What are my options for a flatter stomach?

CoolSculpting is the only FDA cleared non-invasive device for long-lasting fat reduction.  Davis Plastic Surgery is excited to offer this new technology to their patients on top of surgical procedures.  We are able not only offer the full spectrum of body contouring options, but the knowledge to know the limits of each to help you decide which choice is best for you! Dr. Davis also remains current in examining the other new technologies and can help you weed through the confusion of marketing hype vs real results.

The three main options for abdominal contouring are from least invasive to most invasive: CoolSculpting, Liposuction, and Tummy Tuck (aka Abdominoplasty.)

CoolSculpting's biggest benefit is by far the non-invasiveness, minimal downtime aspect. The procedure is done in the office with no pain medicine required. Though there is an initial intense pull from the suction of the device, the cooling quickly takes effect and the remainder of the procedure is quite comfortable. The procedure takes an hour per area. The middle of the abdomen, the love handles, muffin tops, flanks, and bra rolls have the best result if there is enough to grab. There are two sizes of the device which can be used per area. The larger size costs around $1400, the smaller costs around $700. The correct size necessary depends on the examination.

The best results are going to be patients within 10-25 lbs of ideal body weight with good skin tone with localized fatty deposits. CoolSculpting is literally spot treating fat, something sit-ups simply cannot do. It is an excellent option because the no down time, means you can have it done, then go workout, go back to work, whatever you like. As to be expected, the treatment is not a green light for excessive eating and sedentary living.  Patients with large fatty deposits, spread out fatty deposits, large rotund bellies with internal abdominal fat, and those with extra skin do not benefit well from CoolSculpting.

The other non-invasive options do not even come close at this point, relying heavily on marketing hype and gimmicks to entice the consumer. This includes low level laser energy which does not even penetrate the skin, radio-frequency technologies, externally applied creams, etc.  Many of these therapies rely heavily on diet restrictions and exercise which are essential to weight loss, but do not spot treat problem areas.

The next option for body contouring is Liposuction. Liposuction is done by making small incisions and using a suction cannula removing the fat.  This is not however considered a weight loss procedure and though it is done through small incisions IS definitely invasive. Current techniques are done to make the procedure more comfortable, more effective, and have less complications. Different technologies can be used to help  make the removal of fat easier for the  the surgeon. This includes lasers, ultrasonic, radio-frequency, power assisted, power washed, etc. Each of these companies would like the patient to think that the technology is better, safer, lease invasive, etc. This has not ever been scientifically proven and simply is not true. (In fact studies have shown few plastic surgeons use the laser lipo devices and those that do, most only do it for the marketing angle.) The use of tumescent fluid and a "super wet" technique is done for comfort (because the fluid contains local anesthetic), for less bruising and bleeding (because the fluid contains epinephrine), and for safety of the tissues as it relates to the heating of the tissues using either a laser or ultrasonic probe. Small amounts of this can typically be tolerated without anesthesia, larger amounts benefit greatly from sedation and general anesthesia.  This is what we use at Davis Plastic Surgery.

The benefits of liposuction include the greater ability to contour and remove larger areas of fat.   The drawbacks are the recovery time and cost for liposuction is higher because of the operating room and anesthesia necessary. Safety is key, this procedure is not without complications and should only be done by properly trained physicians. A patient should strongly consider the physician and their credentials. Be aware that specific technologies such as laser liposuction heavily target non-core physicians (non Plastic Surgeons) who are eager to please and happy to charge, without the knowledge in safety nor the ability to gauge their own limitations. Many physicians will feel confident after a weekend course or an online webinar.  A garment is typically worn for several weeks as well. Downtime varies per person and per area, but is not insignificant in even the smallest of areas treated. Return to full activities generally takes  a couple of weeks. Liposuction remains a poor choice when extra skin is the problem. Excess skin and patients with poor skin tone do not benefit from fat removal without skin excision.

Finally abdominoplasty, aka tummy tuck, is the procedure of choice for skin redundancy of the abdomen. Frequently this will be used along with liposuction of the flanks for contouring of the trunk.  The benefits are readily apparent with a tight abdominal wall and removal of excess skin and fat. The drawbacks are the downtime, the cost, the pain, the scarring, the potential for complications of either the anesthesia, the recovery, or the scarring. That being said frequently this is the best procedure for the patient's wishes and is well worth the risk. For the rotund abdomen with intra-abdominal fat (it can't be pinched on the outside with the abdominal muscles tight) can only be treated with weight loss. Again, a tummy tuck is also not a treatment for weight loss. However, in the right patient, It can be a great boost to someones overall appearance and self confidence. Recovery time is typically 4-6 weeks, though return to work and most activities is within a couple of weeks.