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Blasting away the rumor, innuendo, and misinformation about body contouring, drop these authentic Board Certified Plastic Surgeon facts into your decision tree, and find a good aesthetic surgeon near you to confirm.
Numbers one and two are fitness and diet. If your body weight is above ideal according to published body mass index (BMI) charts (link) and you want a leaner shape, the first consideration is weight loss to the green zone. Fitness will not necessarily lose your extra weight, but is always a mandatory number one. There is no substitute for a regular routine of physical exercise to maintain and improve physical AND mental health. Invest the time and effort: strength, flexibility, endurance, and balance. Weight loss is accomplished by permanent dietary modification, and is easier than ever without starvation due to the following contemporary developments:
Glucagon like peptide medications (GLP-1 receptor agonists) tirzepatide and semaglutide. Tolerable or no side effects, need a good doctor to prescribe and adjust dose based on your response. These are once-a-week injectables. Semaglutide is produced by NovoNordisk under the trade names Ozempic®, Wegovy®, and Rybelsus®. Tirzepatide is produced by Eli Lilly, brand names Zepbound ® and Mounjaro ®. Expensive (up to $1200./month), but for many the leaner body is worth it. Med-Spas (and our office) provide equally effective semaglutide and tirzepatide from accredited certified compounding pharmacies at lower prices because of the ongoing shortage of these medications in the marketplace. Studies show 15-20% body weight loss but practical experience with these medications shows most users can drop as much weight as needed, although greater weight loss demands a longer course of injections.
Masters of food science have innovated companies producing satisfying carb substitutes that will drop your weight. Adopting these alternatives into your diet over time will ease the scale down and your mobility up. The online marketplace Netrition.com directs you to leaner choices and substitutes. Calorie:protein ratios of 10:1 or less maintain your structural integrity, keep you satisfied (not hungry), and allow your body to mobilize stored fat (lose weight) to meet your energy needs. Some of our favorite brands that allow you to feel like you’re cheating without actually cheating are eatbetter.com, Great Low Carb Bread Company (their pasta is killer), Smart Baking Company, (muffins) and Quest Nutrition (if you cannot do without chips). Among the most powerful introductions are substituting great tasting fiber, a carbohydrate not absorbed by your intestine, for flour, which is absorbed and immediately converted to sugar. Substitution of erythritol and/or monkfruit (get the pure version from Lakanto) for sugar is another item for your Nutrition Facts label search.
Phentermine is a much less expensive oral (pill) appetite suppressant to go along with your fitness program and healthier diet to accelerate weight loss by dropping hunger and cravings. FDA approved since the 1950s, phentermine works by an entirely different mechanism than GLP-1 medications. Because it is a stimulant, phentermine may be contra-indicated if you suffer from anxiety, insomnia, high blood pressure, heart rhythm problems, and/or other issues.
Liposuction improves body shape for individuals at or near their ideal body weight. Liposuction is exactly what the term implies: lipo (from Greek lipos) = fat and suction = “to draw out or remove by aspiration.” Pioneered by European surgeons, the practice of liposuction has advanced to its current state of safety and effectiveness to become the gold standard for reducing and/or removing localized bulges or fullness from fat in the neck, arms, sides, waist, flanks, abdomen, thighs, legs, and wherever desired on the surface of the face or body. For smaller areas, liposuction is an office procedure under local anesthesia. For several areas of the body or larger amounts of fat, general anesthesia is preferred. The primary limitation of liposuction is that overlying skin may become loose, sag, or wrinkle after the fat is gone, swelling resolves, and the treated area deflates. For this reason, a bulging or full area of the face or body with loose skin is preferably treated by both fat AND skin removal, “dermolipectomy.”
Fat transfer – Fat removed by liposuction is kept sterile in the operating room and re-positioned by gently pumping the fat into areas of the body where augmentation for more fullness and/or roundness is desired. Most commonly, fat transfer is applied in small quantities beneath aging skin of the face for added youthfulness or in larger quantities to the breasts and/or the buttocks (BBL = Brazilian Butt Lift) to add roundness of shape and/or fullness, curvature, smoothness of the skin, and projection.
Dermolipectomy = surgical removal of extra fat and skin with tightening and lifting of remaining skin. Extra fat AND skin in areas of the face, neck, breasts, body, or extremities (arms, thighs, legs) should be treated by removal of BOTH skin AND fat for aesthetic improvement. Standard techniques for DERMO (skin) LIP (fat) ECTOMY (to cut out) are well described, but the surgical approach for each procedure must be planned and performed individually based on unique situational needs. Size of the body, shape and distribution of excess skin, amount of excess loose skin, elasticity of remaining skin, scar size and placement are all features to plan and mark before the procedure with agreement between patient and surgeon to avoid surprises. Dermolipectomy includes such procedures as face and neck lift, brachioplasty (arm lift), mastopexy (breast lift), abdominoplasty (tummy tuck), thighplasty (thigh lift) and others. Dermolipectomy results in a scar or scars at the edge(s) of the area of skin removal, and it is the plastic surgeon’s art to conceal and/or minimize the visibility of scars in normal anatomic boundaries, shadows, and/or behind clothed areas.
Non-invasive (Coolsculpting, etc.) – In 2024 and for the near future, the most dramatic visible long-lasting improvements in body contour are achieved by the above five measures, period. Application of heat, cold, radiofrequency, ultrasound, laser, and other devices (e.g. Emsculpt) despite the advertising blitz, are for minimal changes, and in general are cost ineffective. The summary message is that if you want real change, engage new diet habits, a regular fitness routine, and/or surgery (liposuction, fat transfer, or some form of dermolipectomy).
Because we are all unique, for professional recommendations that apply to you, consult with a Board Certified Aesthetic Plastic Surgeon for information of personal value for you.
Steve Laverson MD
858-295-4001
