Battle of the Bulge: Your Best Dermatology Options for Fighting Fat

Extra Fat on Model

The best candidates for plastic surgery are those who are interested in living a healthy lifestyle and want to look and feel their best. This is fortunate, because while plastic surgery can do a lot of things, it cannot guarantee a loss of cholesterol, a dramatic amount of weight-loss or remove dangerous visceral fat that surrounds the organs. What it can do is help you achieve your aesthetic goals while you are on your way to a healthier body and future.

If you have made large gains in weight-loss, removing excess skin and fat can help you fully appreciate your new body and shape. Likewise, if you have had children or aging has emphasized areas that always carried a bit of extra weight, you can tighten and re-contour areas to help motivate you to stay in shape. Now more than ever, there are surgical, nonsurgical and minimally invasive ways to deal with the fat that plagues your life.

Not all fat is the same

Fat is not a bad thing – in fact, we need it to function normally. Fat stores excess calories in our body so we can use it when we deplete our immediate stores. It releases hormones that control metabolism and keeps us warm. However, like many other things, too much of a good thing becomes bad.

The worst fat out there is visceral fat. It wraps around the organs and increases the risk of heart disease, diabetes and many other illnesses. Subcutaneous fat lives directly under the skin and generally has less health implications than visceral. Liposuction breaks up and removes deep subcutaneous fat, avoiding the superficial layer of fat to prevent damaging the skin.

 Location, location, location

The biggest sign of having too much visceral fat is a large abdomen – that’s why those with an “apple shape” are at higher risk of cardiovascular diseases. Those who are “pear shaped” are luckier in that respect, being that the deep subcutaneous fat around the buttocks and thighs can be treated effectively using liposuction.

Exercise and a healthy diet can help reduce both types of fat and increase health, but most people have at least one area where the fat is stubbornly resistant. Most men will have deposits in their chest (gynecomastia), waist area and buttocks. Women will usually carry extra in their breasts, hips, waist and thighs. Liposuction can also treat smaller areas like the neck, arms and lower legs.

The science

Much research has been done on liposuction. An American study in 2011 showed that those with high or unhealthy levels of triglycerides and cholesterol saw some improvement after liposuction (average of 43% reduction). This shows doctors that having high levels of subcutaneous fat affects our health along with dangerous visceral fat. Having liposuction is a benefit in these cases, but should not be seen as a cure all. In fact, a Brazilian study found that exercise helps prevent visceral fat from forming after liposuction. While the subcutaneous fat cells are removed, visceral fat can come back and increase at any time.

Lastly, fat that disappears is usually gone from the location that has been treated, but might come back to another area. To see the best results, it’s advised to maintain a consistent weight, but if you do gain weight, that fat will end up elsewhere. Multiple studies and professional experience shows that liposuction patients might lose weight initially, but will usually gain back the fat in another area. This is why liposuction is meant to contour the body, not help you lose weight.

 Nonsurgical alternatives

There are two type of nonsurgical fat reduction on the market today: ultrasound and cryolipolysis technology. Both target fat by using a handheld device that damages subcutaneous fat cells  that are then absorbed over time by the body. These treatments usually need multiple sessions to see the best results, but can be done with little side effects, recovery and downtime.

A recent article in the Aesthetic Surgery Journal found very encouraging results regarding cryolipolysis, which works best on patients who have fat that can be pinched and drawn into the paddles that cool the fat. After two to four months, most saw a 20 percent fat reduction that took multiple treatments of less than one hour each. Authors found that men favored the procedure to target stubborn areas without missing work or recovering from a surgical procedure.


While most fat is stubborn, cellulite is an especially stubborn (and dreaded) type of fat that most women have on their thighs and buttocks. New scientific research has shown that bands of tissue running through superficial fat pockets create the dimpled, cottage cheese-like effect of cellulite under the skin. In men, the bands are crisscrossed like mesh to hold the fat down, whereas women have bands that wrap around small groups of fat cells squeezing them together and creating lumps.

While you can be skinny and still have cellulite, weight-loss and exercise are effective methods for minimizing the look of cellulite. This will tighten muscles and reduce large fat cells that push out against the bands under your skin. Some surgical lift procedures that combine the use of liposuction and skin excision can improve the condition by smoothing and tightening the skin and tissue. Minimally invasive and noninvasive procedures include Cellulaze, Velashape, VASER shape and Venus Freeze. Cellulaze has been shown to have permanent results.

 Take a stand

Whether your problem with fat is deep or superficial, the best plan of attack begins with a healthy lifestyle and a positive attitude. Weight-loss to reduce fat might involve the help of your primary care physician, a nutritionist, a fitness professional and lastly, your plastic surgeon. Knowing what your choices are and building a plan to achieve your goals is the first step.