What procedure is appropriate (Coolsculpting vs...all the Lipos) for a very fit but very bottom-heavy person?

Question

Early 20s, 5'4, athletic but bottom-heavy. I've tried all combos of diet/exercise and have struggled with an eating disorder to target my thighs. I don't have BDD, it's the way my body is built prevents thinner thighs unless I dangerously reduce my weight, which I don't want! Even in the current awesome 96-106 lbs photos, I struggle to keep my legs that small. I'd love to bulk up my torso and arms after a procedure. I know the fat will be redistributed. What lipo or non-invasive procedure would be good?

Jason Emer, MD · Answer

you can do liposuciton + internatl heating typically if there is looseness then a mini thigh lift does best. fat should be used for buttock lifting. add sculptra for best results.

my whole practice is doing lipoabdominoplasty, or at least liposuction with internal heating (which is not the gold standard for skin tightening with body contouring).

the smaller you are before liposuction the more contouring you can get from the procedure. most of my liposuction patients get pre and post surgical optimization with hormonal therapy (see link to help boost their weight loss before surgery and help them heal after).

You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radio-frequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

James E. Chappell, MD · Answer

I’d consult with a local BCPS. You might not need anything, or maybe some targeted Coolsculpting at the most.

Mats Hagstrom, MD (license on probation) · Answer

Please simply forget that you ever heard the term cool sculpting and put that out of your mind.

To do circumferencial total thigh reduction with Liposuction is tricky business on someone who has and virtually perfect body.

If you opt for Liposuction then you absolutely have to make sure you’re in the hands of someone who has spent a lifetime perfecting their liposuction skills.

Lower extremities are difficult and I wonder if having the procedure even justifies the small scars you get from Liposuction.

My practice has been devoted exclusively to Liposuction and fat transfer for the last decade. I’ve been a plastic surgeon for over 20 years.

I’ve done over 7000 Liposuction procedures.

My recommendation to you would be to leave it you’re very attractive body alone and stay away from surgeons.

Best,

Mats Hagstrom MD

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