Dr. Patti Flint

Freeze, Fry or Suck?

That is the question when it comes to stubborn unwanted fat. Most Americans would like a better physique as evidenced by the popularity of gym memberships and appointments made for various fat reduction treatments. If you have tried the diet and exercise route and are not getting the results you want, it is reasonable to assess other options. It is hard to know which of the highly advertised treatments are safe and effective.

In this article, I am going to help you understand your options and the plusses and minuses of each option. Liposuction has been around for decades on one form or another. It is repeatedly in the top three aesthetic procedures performed in the US with well over 200,000 patients per year choosing to undergo the procedure. Its popularity is not hard to understand when you take into account that unlike diet and exercise, liposuction can spot reduce fat in specific problem areas. Also the procedure is generally relatively short and the post-operative discomfort very tolerable. The results are routinely judged by patients to be excellent. In fact, the Realself online patient “worth it” rating for liposuction is 88%.
Liposuction can be performed under local anesthesia, but I much prefer my patients to be asleep under general anesthesia. My approach allows positioning patients in such a way that I can give them the most complete result, and I am not limited by the concern of causing them discomfort. It is an out-patient procedure, and most patients are back to full activities within two to three weeks. Complete resolution of swelling generally takes three to four months. Obese patients are not good candidates for liposuction as the risks of serious blood clots are dramatically higher in patients that are markedly heavier than ideal body weight.

There are multiple ways to remove the fat during surgical liposuction including laser-assisted, power-assisted, and ultrasonic liposuction. I have never found there to be significant benefits of any of these techniques over standard liposuction. Laser assisted liposuction can result in skin burns, and in my opinion, skin tightening that is purported to occur, does not. Ultrasonic liposuction was also designed to help tighten skin and the results are underwhelming.

Other forms of fat reduction have become popular due to direct to consumer marketing that I believe overstates what expected results are. Coolsculpting is extremely popular and involves a treatment in the office with a device that cools the fat in the areas of concern and results in slow but sure fat cell death. I do not perform this procedure because I was underwhelmed by many of the results I saw, and had many patients come to my office after disappointment with their results from this treatment. They all reported to me the treatment was very painful and they were told they needed a series of treatments for best results. Ultimately many of them spent the same amount as they would have spent on surgical liposuction, but did not get an acceptable result. The satisfaction rating on Realself for Coolsculpting is significantly lower at 71%, and considering the above, that is not hard to understand.
There has also been an increase frequency of a complication called paradoxical adipose hyperplasia. This is a process whereby some patients actually lay down an increased amount of fat in the areas treated after treatment. It does not resorb on its own and in most cases requires surgical liposuction to correct. Some patients have even required tummy tucks to correct the problem. Originally it was reported as occurring in less than 1/10,000 patients. Now the incidence is approaching 1/130 patients. I have never seen this occur in standard surgical liposuction.
SmartLipo enjoyed popularity for a brief time, but I believe this has waned. This is a laser based system that basically fries the fat with heat. The liquified fat then has to be suctioned away with standard liposuction tools. Original it was stated that this procedure could be done with patients awake and comfortable. Some surgeons in the surgicenter I used to work in performed this procedure I was acutely aware of when they were doing it because I could hear the patients. Let’s just say they did not sound like they were comfortable. Once again it purportedly tightens skin. I have seen some burns, but I don’t believe it provides long term skin tightening. It is sometimes used for liposculpture or etching in abs. This is a difficult procedure to get exactly right and it can create odd looking results. I strongly feel there are better options. While the Realself “worth it” rating is listed as 87%, the fine print says they did not factor in the “not sure” responses. When you do factor those in, the rating plummets to 61%.

Injectable drug Kybella is now being used in areas other than the double chin to dissolve fat. This drug is deoxycholic acid that can be injected into problem areas in the office with an awake patient. It results in bruising and swelling and some soreness that can last a week or two. It definitely requires three to six treatments for best results, and does not tighten skin that has significant laxity. When used in areas other than the double chin, it is considered and off label use. Once you have multiple treatments and several down times with swelling and bruising, the money and time you would have spent on surgical liposuction would generally be less.
When diet and exercise does not provide you with the results on your physique that you desire, it is reasonable to explore your treatment options. Always seek a board certified plastic surgeon who will take a complete medical history, perform a thorough physical exam, and offer you options for treatment. Selecting a provider who is knowledgeable about the variety of treatments available will benefit you significantly. If you are considering a body contouring procedure, please contact my staff to arrange a consultation. You don’t have to put up with a body that is less than you desire.

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