Tummy Fat (Abdominal Fat): What is the best way to get rid of it?

Posted by Dr. Hardesty

I. INTRODUCTION

Unfortunately, despite the best efforts with diet and exercise many people still experience stubborn pockets of fat on their abdomens. This can happen because of stubborn fat that is natural or left-over from pregnancy. Whatever the reason, a tummy tuck is designed to help solve this problem.

There are three main modalities and various techniques that one can use to deal with unwanted diet-resistant tummy or abdominal fat.

• Non-surgical fat removal
• Liposuction
• Abdominoplasty (tummy tuck)
• Combination of the above three modalities

The “Best” treatment for abdominal contour rejuvenation or restoration depends on and is determined by a personal exam, your desires, discussion of the benefits and the limitations of the technology, and procedure(s) available. Abdominal contouring can be accomplished using a combination of various procedures and technologies. We here at Imagine Plastic Surgery refer to this as “One goal, Many Options”.

Often a combination of non-surgical, surgical technologies and minimally invasive procedures are used in conjunction to attain a superior result than if only one technique was used alone. When using multiple modalities to contour the abdomen Dr. Hardesty refers to this combination of treatments as “Synergy”.

II. NON-SURGICAL FAT REDUCTION

There are various technologies that are non-surgical fat reduction/removal and they include but are not limited to:

• Ultrasound (Ultrashape Plus)
• Freezing (Coolsculpt)
• Radio Frequency (RF)
• Topical (Vellashape III, Thermi Smooth)
• Injectable (Thermi Tight)
• Injectable enzymes (Kybella)
• Topical cool light laser (Zerona)

After trying and comparing CoolSculpting and UltraShape Plus, I personally found the UltraShape Plus was a superior technology. UltraShape Plus was painless compared to CoolSculpting and didn’t leave numb areas, demonstrated similar or often better results, and took less time to perform. I also tried Zerona and unfortunately was not impressed with the results. Thus, I most often use a combination of Ultrashape Plus and Vellashape III (RF=radio frequency) to shrink the skin after Ultrashape Plus for most of my non-surgical fat reduction body contouring. Thermi (Injectable RF) and/or Kybella, is reserved for those patients with smaller isolated areas of diet-resistant fat, who after discussion would like a non-surgical alternative.

Benefits:

• Anesthesia: minimal to none
• Pain: little pain to no pain
• Recovery/downtime: minimal recovery/downtime
• Skin shrinkage: Vellashape III and Thermi only

Cons:

• Restrictions: Can only use in only certain anatomical areas
• Will not treat separated abdominal muscles
• Will not remove excess and stretched skin

III. LIPOSUCTION

Liposuction is the favored treatment for isolated diet resident fat removal of the abdominal wall when there is not abdominal wall muscle separation (diastasis recti) and excess loose skin.

There are various types of liposuction technologies including but not limited to:

• Suction asst. Liposuction (SAL)
• Ultrasonic asst. liposuction (UAL)
• Power asst. liposuction (PAL)
• Laser asst. liposuction (LAL)
• Water asst. liposuction (WAL)

They are all effective and are secondary to the experience of the Plastic Surgeon within the liposuction technology. In addition to liposculpting, many of us have added non-surgical methods “to shrink skin” after liposculpture using Radio Frequency (RF) devices. Two such devices I personally use are Vellashape III and Thermi Tight, in conjunction with liposuction to reduce the deflated postoperative lax skin.

Benefits:

• Anesthesia: Local, sedation or general anesthesia depending on the amount anticipated liposuction volume, patients pain tolerance or desire.
• Recovery/downtime: depending on volume and location usually minimal recovery and time off work.
• Minimally invasive: small-sized access incision
• Can remove diet-resistant fat in most areas.

Cons:

• Will not treat separated abdominal muscles.
• Will not remove excess and stretched skin.
• Skin looseness: may result in looser skin after liposuction.

IV. ABDOMINOPLASTY (tummy tuck)

Abdominoplasty or tummy tuck is considered the “gold standard” for abdominal contour restoration after pregnancy or weight loss. Why? Because it addresses all the common causes of the “Mommy bump”.  The abdominoplasty will be tailored to your anatomical needs.

There are five types of abdominoplasties that can be performed depending on your anatomy, amount of stretched and excess skin.

• All tighten and repair the separated muscle to some extent
• A-C all have horizontal incisions and D has a significant vertical component.
• All (A-E) remove excess and loose skin (D the most).

In addition, Dr. Hardesty includes in all his tummy tucks:

• Anterior (frontal) and lateral (side) liposuction of the flanks (love handles)
• A non-narcotic and locally delivered pain pump medication device that constantly baths the pain nerves with a local anesthesia substance.

The various types of abdominoplasty are listed below and based mainly based on your physical findings and your goals the most appropriate technique will be recommended.

• A mini muscle tightened below the umbilicus to the pubic bone
• A standard abdominoplasty muscle tightened from breastbone to pubic bone
• An extended abdominoplasty similar to a standard abdominoplasty but the incision is horizontally longer to excise excess skin/fat in the outer thigh area and to remove the excess skin and fat after massive weight loss or significant stretched skin after pregnancy.
• The fleur-de-lis abdominoplasty is the same as the standard abdominoplasty but in addition excess skin/fat excised in a vertical direction. This technique is preferred if there is already a vertical scar from previous surgery or when there is significant excess skin in the horizontal abdominal plane.
• A “reverse abdominoplasty” which places scar under the breast line and usually for limited fat and skin excision isolated to the upper abdominal area.

Each of the above categories (and the various subgroups) have their own specific benefits and limitations and need a personal examination and discussion of them. However, in general, and when comparing to non-surgical or liposuction abdominoplasty can be characterized as:

Benefits:

• Removes directly excess abdominal fat and stretched skin resulting in a tight abdominal skin.
• Repairs separated abdominal muscle
• Liposuction of flanks often included

Cons:

• Longer recovery and downtime
• A scar of the abdomen and around the umbilicus (tummy button).

V. ADDITIONAL INFORMATION

For additional information please see our Frequently Asked Question Section (FAQ).

VI. SUMMARY

Each of the above categories have their benefits and limitations and need/ require a personal examination and discussion. With an experienced Plastic Surgeon, such as Dr. Hardesty to determine what procedure(s) are best to reach your goals and desires.

VII. COST/FEES

The fees are based on the anesthesia used (local vs sedation or general anesthesia), the facility (minor surgical suite, outpatient operating room or hospital setting) and if combined with other procedures. All pre and post-operative care are included.  Some preoperative laboratory analysis may be required (usually covered by your medical insurance).

Refer to cosmetic surgery pricing for a more detailed overview of our costs and fees.

VIII. CONCLUSIONS

The most important factor to consider is seeking the opinion and services of a skilled, experienced and Board-Certified Plastic Surgeon who are experts in non-surgical techniques. The Imagine Plastic Surgery team uniquely provides the full array of both non-surgical and surgical alternatives to abdominal wall fat reduction and rejuvenation thus filling our motto of “One Goal, Many Options”. For more information, call and schedule a consultation.