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Treatment Options for Targeted Fat Reduction

By Dr. Raja Nalluri
Posted: 27th April 2016 09:05
While control of dietary intake and frequent exercise are the cornerstones of a healthy lifestyle as well as healthy weight loss programs that provide scientifically proven health benefits, there are cases in which limitations arise, particularly in spot reduction or resistant areas of fat excess. Massive weight loss of hundreds of pounds has also been achievable with low complication relates through surgical approaches to the stomach including banding, stapling, resections and other techniques. In some of these cases as well limitations of the aesthetic result may be reached when recoil of excess skin laxity does not occur.
Patients of all varieties present to the plastic surgeon with varying complaints. A medical judgment occurs initially such that patients who have not adequately reached maximal benefit from diet and exercise are directed accordingly. Medical weight loss is appropriate in some cases whether with a specific diet and/or pharmacological supplementation with amphetamine based or other supplement. Surgical approaches are considered in patients that are appropriate candidates for massive weight loss.
After maximising benefit from these initial approaches, some common resistant areas causing patients to seek plastic surgery include the flanks (love handles), thighs both medically and laterally), buttocks, abdominal, neck and arms. The limitations in some cases of diet and exercise including the inability to provide for spot reduction or targeted fat reduction. While aggressive continued weight loss beyond the patient's desired aesthetic could proceed, this may result in excessive thinning of body regions where further weight loss is not desired (such as breast volume loss or facial emaciation). The end result here could be smaller breasts or a more aged face with skin laxity in order to see a reduction in fat in the above referenced resistant areas. Skin laxity is another side effect that is more pronounced in cases of weight cycling where repeated weight loss and weight gain cycles stretch the skin. Multiple pregnancies, large weight gains with pregnancies exacerbate skin laxity in women.
Fortunately, the plastic surgeon has a toolset for assisting patient with these resistant areas and to target both localised fat depositions and skin laxity to effectively treat them to achieve a more balanced aesthetic result.
Zerona is a non-invasive cold laser that is painless. It is applied over the skin of the abdomen, flanks and thighs in six treatment sessions of 40-minutes each over a two week period. Mild reductions in overall circumference in the abdomen, hips and thighs have been achieved. The treatment is FDA approved. While extremely safe and a good consideration for patients who are not candidates for surgery, the downside is its extremely limited result, with typical results showing just 1 to 1.5 inch inches of circumferential reduction in each body area, as high as 3.5 inches in some cases. Further, the reduction is circumferential and not spot reduction. Treatment cost is approximately $2,000 for six sessions.
Radio frequency (RF) is a FDA-approved therapy for improvement of skin wrinkling. Here, the RF energy is applied to the target skin area. The sensation is of heat and mild discomfort but not painful and tolerated by most patients. Heating the collagen fibres beneath the skin surface promotes collagen stimulation and realignment for smoothing skin. Similar in safety profile to Zerona, both treatments can be applied to virtually any skin type and patients with any medical conditions since they are safe and nonsurgical. Between 3-8 treatment sessions of 30-minutes each spaced 3-6 weeks apart are recommended for optimal results, at a cost of a few hundred dollars per session.
Traditional liposuction is a surgical procedure using long skinny tubes (cannulas) that are inserted through small incisions placed near the target area of fat reduction. Through this approach, fat is removed by application of vacuum. In traditional liposuction, there is targeted fat reduction, however approximately 50% blood and 50% fat is removed which markedly limits how much fat can be removed (about 1 litre) in one session. It is a surgical procedure and carries downside risks associated with surgery, a discussion to be carefully weighed with your plastic surgeon.
Wet, Superwet and Tumescent Liposuction are advances in the technique of liposuction wherein fluid containing lidocaine (to reduce pain and decrease the need for anaesthesia) and epinephrine (to reduce bleeding) are injected into the target fat prior to application of vacuum for suction. The refinement has dramatically increased the percentage of fat removed to 99% and blood removal to just 1%. Added risks associated with these medications need to be considered.
Power Suction Assisted Lipectomy (PSAL) has improved the technology in the cannulas used, allowed smaller cannulas to be inserted through smaller incisions but with a power oscillating function, the cannula is able to break up the fat prior to removal to ease the fat removal process. More precise and effective liposculpture is achieved.
Ultrasound Assisted Lipectomy (UAL) utilises an advanced cannula tip that emits ultrasonic waves that cause the target fat cells to cavitate (implode on themselves). Not only does this ease the removal of fat but it is also particularly effective for cases of fibrous fat such as in breasts. Added risks include burns to the skin or other organs from the ultrasound waves.
Laser Lipolysis is an adjunctive treatment applied wherein laser light energy is administered in the targeted area with the goal of smoothing the skin in the treatment areas. Studies have indicated reduced pain with laser lipolysis.
Fees for all types of liposuction vary and are on the order of a few thousand dollars for each area treated.
Board Certification matters. Caution is advised to the reader in that these procedures carry risks and have the potential for complications or problems. With the improvements in technology and an increasingly self-conscious society, there has been a rise in the demand for plastic surgery procedures, both invasive and non-invasive. Due to the extensive and rigorous training with lengthy medical education and expense to become a plastic surgeon, along with the expense of properly meeting regulation standards, the cost for these procedures is substantial. Unfortunately, the marketplace for plastic surgery procedures has been flooded by the entry of non-plastic surgeons practicing procedures outside of their scope of board certification for financial gain. Dentists, family practice doctors, obstetricians and other doctors and non-doctors have chosen to take a weekend course or watch a demonstration video, even purchase equipment and take training from a device representative to then begin charging at reduced fees to offer these procedures. Having treated numerous patients with serious complications suffered at the hands of these unqualified individuals, caution is advised to the reader to seek a plastic surgeon that is Board Certified by the American Board of Plastic Surgery or corresponding International Board. Often, flashy advertising or misleading credentials such as Board Certification by the American Board of Cosmetic Surgery (which is not a Medical Board), confuses patients into a false sense of security. Any agency legally can create a title beginning with the word Board but not be an official Medical Board. Examined the results of the actual surgeon since variation in surgical skill and quality of training exist. Safety, effective results and ethical plastic surgery is of utmost concern at my practice. Consultations are taken from all over the world, whether in person, by Skype or FaceTime video-conference.
Dr. Raja Nalluri

Repairs of complications and botched surgery of the face and body are a specialty of Dr. Raja Nalluri. He has been rigorously trained and has 15 years of experience in plastic surgical procedures. Performing the full breadth of plastic surgery procedures, he is ready willing and able to provide you with his individual attention to help guide you through your transformation. He is certified by the American Board of Plastic Surgery. Recognition is a Best Plastic Surgeon has been bestowed upon him by multiple independent agencies including U.S. News & World Report, Castle Connolly, Cosmopolitan Magazine, Sarasota Magazine, America's Top Doctors, the International Association of Plastic Surgeons and other organisations. He is a Clinical Assistant Profession for the Florida State University School of Medicine. He is frequently called upon for challenging and otherwise unsolvable cases by multiple hospitals in need of his expertise. Patient from around the world seek Dr. Nalluri's expertise for the utmost safe and effective result for their needs.

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