Liposuction or coolsculpting - which procedure would best remove stubborn fat from previous pregnancy? (photos)

Question

Hello, I am wondering whether I can get good results with minor fat removal in my abdominal area through coolsculpting or similar? If lipo is preferred, would I also need a tummy tuck? I have stubborn fat from prior pregnancy, 118lbs, 5'3", 40yrs old.

Gerald Minniti, MD, FACS · Answer

Coolsculpting is best for people who are afraid of anesthesia, cannot tolerate or are afraid of post operative pain, or have no time for recovery. It is unpredictable and requires multiple sessions over many months to get a small result. On the other hand, you would do poorly with liposuction due to loss of skin/soft tissue elasticity and abdominal wall laxity from pregnancy. You are an excellent candidate for liposuction and a tummy tuck. Please beware: you don't have a lot of excess skin above your belly button, and most surgeons will make your scar too high in order to avoid a small vertical scar (where the skin once was attached to the belly button). Although this line of thinking is prevalent around the world, it is wrong. A very, very low, long, transverse scar that hugs the border between of thigh and the belly laterally, and the pubis with the belly medially far more inconspicuous than one that sit much higher in the lower abdomen. The trade off is the small vertical scar in the lower abdomen, which even when above the bikini line, is hard to see. Pics on social media of surgeons that do this are available for viewing. ;)

J. Timothy Katzen, MD, FACS · Answer

Hello jojo0043,

Thank you for your question regarding the best procedure to remove stubborn fat after pregnancy.

Why I Recommend Liposuction:

Experience with CoolSculpting Complications:

I have extensive experience correcting complications from CoolSculpting. Although CoolSculpting can be effective for some, it may not always provide the desired results and can sometimes lead to issues like paradoxical adipose hyperplasia (PAH), where the treated area becomes larger instead of smaller.
Effectiveness of Liposuction:

Liposuction is the gold standard for fat removal and has stood the test of time. It involves physically removing fat cells from your body, which are then discarded. Unlike non-invasive methods, liposuction ensures that the fat cells do not grow back in the treated area.
Reliability and Precision:

Liposuction is the most surefire way to get rid of unwanted fat. It allows for precise sculpting and contouring of your body, providing more predictable and consistent results compared to CoolSculpting.
Potential Rectus Diastasis:

You mentioned having stubborn fat from a previous pregnancy. It’s possible that you have some degree of rectus diastasis (separation of the abdominal muscles), which can cause your stomach to bulge. Liposuction can address the fat, but if you have significant muscle separation, you might eventually consider a tummy tuck to repair the muscle. However, this is not necessarily required after liposuction.
Conclusion:

Given your situation and my extensive experience, I strongly recommend liposuction as the best approach to remove the stubborn fat in your abdominal area. It provides more reliable results and addresses the fat more effectively than CoolSculpting. After liposuction, if you find that your abdominal muscles need repair, a tummy tuck can be considered. However, many patients find that liposuction alone gives them the results they desire.

Good luck, and I hope I’ve answered your question regarding the best procedure for fat removal post-pregnancy.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Dev Vibhakar, DO, FACS · Answer

Hello,Thanks for your inquiry and photos. It looks like you have central fat excess (stubborn fat), a rectus diastases (stretched abdominal muscle) and skin laxity. Liposuction will help target the stubborn fat, however, it will not address the abdominal bulging from the muscle separation and it may worsen the appearance of the loose skin (as I not anticipate the skin to retract based off your pictures). I think the best aesthetic outcome is a tummy tuck with liposuction of the flanks (possibly upper back) and rectus muscle repair. I do not recommend cool sculpting for you.Hope this helps!Dr. Dev

Daniel Barrett, MD · Answer

Dear jojo0043,
it is hard to tell for sure without an examination. Based on your photos, there is a chance that you will need tummy tuck in order to get flat abdomen. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ryan Rebowe, MD · Answer

Based on the pictures that you have submitted, it appears you have a fair amount of excess skin. Because of this, you will need something to more aggressively manage the skin than non invasive or even moderately invasive methods. You will get the best results with a tummy tuck to remove the excess skin. While you may get some skin retraction with other methods, it will not be as significant or reliable. If pursuing a consult for other noninvasive methods, be sure your provider can also offer an abdominoplasty so that you are not being sold a "one size treats all" type of procedure.

Reza Rod, MD · Answer

Thank you for submitting your question in photos. Although it’s difficult to do a proper assessment without the physical examination, I think you’re an excellent candidate for liposuction. You do not have a significant amount of loose skin, so this should retract nicely after fat removal.

Jonghyun Hong, MD · Answer

Hello Dear jojo0043, It is Dr. Hong from Fresh Plastic Surgery Clinic South Korea, Seoul. 
Everything depends on your budget and timeline. Let's star from budget: basically in Korea coolsculpting for 1 session 350$~500$, but one session is absolutely not enough, so about 5 sessions at least need to be done to visually make this part slimmer. Abdomen liposuction price in Korea about 4000$~6000$ (upper and lower) . In the end, price is the same, so main difference is timeline and effect lasting period. Liposuction visible effect will be appear after all major swelling will go and tissue stick to each other (after 3 month dramatically changes) and effect is permanent (if you not gain too much weight). Coolsculpting effect might be visible after 2 month as well, however it just reduce fat cell size, not eliminate it, so effect will be very weak, even you gain some kg. 
Hope our info will be useful ^^ 
Best regards,Dr. Hong

Eric Swanson, MD · Answer

Coolsculpting sounds attractive to patients because it is nonsurgical. However, it is not as effective as surgical options, and can even produce a very troubling problem called paradoxical adipose hyperplasia (and it is costly). Liposuction is smoother, more effective, more 3-dimensional, and avoids PAH. You have a wide diastasis with an unattractive belly button, which could be corrected with a tummy tuck and diastasis repair. Liposuction is usually done simultaneously.

Thomas Trevisani, MD · Answer

Based on limited photos and history of pregnancy - you appear to be a candidate for tummy tuck with muscle tightening. Liposuction alone will not address excess skin . I do not recommend non surgical option in this case . I suggest that you seek an experienced BC PS and review the options during in person consultation

Gary M. Horndeski, MD · Answer

Pregnancy damages the mechanical strength of the anterior abdominal wall. As you can see, your abdominal wall is protruding anteriorly. If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

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