance in the long run. In order to maintain the slimmed body shape on a long-term basis, a change in nutrition and an exercise-based fat burning is absolutely essential [1, 2, 3].

Ultrasound cavitation methods use low frequency ultrasound (38-40 KHz, energy density up to 5 Watt/cm²). Cavitation is a physical process which uses oscillations in the fat tissue in order to generate gas bubbles which subsequently implode with high energy and high temperatures. Cavitation in technical applications leads to material fatigue and destruction, such as in propellers of ships [4,5]. The medical diagnosis aims at avoiding cavitation processes. For this purpose, the ultrasonic power of the devices is limited. Particularly in the pregnancy management, it has to be ensured that cavitation processes in the tissue of the fetus are strictly ruled out. In the context of a fat cell reduction however, the cavitation processes in fat cells are provoked. The sound energy generated here is lower than with the HIFU method. As a result, the lipid cell membrane is stretched and becomes more permeable. This process can be visualized as a once overstretched balloon which then loses its capacity to keep inflated. Similarly, overstretched fat cells are no longer able to store triglycerides to the extent they used to. The number of fat cells in the human body is genetically determined. In other words, the body will not form new fat cells. After the cavitation treatment, the existent cells lose their capacity to store fat with the result that the body circumference shrinks.

In medicine, the lipoclasia technique is a well-known method to treat lipomas. Unlike fat cells, lipomas are characterized by a tough connective tissue capsule. As a consequence, lipomas are more difficult to cure than the fat stores in problem areas. In a small-scale study, lipomas have been treated with 38 kHz ultrasound. For instance, a 12 x 8 x 2.5 cm lipoma has been attended for 10 minutes with low frequency ultrasound. Subsequently, the tissue was analyzed with diagnostic ultrasound. The lipoma could be reduced by 0.3 cm in diameter and lipid pools could be observed within the lipoma, a fact which proved the release of triglycerides from the fat cells [6].

 

It has to be mentioned though, that cavitation techniques alone are inadequate fat reduction methods in the long run. A lasting success only is ensured by a change in nutrition and exercise-based fat burning processes in the muscular tissue.

Radio frequency treatments

Radio waves allow to heat specific areas of the skin and the subcutaneous fat tissue through electromagnetic energy. Diathermia leads to a warming of the tissue by stimulating the oscillations of water dipoles, and also causes a fluidizing of the cell membranes. During the monopolar radio frequency treatment, radio waves penetrate into the deeper skin layers until they are absorbed by the lipocytes in the hypodermis. The fatty tissue shows a high resistance to radio waves of 2,180 Ohm (compared to muscle fibers with a RF resistance of 110 Ohm). The considerable resistance step between the different tissues causes a heating of the tissue with higher resistance. As a result, the cell membrane is damaged to the extent that the fat storing capacities of the lipocytes are considerably reduced. The physical properties of the cell membrane are modified by the radio waves. The cell membranes of the fat cells become more permeable and the content of the cells (triglycerides) is released into the interstitial fluid. In addition, the connective tissue is tightened by radio waves and both heat shock proteins and collagen synthesis are stimulated. This again causes the fatty tissue to shrink and tightens the connective tissue. radioSURG 2200 (Fa. Meyer-Haake GmbH, Ober-Mörlen) is a monopolar radio frequency unit for radio surgery; it generates differently modulated and unmodulated high frequency currents at a frequency of 2.2 MHz. Equipped with a specific RF cone electrode the device is used for radio frequency treatments of the skin and the subcutaneous fat tissue.

Regarding the bi, tri or multipolar radio frequency techniques which also are used for fat cell reduction, the active electrodes and the antenna are integrated into a hand piece and connected against each other. The result is that the radio frequency field in parallel skin layers spreads with the same resistance. The skin layers warm up evenly, however, the temperature ranges required for fluidizing the lipid bilayers on the fatty cell membranes are insufficient. It should also be mentioned that hydrophilic actives cannot be used with bi and multipolar techniques as this would cause short circuits between the electrodes. This is the reason why only isolating oils and lipophilic substances are applied. Hence, the monopolar radio frequency technique to fluidize the fat cell membrane is more appropriate for the reduction of fat cells.

The different physical fat cell reduction methods only are appropriate means to treat localized fat stores. Thus, adipose patients need to reduce their weight before the treatment. It is a widespread misapprehension though, that high tech magic is able to melt down weight, and that a slim body shape can be achieved for good without diets and efforts. Nevertheless, if both sport and diets are no longer successful, there exists indeed relief for problem zones with "saddlebags", "love handles" and cellulite.

