What would be the best approach to get rid of this post mommy pooch? (Photo)

Question

I am a skinny 115 lb mom post 3 kids, have a small diastasis 1-2 fingers & small abdominal pooch. diet & exercise, pooch has gone down a bit. Should I start with Emsculpt and see results are, and liposuction later? or do liposuction first, and wait a few months and do Emsculpt? Or do Emsculpt and Coolsculpting? trying to find the least invasive combo with the best results. I understand that lipo has the guaranteed flat stomach. But is there a non-surgical option? I am petite and active?

Ryan A. Stanton, MD · Answer

If you have done all you can with diet and exercise and you still have a small pooch, then it is indeed more than likely from your diastasis and/or a small amount of stubborn fat. If you truly do have diastasis, the only way to fix this is with a tummy tuck to plicate the diastasis back together, period. Devices such as Emsculpt will not significantly reduce diastasis.  If it is only a small volume of fat with some mild skin laxity left over from the pregnancy then something such as Evolve®️, or better yet BodyTite®️, which is based on the “radio-frequency assisted liposuction” will  both melt away the fat and  tighten the skin and subcutaneous ligaments between the muscle and the skin. Glad to help.

Jason Emer, MD · Answer

mommy pouches if tight can be treatd with non invasive treatments like coolsculpting or trusculpt ID, if you have loose skin you may need internal heating liposuction and/or tummy tuck.

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.

Daniel Barrett, MD · Answer

Dear sherryk77,
based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Scott W. Vann, MD, FACS · Answer

It appears you have a typical pooch from having kids which is caused by stretching your muscle fascia while pregnant. Neither liposuction or emsculpt will fix this. Your problem is not fat it is the stretched abdominal wall. It will take a tummy tuck to repair the fascia to flatten your abdomen. To be sure be examined in person and discuss with your plastic surgeon. Good luck.

Kelly O'Malley Mattone, MD · Answer

My advice, since you are active fit and have 3 children, would be to start with Emsculpt. It is the least invasive procedure that can address 3 of your issues simultaneously without much of a time commitment, surgery, pain or downtime. Emsculpt will burn fat, build and sculpt your abs and also bring your abdominal muscles closer together to close the gap.

David Grindem, DO · Answer

The Emsculpt is a GREAT option for post partum women. Not only will it strengthen your core and reduce belly fat, it is proven to treat diastasis recti.

Dmitriy Schwarzburg, MD · Answer

Loose skin is normal after giving birth. I would suggest CoolSculpting to eliminate unwanted fat and then following with EMSculpting treatments to tighten your abdominal muscles.

Amrish Patel, MD · Answer

You likely won't need liposuction, I would go with Emsculpt first and get the muscles toned and stronger again, the fat loss with EMSCULPT and EMSCULPT NEO will help your strength and your pooch. If you have a provider that does Trusculpt ID you can do that first to help accelerate the fat loss then do EmSculpt immediately after to help with the fat loss and hopefully will be able to avoid any liposuction at all.

Matthew Stanizzi, MD · Answer

Given what I'm seeing here I would strongly consider the EmSculpt NEO. 
The combination of building muscle mass and tone, reducing fat and tightening the the skin You may find you have all there results you need and its less invasive and lest costly than the other treatments you're considering.

Mary Beth Mudd, MD · Answer

Unfortunately, your photo only shows a profile and not a straight on view, so it is impossible to determine the condition of your skin. "Mommy pooches" are caused by fat deposition as well as stretched out skin from pregnancy. It is important not to confuse skin laxity with fat since if you remove fat from an area and don't treat the skin, the skin will hang and the area will actually look worse. (Think about taking the stuffing out of a pillow-the walls get very floppy and the pillow loses shape). Emsculpt may help the diastasis but would not help any skin laxity.  I would suggest consultation with a physician familiar with fat deposition/skin laxity/diastasis to assess you and advise you as to how best to help you solve your pooch so you can look your best!  Best wishes, Mary Beth Mudd

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