Services we don’t offer — and why.

What it is

Non-invasive fat reduction using controlled cooling to damage subcutaneous fat cells.

Why we don’t offer it

Paradoxical adipose hyperplasia (PAH) — a known complication where treated fat tissue grows instead of shrinks. The manufacturer’s early estimate was about 0.0051% (1 in 20,000), but the published literature puts it materially higher: a single-center series reported 0.47% (about 1 in 211), and a 2025 systematic review and meta-analysis of 13,078 patients found a pooled incidence of 0.22% (1 in 455) — consistently above the manufacturer’s figure. PAH typically requires liposuction to correct, which means a non-invasive procedure becomes a surgical one. The modest fat-reduction effect (~20–25%) does not justify a complication profile that includes a non-trivial risk of an effect opposite to the marketed one.

What we suggest instead

Honest conversation with your primary care provider about diet, training, and metabolic workup. For surgical fat reduction, a board-certified plastic surgeon.

What it is

High-intensity focused electromagnetic stimulation marketed to build muscle and reduce fat without exercise.

Why we don’t offer it

An independent, GRADE-rated systematic review found only modest absolute changes — on the order of 5.5 mm of abdominal fat thickness and 2 mm of muscle thickness — with two of the included studies reporting marginal or no benefit, and noted that the evidence base is small and largely produced by manufacturer-affiliated investigators. The effect is also not durable: like trained muscle, it regresses within months of stopping. At $750–$1,500 per session and roughly four sessions per body area, that’s $3,000–$6,000 for a temporary, modest change that consistent resistance training can reproduce at no cost.

What we suggest instead

A structured strength training program. We’ll refer to local trainers and PTs.

What it is

Low-frequency ultrasound delivered through a handpiece to disrupt fat-cell membranes.

Why we don’t offer it

The independent evidence is thin: the supporting studies are small, short, and frequently industry-associated, and rigorous sham-controlled trials demonstrating clinically meaningful fat reduction are lacking. Where reductions are reported, they’re modest and hard to separate from post-treatment massage, temporary edema, and regression to the mean. We don’t offer a fat-reduction device whose benefit hasn’t been demonstrated under rigorous, independent, controlled conditions.

What we suggest instead

Diet, training, and a plastic surgeon if surgical contouring is the goal.

What it is

RF energy applied to subcutaneous tissue with the claim of inducing fat-cell apoptosis. (Note: distinct from RF microneedling for skin tightening and collagen remodeling, which is a separate indication with a separate evidence base.)

Why we don’t offer it

Independent evidence is limited and heterogeneous. Reviews of non-invasive body-contouring devices find only mild-to-moderate effects for radiofrequency fat reduction — on the order of a few centimeters of circumference change — across small studies of variable quality, with large, rigorous sham-controlled trials largely missing. (RF microneedling for collagen remodeling is a distinct indication with a separate, stronger evidence base, and is not what we’re critiquing here.) RF-only fat reduction doesn’t meet our evidence bar, so we don’t offer it.

What we suggest instead

For fat reduction, see № 01 and № 03 above.

What it is

A device combining mild dermabrasion with a serum-infusion handpiece, marketed as delivering active ingredients deeper into the skin than topical application alone.

Why we don’t offer it

The fundamental claim doesn’t hold up. Skin penetration is governed by molecular size and the stratum-corneum barrier — the basis of the well-established “500-Dalton rule” — and a serum-infusion handpiece doesn’t change that physics. Most actives delivered this way stay in the superficial epidermis, the same place a properly formulated at-home topical reaches for a fraction of the cost. So the treatment is a pleasant in-office experience, priced as a clinical “infusion” that doesn’t deliver much deeper than a topical would. What a facial of any kind reaches, and where it stops, is set out on our facials page.

What we suggest instead

Dermapen 4 microneedling for deeper skin texture improvement, or a prescription topical regimen — tretinoin and appropriate actives applied at home will outperform an in-office infusion that doesn’t reach the dermis.

What it is

At-home or in-spa soft-shell chambers at 1.3–1.4 ATA with ambient oxygen, marketed for recovery, longevity, and skin quality.

Why we don’t offer it

Real hyperbaric oxygen therapy works at higher pressures (2.0–3.0 ATA) with 100% oxygen for specific FDA-cleared indications, under strict medical supervision. The soft-shell wellness devices don’t reproduce those conditions. The benefits described in the marketing come from studies of true hyperbaric oxygen therapy, not from these devices.

What we suggest instead

If you have a clinical indication for HBOT, a hospital-based hyperbaric referral. Otherwise, sleep, training, nutrition, and our PRP / microneedling services.

What it is

Facial serums, post-microneedling topicals, and injectable products marketed as containing “stem cells” or stem-cell-derived growth factors and exosomes.

Why we don’t offer it (yet, and carefully)

Two issues. First: most “stem cell” products do not contain living stem cells. The cells, if ever present, were lysed during processing. Second: the exosome category is in a complicated regulatory moment. The FDA has issued multiple safety communications about unapproved exosome products, including warnings about patient harm. There are legitimate research-grade programs underway, but they are not the products being sold by most medspas. We use autologous PRP — your own plasma, processed in front of you — for the same use cases instead.

What we suggest instead

Autologous PRP for microneedling combination, hair restoration, facial rejuvenation.