49, woman, 3 pregnancies. Coolsculpting versus Lipo for belly pooch and flanks? (Photos)

Question

Hi all! I am an almost 49 year old woman who has 3 pregnancies. I had a consult recently with a highly recommended local plastic surgeon to address my lower belly pooch. She recommended a tummy tuck for the best result. I was hoping for lipo but she thinks I will be left with sagging skin and would be unhappy with the result. She also thinks I am a great candidate for CoolSculpting. In fact, she has said that she thinks that she would prefer coolsculpting for me over lipo. I was surprised to have been presented with the option of a TT as I am not chasing perfection. I just want to remove the belly pooch that has accumulated over the last 4 years or so and slim my love handles. Thoughts on coolsculpting versus lipo? I respect my surgeon so I am not taking their recommendation lightly but the horror stories of Coolsculpting are giving me pause. I will also add that my Plastic Surgeon’s office is very highly respected in my town and their CS provider is highly regarded as well.

Gerald Minniti, MD, FACS · Answer

There is nothing truly horrific about Coolsculpting; Paroxysmal Adipose Hypertrophy is rare, but when it happens to a B celebrity/influencer it can seem like a given. The problem with Coolsculpting is that it barely works and takes 3 sessions spread out over 6 months. Most people get a 10-20% improvement. In the hands of an expert, liposuction is the way to go. You are a great candidate for liposuction, and you if you do go that route, you would benefit from skin removal in the lower belly at the very least (a 'mini' or 'modified' abdominoplasty). Depending on your physical examination, your pouch may in part be due to abdominal wall laxity. If that is the case, then a repair of the abdominal wall would be recommended.

Zoran Potparic, MD · Answer

Providing that you must do something about this mild lipodystrophy my suggestion would be to do liposuction. I hope this helps. Good luck.

Richard R. Orr, MD · Answer

Without actually feeling your abdomen and seeing the thickness of the fat and the laxity of the skin, I would probably suggest liposuction.  You do not have skin hanging so you do not NEED a tummy tuck.  However, if you have loose skin at the bottom of your tummy, a mini-tummy tuck would tighten that up nicely.  
The horror stories of CoolSculpt are real.  I have seen many patients with problems following CoolSculpt.  One patient had that done to her abdomen with almost no visible results.  Yet feeling her abdomen felt like it had a layer of gravel under the skin.  I took her to surgery for liposuction, but as I liposuctioned, it was as if I was shrink-wrapping the skin down to all that gravel and her stomach was looking WORSE.  I quit the procedure and spoke to the husband that I was stopping the procedure because I was making it look worse.
One patient, who actually does the CoolSculpt in the spa where she works, had a very unusual complication of rebound hypertrophy of the fat in the abdomen.  She appeared to me to be 6 months pregnant with the overgrowth of fat, just limited to the area of CoolSculpting.
I would never do CoolSculpting to a member of my family!!  And I have been at this job over 30 years.  
I am sorry that patients get so many recommendations from different surgeons.  I wish you good luck!

Darryl J. Blinski, MD · Answer

Based on the posted photos I disagree with CoolSculpting!! I recommend superficial liposculpting with J-Plasma combo. Expect fees in $5,000+ ranges. Best to virtual consult

49, woman, 3 pregnancies. Coolsculpting versus Lipo for belly pooch and flanks? (Photos)

Answers (4)

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