Now, the question arises why invariably women suffer from these "problem zones"? To illustrate this phenomenon, we need to go far back in the evolution of men. Up to the 7th month of pregnancy, male and female embryos show the same pattern of development. From the 7th month onwards the testosterone hormone takes effect in the male fetus. Hence, a tight and cross-linked connective tissue starts to develop. The estrogen influence causes the formation of an elastic connective tissue due to parallel collagen fibrils particularly in the abdominal area, upper thighs and buttocks of the female fetus. During puberty, the subcutaneous fat tissue of women again modifies and fat cells start to accumulate in the loose connective tissue. If the fat cells swell due to a gain in weight, indentations and bumps will form on the skin surface, a condition which is called cellulite.

The specific structure of the female connective tissue allows the considerable stretching of the skin during pregnancy. Thereby, room is made for the growing baby. In addition, specific hormone active fat tissue accumulates in the" problem zones". The so-called gender-specific fat stores are the reserve fund for bad times and have guaranteed the survival of mankind in prehistoric times. Today, we live in abundance and there is no need to be afraid of famines. The reserve fund has finally developed into a "problem zone". Diets cause fat reductions in every other body area except for the problem zones. The reserves are only tapped in extremities. Hence, "love handles", "saddlebags" and cellulite can only be fought with drastic measures. Nevertheless, the body will fight back with all available resources. Crash diets are well-known for their yoyo effect though. And wounds and sores automatically activate repair mechanisms. The HIFU method causes bleeding wounds in the fatty tissue, which subsequently heal but leave marks such as fibrotisation and indentations. The immediate effect is a reduced body circumference which makes the customers happy. The long-term effects, however, are indentations and an irregular body contour.

Also all the other methods of fat cell reduction lack a long-term or permanent effect if the natural reactions of the body to the attacks on its energy reserves, the "fatty tissue" are not taken into consideration.

With due regard to the physiology and pathophysiology of the fat metabolism, the liporeduction method according to Dr. Jabs has been developed.

A combination of a change in nutrition following the insulin food combining according to Dr. Pape [7], fat burning through exercising, lymph drainage using the Schumann-3D-plate^®, the emptying of fat cells and modified cell membranes through appropriate physical techniques und membrane modifying preparations achieves a long-term degradation of fat stores in problem zones, an improved body contour and a reduction of cellulite.

Change of nutrition

The nutrients ingested with food are metabolized or, in other words, "burned" with the help of the inhaled oxygen in order to generate energy. Instead of an open flame, the burning process occurs in the body cells in form of various well-organized chemical reactions. If the nutrient supply is higher than the consumption, the surplus energy is stored in form of fat in the fat tissue.

The fat tissue serves not only as storage depot, as a matter of fact it also is an endocrinal and hormone sensitive organ that controls the storage and release of energy. In this system, the insulin monitors the blood sugar level but also the fat storage. With high insulin level, fat is stored in the depots, with low insulin level, the fat cells are "opened" and the released triglycerides are used to generate energy.

Nevertheless, the insulin food combining is not a lopsided crash diet but rather implies that the supply of food is adapted to the respective insulin level.

In the morning, mainly carbohydrates are ingested. The carbohydrates are then made available in the liver in order to produce short-term energy. Top level athletes can be stated here as an example with their spaghetti parties where they eat enormous amounts of carbohydrates in order to quickly fill up their energy stores before the start of their competitions.

At noon, a balanced diet is eaten.

In the evenings, only salads, soups and proteins are ingested but no carbohydrates.

Insulin is released from the pancreas. If the meals do not contain carbohydrates or only a small amount of carbohydrates, the insulin level decreases. Hence, the fatty cells are emptied and the triglycerides are used to generate energy. The insulin food combining according to Dr. Pape is also known with the slogan "slim down while you sleep". The basic idea is that the energy needs for cardiac activity and the balanced body temperature, for instance, is covered by the fatty cells when the insulin level is low. The result is that the fatty cells shrink, the body circumference reduces and the body weight is decreasing.

Exercise

The released fat is needed to generate energy in the muscular system. This means that fat only is degraded by muscular activity. Weight reduction or a reduction of fat depots without physical effort is simply an illusion and basically impossible due to physiological reasons. At most, it could result in a relocation of the fatty tissue. In order to lose weight on a long term base and empty the fat depots, it is necessary to exercise at a moderate pace. This can be done in form of a fast walk which accelerates the heart frequency or by jogging or walking. Also a treatment on the Schumann-3D-plate^® activates the muscles and causes an increased lymph flow.

