Consider Options Carefully for Losing Excess Weight

We all go through changes in our weight throughout our lifetimes. Large fluctuations in weight, or a major life event like pregnancy, can make permanent changes to the body that an individual may find undesirable. Common concerns (such as excess skin after weight loss, stretched abdominal muscles after pregnancy, or stubborn fat on the legs or hips that does not go away with diet and exercise) may be addressed with body contouring procedures. It is important to note that no intervention mentioned here is designed to help people lose weight. Losing weight requires a lifestyle change and may also involve bariatric surgery. The following options are for patients at their stable goal weight.

The issues of concern to patients and the available interventions can be divided into three categories: excess fat, excess skin, and loose muscles (particularly in the abdominal wall). Everyone, including your doctor, wants to use the least invasive method to get you the results you want. There are some good minimally invasive options that can reduce small amounts of fat. Unfortunately, significant skin and muscle tightening is not obtainable without surgery, and current devices often fall short of patient expectations.

Cryolipolysis, more commonly known as “Coolsculpting,” freezes underlying fat with the application of a handpiece without damaging the overlying skin. This can help reduce the fat in an area by 10-25% per treatment. Injections, in the form of a product called Kybella, radiofrequency, and laser are also options, in decreasing order of popularity. The advantage of these procedures is that they can be done in the office without anesthesia. The disadvantages are that they do not tighten the overlying skin and only treat areas in a piecemeal fashion, with the possibility of leaving concavities. As always, patient selection is critical with these procedures, and not everyone is a good candidate.

Liposuction is a form of fat removal performed through tiny incisions in the skin. A tool called a cannula is used to suction out the unwanted fat. Small areas of liposuction can be done in the office in what is called “wide awake” liposuction or “local anesthesia” liposuction. Most patients want a broader area treated and are comfortable with some sedation in the operating room. The biggest advantage of liposuction is that the surgeon can sculpt areas by hand, as with clay, creating a natural contour. This is in contrast to the fixed-size handpiece application in cryolipolysis. Additionally, during liposuction, multiple areas may be treated in one session.

Surgery feels like the last resort for most patients. The most frequent scenario I encounter is when a patient wants surgical results for concerns in the belly area but desires something less invasive. Sometimes a patient has already gone through a less invasive procedure that has left them disappointed. Though surgery requires anesthesia and has more downtime, it is the most powerful way to reshape and restore the entire abdominal area. The advantages of surgery are that excess fat and skin can be removed, and stretched-out muscles can be repaired. This procedure, known as Abdominoplasty or a Tummy Tuck, involves a low incision below the underwear line. Excess skin is removed, and the abdominal muscles are tightened. Patients usually take a week off of work to recover. It is important to talk to someone about all your options before making a decision. The surgeon will perform an exam at your consultation, talk about your body and goals, and get all your questions answered. This field is constantly evolving, so finding someone you trust to keep you informed is essential.