Body Contouring: Consistently one of the top requested cosmetic procedures in 2020-2021

It should come as no surprise that when annual surveys are done on the top plastic surgery procedures, body contouring is consistently in the top few. It makes sense because since time immemorial, people have wanted to alter their bodies to make them more attractive for themselves and their partner or to find a partner. 

What changes over the years is what people consider a desirable figure. How safe are the procedures which accomplish these goals? How long is the recovery period? What is the cost of the procedure? How long will the benefits last and what is the scarring? Does it matter who performs these procedures and where you have them done?

If you review photos and paintings over the years, it was clear that in the Middle Ages people tended to prefer a fuller, more curvy and heavyset appearance (compared to today). They even labelled it a Romanesque figure. In the 60’s the pendulum swung the other way and Twiggy was the rage, with an extremely thin figure with minimal breasts and hips. 

Fortunately with time, people recognized that being ultrathin was often unhealthy for most of these people (usually women). I think today, we are in a split area. I think there is a large segment of the population that is aiming for a natural and athletic look. There is also a segment, which is definitely ethnically based, that strives for the very, very full butt look (hence the Brazilian butt lift).  

My own strong bias is towards a more natural, healthy look. 

There are really 3 main types/approaches to body contouring:

1. Procedures which reduce redundant skin, for example, excise or remove the extra skin (and those that try and mimic this such as Body-Tite, etc).
2. Procedures that reduce fat. These can be either invasive (various types of liposuction) or non-invasive (such as Sculpsure and Coolsculpting, etc).
3. Procedures that add fat. 

SKIN REDUCING PROCEDURES

Those surgical procedures that remove skin are named depending on which area they address. There are tummy tucks, thigh lifts, bra lifts, arm lifts etc. I will briefly discuss these. However, these could all be their own separate blog topic so I don’t want to be all encompassing. When there is a significant amount of redundant skin, there is just no other reliable way to remove it, other than to excise it. You cannot laser, exercise or use a cream to make the skin tighten adequately. This is why these procedures are not going to be replaced by technology. 

The most common procedure in this venue is the Tummy Tuck or as known in the medical world, an “abdominoplasty”. This is done under general anesthesia and as an outpatient. This is a fantastic operation for the correct candidate. It involves a long, low incision (at the top of your pubic hairline or previous C-section scar or lower) and allows the surgeon to both remove the extra skin on the abdomen and also to tighten (not cut) the abdominal muscles. 

This will give a much flatter, cleaner appearance to the abdomen. Quite frequently, a Liposuction of the flanks/love handles is done at the same time. Most patients will return to working in the office in 10 days or less. If you work remotely and are motivated, you should be able to return to working remotely by 7 days (maybe not a full 8 hour day but at least 5-8 hours per day). See my previous blogs on this topic for more details. A Tummy Tuck can be combined with other procedures.

An Arm-Lift is designed to remove the extra hanging skin from the upper arm. It is also done under general anesthesia. The scar is usually on the back of the arm or posterior-medial aspect of the upper arm. The scar will improve with time but will never disappear. There are shorter incisions that are placed more in the armpit/upper arm area but they remove very little skin and I think are mostly ineffective. 

A Thigh Lift removes the excess skin of the medial thigh skin. I feel strongly that most people need the long vertical scar running from their groin to almost their knees. This allows a significant amount of loose skin to be removed. I almost always do a Liposuction first in the OR and then immediately, excise the extra skin. There is an alternative excision with the scar being placed in the groin. However, this cannot remove very much skin and in my experience, it is much more effective with much better results to do the vertical excision. 

A Bra Lift is worthwhile occasionally to excise loose skin with the horizontal scar line running across a bra line, so that it is covered by either a bra or bathing suit top. This is best suited for someone on the thinner side with loose skin causing folds along their lower lateral back. 

FAT REDUCING PROCEDURES 

These can be divided into invasive and non-invasive. Invasive means that small incisions are placed. Non-invasive means that there are absolutely no incisions. Least people get caught up in the advertising mania, you cannot get something for nothing. 

What I mean is that invasive procedures are almost always going to remove more fat and get you a more dramatic change. In addition, for all of these procedures, there is no magic. If you want to look your most buff, then you can enhance your final result by decreasing your total body fat. 

They will all last forever if you keep your body fat the same. If you put on significant weight, there is a good chance that these areas will get fat again. The best results are always going to be in the person, who gets motivated and adopts a better diet (and exercises, however, dieting is more influential than exercising) to enhance the procedure’s result. 

They are particularly helpful for areas that are hard to decrease the fat. For men, this means lower abdomen and flanks (love handles). For women this can vary from woman to woman but can include: abdomen, bra/back fat, thighs – medial/lateral, knees, pubic area, upper arms, superior and lateral to the breasts, submental (upper neck). 

Incidentally, despite a million Youtube videos to the contrary, you cannot specifically target a fat pocket with exercise! You can certainly build up the muscle with targeted exercising but you cannot specifically decrease the fat in that particular area. 