Schumann-3D-plate^®

The Schumann-3D-plate^® is a newly developed biodynamic energy system (BDES) that imitates the natural movement sequences without applying stimulation currents and chemical substances (CoW Health Technologies, Gomaringen). The device does not involve the typical unnatural "hard" movements that occur in the majority of traditional vibration plates and are a strain for the joints. The finely tuned three dimensional and rhythmic oscillation pulses of the Schumann-3D-plate^® use the Schumann resonance frequency and have a holistic effect on the metabolism and the cellular system of the body.

Figure: Schumann-3D-plate^®

Professor Otto W. Schumann, physician, discovered electromagnetic resonance frequencies which have a positive effect on the human body and activate the metabolism. The Schumann-3D-plate^® treatment supports the transport of triglycerides released from the emptied fatty cells to the liver in the lymph flow, activates the fat metabolism in the fat tissue, stimulates fat degrading enzymes and hormones and induces the muscular system to burn fats. A 5 minute treatment on the Schumann-3D-plate^® has the same fat burning effect as a 30 minute walk.

Low frequency ultrasound (cavitation)

Unlike the HIFU method, the low frequency ultrasound does not cause micro lesions in the fatty tissue in order to induce repair mechanisms. The alternating high and low pressure of sound waves in the range between 38-40 KHz only causes the fatty cell membranes to oscillate. The thus overstretched membrane fluidizes the lipid bilayer and the stored triglycerides can escape. The resonance stress damages the membrane with the result that the storage capacity of the fat cells is considerably reduced ("the balloon has been overstretched and is no longer able to hold the air"). The triglycerides are emulsified with membrane components such as phospholipids and then released into the lymph flow. Appropriate preparations can intensify the emulsification.

A liposomal formulation with phosphatidylcholine, green tea extract, which contains caffeine and stimulates the fat metabolism, and butcher's broom, which activates the blood flow, is used in combination with the liporeduction method. The removal of the emulsified fats in the lymph flow is supported by the drainage effect of the Schumann-3D-plate^®. It also oscillates large groups of muscles which stimulates the fat burning process in the muscular system. 

The liporeduction method according to Dr. med. Jabs

The treatment starts with a detailed analysis of the nutrition and a measurement of the body constitution (B.I.A. = Bioelectrical impedance analysis). Adipose patients should proceed with a weight reduction based on insulin food combining and an exercise program. Localized fat stores in problem zones and cellulite areas are tested for their acuteness with the Thermo-Cell-Test^® (liquid crystal foils for thermographic applications).

Subsequently, the fat deposits are treated with low frequency ultrasound (BODYFORMA, Fa. Forever Hairfree GmbH, Moers).

Figure: Bodyforma ultrasound device

A specific ultrasound gel containing a mixture of liposomal green tea extract, butcher's broom extract and NMF complex (Fa. KOKO GmbH & Co.KG, Leichlingen) is used during the therapy. The respective body parts are treated with ultrasound for about 30 minutes. The ultrasound device Megason (ESM-4500MO, Medical CE 1023, SensorData GmbH, Lüdenscheid) works in a frequency range of 32-43 kHz. This frequency spectrum causes a resonance of the membranes of differently sized fat cells. The 38 mm ultrasonic probe also is equipped with integrated infrared LEDs.

The infrared light additionally activates the flavonoids and polyphenols of the green tea extract. Green tea stimulates the fat metabolism and the thermogenesis. After that, a 15 minute radio frequency treatment (Fa. Meyer-Haake GmbH, Wehrheim) will follow. Finally, the Schumann-3D-plate^® is used for the lymph drainage and muscular stimulation. (CoW Health Technologies, Gomaringen). 

Figure: Schumann-3D-plate^® - use in horizontal position

The customers are handed out a specific cellulite cream (liposomal green tea, butcher's broom, NMF mixed into a dermaviduals^® membrane cream) for the skin care at home. They are also recommended to stimulate the fat metabolism by massaging the problem zones with a brush before they apply the cream at home.

Also the change of nutrition according to the insulin food combining is discussed and individually adapted, if necessary. A daily exercise program rounds off the liporeduction method according to Dr. med. Jabs. The specific treatment of subcutaneous fat in due consideration of physiological and pathophysiological mechanisms in the human body can achieve a long term reduction

published in
Ästhetische Dermatologie (mdm)
2011 (2), 26-32