Treatment to TransformationAssessment and Treatment Techniques To Optimize Patient Satisfaction from

Cryolipolysis

Laura K. Pietrzak, MSHS, PA-CManager, The Institute at Marina Plastic Surgery

Marina del Rey, California

Disclosures

• Laura Pietrzak is an investigator for ZELTIQ research studies

Off-Label Treatments

• In the US, CoolSculpting is cleared for non-invasive fat reduction on the flank and abdomen.

• This presentation contains off-label treatments to additional areas.

THE SCIENCE AND ART OF COOLSCULPTING

"With our new comprehensive and customized patient treatment plans, our patients have been ecstatic with their CoolSculpting results. In the last 3 years, our practice has seen a dramatic increase in patients requesting non-surgical body contouring, many of which are men. In my opinion, CoolSculpting should be a part of every plastic surgeon's practice" - Grant Stevens, M.D., F.A.C.S., Marina Plastic Surgery Associates

The SCIENCE of Cryolipolysis for Fat Elimination

Cryolipolysis

• Derived from two case reports– 1970 - Popsicle panniculitis1

– 1980 - Equestrian cold panniculitis2

• Key findings– Fat cells are more susceptible to cold than

Skin, Nerve, Muscle

– Possible to trigger (apoptosis) natural cell death by delivering cooling through the skin surface

1. Epstein EH, Jr., Oren ME. Popsicle panniculitis. N Engl J Med 1970;282(17):966–967.

2. Beacham BE, Cooper PH, Buchanan CS, Weary PE. Equestrian cold panniculitis in women. Arch

Dermatol 1980;116(9):1025–1027.

Developed from breakthrough research from Dieter Manstein, MD, PhD

and R. Rox Anderson, MD at Massachusetts General Hospital

Proven Evidence of Fat Layer Reduction1

UltrasoundPre-treatment and 3-month post-

treatment images of subcutaneous

fat showed 0.7 cm or >40%

decrease in thickness of fat layer

occurred over a 90-day period

Gross PathologyGross pathology from the same

treatment site showed superficial

fat layer at the center of treatment

site reduced 1 cm or 50% at 90

days post-treatment compared to

untreated region

Skin

Fat layer

Fascia

Pre-treatment 3 months post-treatment

1.6 cm0.9 cm

1.2 cm

1.3 cm

Pre-Treat 3 Months Post-Treat

1 Zelickson, et al., Cryolipolysis™ for Noninvasive Adipocyte Cell Death: Initial Results from a Pig Model, Derm Surg, 35: 10: 1462 – 1470 10/09

The CoolSculpting System

The CoolSculpting Applicator

Vacuum

Applicator

Uniform

Treatment

Cooling Panel with

Freeze-Detect

TechnologyTM

Treated Area

Natural

Feathering

• Each cooling cycle is 60 minutes

• The applicator contains 2 opposing cooling

panels that perform a precise energy extraction

(cold) optimized to injure only adipocytes

Post-Treatment Massage

• On average, at two months post-treatment, the fat layer reduction was 68% greater in the massaged side than in the non-massaged side

Boey et al. Effect of Post-Treatment Manual Massage on Efficacy Following a

Cryolipolysis Procedure. Presented at 2012 ASLMS Conference.

Subject BOEYMAS008

Pre-Procedure 2 Month Follow-Up

Non-massage Massage Non-massage Massage

Evidence of Long-Term Efficacy with

CoolSculpting

8 WEEKS AFTER

(Single side treatment)

2 YEARS AFTER

(Single side treatment)

(+10 pounds)

Procedure by Eric Bernstein, MD

BEFORE

2X

5 YEARS AFTER

(Single side treatment )

(-10 pounds)

BEFORE

Evidence of Long-Term Efficacy with

CoolSculpting

Clinical Publications

• More than 30 published

clinical papers and

abstracts

• Findings conclude:

• No rise above normal levels

for triglycerides or cholesterol

• Histologic evidence shows skin &

surrounding structures are safe

• MD observable reduction in

80% of subjects

• Overall patient satisfaction

from self-assessment“Cryolipolysis is a very low risk, no downtime procedure

that produces consistent observations of modest, gradual

fat layer reduction in properly selected patients.”

A.J. Burns, et al, abstract accepted for 2010 ASLMS: Analysis of Side Effects of

Noninvasive Cryolipolysis for Subcutaneous Fat Layer Reduction – Interim Report

from Controlled Clinical Trials

Clinical Publications• Largest cryolipolysis study published to date, presenting a retrospective

review of 528 patients.

August 2013

CoolSculpting Safety MechanismsThermal Coupling Gel Pad

• Unique patented formula

• Applied to the skin surface before placement of applicator

• Ensures consistent thermal contact

• Insulates skin during treatment

Freeze DetectTM Sensors and Software

• Patented technology detects changes in skin temperature

• If freeze is detected, treatment stops immediately

Thermal Coupling Gel Pad

Freeze DetectTM Sensors

The ART of Treatment to Transformation

Reflecting on the Approach with Fillers Today

• With experience, physicians have changed the approach with fillers

– One syringe does not equal full correction

– Full correction can take 3+ syringes

Old Method New Method

vs.

