I recently went to the office of Dr. Sharon Giese in NYC for a demonstration of ultrasound for fat reduction called VASER. Since I am a big fan of ultrasound for firming the skin and recently launched Ultra Renew Sculpt for body shaping, I was interested to see how professional grade machines would work. Along the way, I also learned something surprising about marionette lines.

First, some background on VASER. There are two technologies, VASERshape and VASERlipo. VASERshape is a non-invasive, massage-like treatment that uses ultrasound delivered via a hand-held device. Sessions last about 45 minutes and the esthetician’s job is to keep the device moving across the skin as it does get quite warm (but not uncomfortably hot). Three to five weekly sessions are needed and, judging from the before and after pictures of Dr. Giese’s clients, it seems to work pretty well on flabby tummies and cellulite.

According to VASER, ultrasound breaks apart fat, while leaving other cells intact. The VASERshape uses 1Mhz ultrasound and reaches about 45 degrees Celsius. The superiority of ultrasound (per VASER) is that laser “bounces,” radio frequency is “absorbed” by surrounding cells, but ultrasound goes straight through by superficially heating the surface of the skin and then shaking the membrane of fat cells to release lipids.

VASERlipo updates liposuction treatments, which have been around forever, to something more advanced and, specifically, precise. Ultrasound is tuned to “preserve connective tissue and maintain fat-cell viability.” The probes are sensitive and the precision (compared to older approaches to liposuction) allows for a much lower revision rate (less than 11%).

Dr. Giese says that ultrasound has pushed the range of treatment, allowing her to treat larger areas and obtain higher definition. Then she showed me some impressive before and after pictures (obviously, Lipo’s results are more dramatic than the non-invasive Shape). I asked if Dr. Giese had ever used either treatment on the face, and this is where she dropped her bombshell.

Dr. Giese uses fat removal for marionette lines. What! I would have thought that marionette lines were due to loss of fat and resulting sagging and that the appropriate treatment is to use hyaluronic fillers. But no, in many cases, it can be that the accumulation of fat around the jowl, pulls the skin down. Dr. Giese believes that it doesn’t just droop, but the fat continues to grow as we get older. To fill the cheeks is, in her opinion, the result of misdiagnosis. And, of course, the ultrasound gives her a method of very precise removal of jowl fat.

I was at first surprised, but her approach seems to make sense. I love having my assumptions challenged and learning something new.