The Future Perfect

How it works: Low-energy sonic waves break apart fat cells and destroy them permanently. The fat is metabolized and burned by the body as energy. Because only a limited amount of fat can be safely melted and absorbed during each session, targeting a single area may require multiple treatments a month apart. (LipoSonix can remove 600 cc--approximately one pound of fat--at a time, says Peter Fodor, associate clinical professor of plastic surgery at UCLA.) Both systems claim to be virtually painless. Patients in the LipoSonix trials, conducted in Mexico, were given no anesthetic and "described a tingling sensation or something like a series of pin pricks," says Jens Quistgaard, chief executive officer of LipoSonix. Studies performed on both systems have so far concentrated on the waist, abdomen, hips, buttocks, and outer thighs.

When available: UltraShape received the European equivalent of FDA approval in July 2005 and is also cleared by the health agencies in several South American countries. Now American studies of UltraShape are complete, and government approval could come by 2007. LipoSonix plans to complete American trials in 2007, with the hope of receiving approval.

FACE-LIFT OF THE FUTURE

What it is: The UltraSite ST System is being engineered to lift and tighten facial muscles without surgery, according to its manufacturer, Ulthera, an ultrasound company in Mesa, Arizona.

How it works: Under the skin of the face there's fat; under the fat there's what doctors commonly refer to as the SMAS (superficial muscolo aponeurotic system), a gauzy layer of muscle fibers that sags with age. This is the area that many plastic surgeons tighten surgically when performing face-lifts; it's also the area the machine targets with ultrasound vibrations to shrink facial tissue and muscle. Because of its ability to home in precisely where directed without disturbing surrounding tissue, "this is an exciting technology," says Richard Fitzpatrick, associate clinical professor of dermatology at the University of California–San Diego, who is conducting one of several planned clinical trials. (Fitzpatrick has tried it on his own arm and says, "There is a warming feeling. The treated area got red and swollen for a few hours.")

When available: Safety tests, the first step toward FDA approval, are complete, and clinical trials of its effectiveness are under way. Ulthera's president, Matthew Liken, says he expects that by the first half of 2007, a small number of physicians will have it.

Botox for Weight Loss?

Doctors keep discovering more and more uses for Botox, which may be why it's often called the penicillin of this decade. Besides smoothing wrinkles, botulinum toxin alleviates migraines, inhibits sweating, and helps heal surgical wounds with less scarring, for example.

Now it's being administered as a controversial weight-loss method. A doctor injects the stomach wall with Botox (in order to target the right area precisely, the shots are administered with sedation through the esophagus, rather than directly through the skin into the abdomen). In theory, this weakens muscles in the area, slowing down food digestion and creating a feeling of fullness.

But in a small Mexican study published in 2005, only a quarter of patients had statistically significant results, says Michael Kane, a plastic surgeon in New York City and author of The Botox Book (St. Martin's Press).

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