Transformation Through

Customized CoolSculpting® Treatments

• Wide range of CoolSculpting® applicators available

• Applicators are essential tools for customized body sculpting

Where We’ve Been: Localized Bulge Reductions

• Excellent results following our original protocols

• Single treatment in as little as one hour

• Diet and exercise-resistant fat

• Well defined fat bulges with borders

• Treat at the peak of the bulge

8 Weeks After CoolSculpting

Procedure by Madeline Krauss, MD

Before

12 Weeks After CoolSculpting

Procedure by Edward Becker, MD

(No weight change)

Before

BEFORE FOUR MONTHS AFTERProcedure by Laura K. Pietrzak, PA-C

Effective Treatment of Discrete Bulges

BEFORE THREE MONTHS AFTERProcedure by Laura K. Pietrzak, PA-C

Effective Treatment of Discrete Bulges

Treatment to Transformation

• Global body assessment of all potential treatment areas

• Customized treatment plan based on individual patient’s shapes, needs, and goals

• Set expectations upfront for follow-up visit to re-assess, re-plan and re-treat

Treatment to Transformation (T2T)

T2T is an advanced concept that allows our practices to successfully

treat patients that they may have previously turned away

• What is Treatment to Transformation?

– An advanced treatment plan focusing on enhancing CoolSculpting® outcomes

– A global approach to assessing the body; addressing all potential treatment areas

– Prescribing a sufficient number of hours in a given treatment area to achieve

desired results

– Re-assessing, re-planning, and re-treating

• Why is it important?

– It leads to more pleasing outcomes

– It’s likely to create the “wow” factor

– It results in greater patient satisfaction and word-of-mouth referrals

T2T Treatment

Plan Example

Treatment to Transformation (T2T) is an advanced

CoolSculpting® concept

• What are the risks of under-treatment?

– Can lead patients to believe that the treatment did not meet expectations

– Increased chance of demarcation or step off

– Non-cosmetically pleasing outcomes that require correction

Treatment to Transformation (T2T)

Example of Under-Treatment

Better Treatment

Plan

Applicator placed too low

Actual Treatment

Plan

1. Under treated

2. Highlights importance of accurate

applicator placement

Key Takeaways:

Optimized Treatment Plan

Anterior

Optimized Treatment Plan

Posterior

Actual Treatment Plan

Example of Under-Treatment

Treatment to Transformation (T2T):Patient Assessment Techniques

Treatment to Transformation (T2T):Patient Assessment Techniques

Treatment to Transformation (T2T):Patient Assessment Techniques

Tools for Success

• With CoolSculpting, you can debulk and sculpt the body

Debulk Sculpt

T2T Patient Assessment

Debulking and Sculpting: Creating Beautiful Outcomes

BEFORE

FIRST TREATMENT SECOND TREATMENT

8 WEEKS AFTER

First CoolSculpting Treatment

9 WEEKS AFTER

Second CoolSculpting TreatmentProcedure by Edward Becker, MD

(No weight change)

ANTERIOR TREATMENT

4 MONTHS AFTERProcedure by John B. Fasano, MD

(No weight change)

BEFORE

POSTERIOR TREATMENT

Debulking and Sculpting: Creating Beautiful Outcomes

ANTERIOR TREATMENT

4 MONTHS AFTER

Procedure by John B. Fasano, MD

(No weight change)

BEFORE

POSTERIOR TREATMENT

Debulking and Sculpting: Creating Beautiful Outcomes

3 MONTHS AFTER

Procedure by Laura K. Pietrzak, PA-C

(-4 pounds)

BEFORE

Debulking and Sculpting: Creating Beautiful Outcomes

FIRST TREATMENT SECOND TREATMENT

FIRST TREATMENT SECOND TREATMENT

1 Year AfterFirst CoolSculpting® Treatment

(No weight change)

2 Years AfterSecond CoolSculpting® Treatment

(No weight change)

Procedure by Laura K. Pietrzak, PA-C

Before

Treatment to Transformation (T2T):Multiple Treatments in the Same Area

FIRST TREATMENT SECOND TREATMENT

CoolSculpting the Abdomen and Flanks

FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE TWO MONTHS

CoolSculpting the Abdomen and Flanks

FIRST TREATMENT SECOND TREATMENT

FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE TWO MONTHS

CoolSculpting the Abdomen

FIVE MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Abdomen and Flanks

TWO MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

BEFORE

THREE MONTHSProcedure by

Laura K. Pietrzak, PA-C

ANTERIOR TREATMENT POSTERIOR TREATMENT

CoolSculpting the Abdomen and Flanks

THREE MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Back

TWO MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Chest

FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE TWO MONTHS

CoolSculpting the Arms

FIRST TREATMENT SECOND TREATMENT

FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Buttocks

TWO MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Inner Thighs

TWO MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Inner Thighs

FOUR MONTHSProcedure by

Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Outer Thighs

Unilateral treatment

FOUR MONTHSProcedure by Laura K. Pietrzak, PA-C

BEFORE

CoolSculpting the Legs

CoolSculpting Formula for Success

• Assess the whole body globally

• Look at the body through the eyes of a surgeon

• Review expectations and timing of results

• Ensure proper placement of the applicator

• Be sure to take consistent before / after photos

• Post-treatment massage to enhance outcomes

• Schedule a 4-8 week follow-up to reassess and establish

retreatment protocol

• Have a well trained CoolSculpting® team

– Treat yourself and your staff as part of training

– Staff enthusiasm – “walking CoolSculpting billboards”

– Staff will want to share success stories and personal results!

DualSculptingTM

• Patients can take advantage of shorter treatment times

• It increases profit potential per hour

• Opportunity for complementary services during treatment

Summary

• Tremendous business growth opportunity

• Backed by science

• Proven clinical efficacy

• Technique matters!

• Treatment to Transformation achieves non-surgical body contouring results that rival liposuction

The Marina Plastic Surgery Team