This is why some people will get immensely frustrated. They work a particular muscle region very hard but they don’t see a fat decrease in that area. This is why, particularly, these minimally invasive liposuction techniques are so very helpful. 

INVASIVE FAT REDUCTION

There are a myriad of these. I have been using SmartLipo for over 8 years. However there is also J Plasma, Vaser, radiofrequency, tickle/vibratory (yes, I agree, it seems like a totally asinine name since I am certain, it does not feel like you are being tickled!). 

What they will all have in common is very small incisions that will heal with a very tiny scar (you cannot be cut without a scar, so don’t believe it when someone tells you otherwise). There should be a rapid return to work. With SmartLipo, almost all of my patients will return to work the very next day. 

With all of these techniques, you will need to be patient since you will continue to improve for months. For patients with SmartLipo, they will continue to improve for 6 months. 

Some of these techniques are quite uncomfortable and will require general anesthesia. One of the reasons I really like SmartLipo is that I do all of them in my office with local anesthetic and oral sedation, and never under general anesthesia. This essentially decreases any risk of blood clots and makes for a quicker recovery. 

Most of these techniques will create some element of skin tightening which will continue for months. However, someone with moderately redundant skin will still need one of the above skin excisions. The best results for skin tightening will be in those patients with a good existing skin tone, who do not need a great deal of tightening. 

DOES IT MATTER WHO DOES YOUR MINIMALLY INVASIVE FAT REDUCTION SURGERY?

As a board certified plastic surgeon, this is one of the topics that most frustrates me. The public does not understand the difference between a board certified plastic surgeon and some doctor, who proclaims himself/herself to be a “cosmetic surgeon” and then performs surgery. 

There is NO true board of “cosmetic surgery.” Board certified plastic surgeons have done at least 6 years of surgical training after medical school. Physicians doing these surgeries may have done no training or just a few hours. Just because we, plastic surgeons, can make it look easy and simple does not mean there are not serious risks if not properly done. 

I answer a lot of questions on RealSelf.com and I have seen numerous burns from SmartLipo because the person doing it was not properly skilled. I have not had a burn and I have done over 1,200 SmartLipo cases. Sadly, there can be even more serious problems, than a burn, if it is not done properly. 

This is true of all of these minimally invasive fat reduction procedures. I would strongly recommend that you ask this very exact question, “Are you a board certified plastic surgeon?”. People obfuscate this and say that they are facial cosmetic surgeons, or dermatologic surgeons, or cosmetic surgeons, or obstetricians with a liposuction special interest, etc. It is not the same and the training is radically different. 

I personally love Smartlipo but I think it is far more important that you select a board certified plastic surgeon over the particular technique used. Incidentally, I definitely do not feel that lymphatic massage is necessary after SmartLipo (or any liposuction for that matter). It is fine to get it, if you have extra money and time, but I don’t believe the final result is any different. 

I think many places add this more because it generates more income, rather than because the final result is any better. It may speed up healing a bit and it certainly does no harm. I am a massage fan but I think some practices push it unnecessarily.

NON-INVASIVE FAT REDUCTION

There are principally 3 main techniques. They use one of the following modalities: heat (Sculpsure), radiofrequency (Vanquish) or freezing (Coolsculpting). They all will be less aggressive than invasive liposuction techniques. They have, by definition, no incision or scars. 

They usually require at least 2 sessions. They are all somewhat uncomfortable during the treatment but this ceases as soon as the treatment is done. They all will continue to improve for several months. At their very best, the difference will be more subtle but you can definitely help get a better result by combining this with an excellent diet. 

It is important to know that not everyone will feel it was worth it. On my looking through the reviews on Realself.com, I think SculpSure had the best overall rating but it was still far from perfect.

Generally they are quite safe. However, Coolsculpting does have some unique side-effects, that although uncommon, are a real problem, if you experience one of these:

1. Uneven results due to the freezing (heat and the radiofrequency tend to spread out more evenly).
2. Nerve irritation to the point of needing Gabapentin for months, due to nerve pain (nerves do not like being frozen).
3. Paradoxical Adipose Hyperplasia (PAH) – this means that instead of the fat going away, the fat actually increases and looks like a giant sausage that then needs liposuction to remove it. 

In my office, we use Sculpsure. I don’t think it matters very much who operates the above 3 machines. However, the HUGE advantage of going to a plastic surgeon’s office is that we will have other options that may be better for you. 

If you just go to a medispa, or a non-plastic surgeon, they may suggest one of the above 3 techniques because that is all they offer and all they know, even if it would be better that you use a different technique or have no procedure.  

FAT GRAFTING

This is the transfer of fat to a different part of the body. It is important to know that only about 50-80% of the fat will survive. Sometimes it can be much less. This means, you should always plan for a second session a few months later.

Schedule a consultation with me to learn more about different body contouring procedures and how they can help you achieve the body of your dreams.