Would like to avoid scar - am i a good candidate for emsculpt? (Photos)

Based on your photos, it is not possible to predict to which degree will your lower abdominal skin retract after liposuction. You should wait at least 6 months after liposuction to find answer to that question. Good luck.

I would first use liposuction to remove the excess fat. Then you can use the EMScuplt for muscle tightening and more fat reduction. You may need two complete sessions, 8, for best results.

It is difficult to assess if you have diastasis recti from a photo alone - sometimes you need to palpate the muscles. Emsculpt is helpful for diastasis recti if you have it though. While no results are guaranteed, Emsculpt NEO could help with fat reduction in the abdomen and muscle building. The radiofrequency of Emsculpt NEO also has a mild skin tightening effect as well. You could get a great benefit with Emsculpt NEO with at least 4 sessions spaced about a week apart, but you may benefit more from 8 sessions.

During consultations I typically break down my assessment for the front of the abdomen as always. Being related to one or more of the four separate variables.

In other words if someone doesn’t like the way their belly looks it is always because of one or more of these four variables. Each of the variables has a certain way of treating it and in order to get the best result patients need to recognize that they need to treat what the underlying problem is.

The first variable is skin laxity. Skin laxity typically comes from having previous pregnancies or significant weight fluctuations.

To assess for skin laxity simply pull on your skin until it’s tight and see if that helps improve what your abdomen looks like. Obviously tight skin usually looks better than loose skin but does pulling on the abdomen fix the contour or fix the problems that bother you.

If they do then you need a tummy tuck.

The second variable is excess subcutaneous fat. This is the fat that’s removed with any form of liposuction. Assess the thickness of your subcutaneous fat put the skin under gentle tension by pulling gently with one hand while at the same time take one finger tip and gently push against your skin until you feel the underlying muscle wall. You don’t have to push hard at all. I’m guessing you’re fat thickness around your belly button is about 1.5”. You can expect Liposuction to remove half to 75% of that. in other words well done Liposuction would bring in your abdominal skin by up to 1 inch. That’s far from having a flat abdomen.

The third variable is muscle separation from previous pregnancies called diastaces rectii.

All the women who had term pregnancies have this to some degree but some develop much more than others.

It causes the muscle wall to bow out causing a bulging abdomen.

A straight abdominal wall should be a B line between your sternum and your pubic bone.

You can feel where your muscle wall is in the same way I showed you how to measure your own fat thickness. Gently push on your skin with one finger until you feel a little resistance with a muscle wall is. In your case you’ll probably notice that your muscle wall sits well in front of a B-line between your sternum (chest bone) and your pubic bone.

Muscle separation can only be corrected with a full tummy tuck.

The last variable is excess visceral fat sometimes called intra-abdominal fat or gut fat.

It’s fat around our internal organs that cannot be removed surgically.
Excess visceral fat behaves and looks similar to having diastasis recti or muscle separation.

To differentiate between those who just have muscle separation and those who have visceral fat is done by an examination. If it takes a significant amount of pressure to push your abdomen flat then most likely there is excess visceral fat.

Another way to check this is to lay flat on your back and see if your abdomen drops flat and creates a B line between your sternum and your pubic bone or if it’s still bulges while laying on your back.

Based on your pictures my best guess is you have all four of these variables.

Considering that I would say Emsculpt is probably the worst treatment option.

It’s really safe and it has virtually no side effects so if you have lots of money to spend and feel like having non-surgical procedures that don’t do much you can certainly try it.

I don’t think you will see the results.

If you want a tight good looking abdomen presumably the way it looked when you were young if you were not obese at that time would be weight loss followed by a full tummy tuck.

Liposuction isn’t going to address the visceral fat or muscle separation without that you’re gonna have a bulging abdomen.

Even if you’re OK with having loose skin you’re not going to get muscle tightening without having a full tummy tuck.

If you’re apprehensive of having a tummy tuck at this point then start with the easiest part which is weight loss.

For those who have access visceral fat weight loss is 100% required if they want to ever have a flat good looking abdomen.

Whatever you decide to do weight loss has to be part of the picture so that’s the easiest part to start with.

That will give you time to think about your options. In the meantime I suggest having multiple in person consultations with other local board-certified plastic surgeons to see what each one has to say.

Stay away from providers who are not fully trained or cannot offer tummy tuck as part of their armamentarium.
There are non-plastic surgeons in the community doing liposuction and since they don’t have the skill or training to do a tummy tuck they may recommend Liposuction for you since it’s the only operation they can perform and it makes money for them.

All of this said you are an excellent candidate for Liposuction for your love handles waist back and under arms(armpits). None of these areas are affected by previous pregnancies or having visceral fat. likewise these areas are not treated with a full tummy tuck and our ideal for Liposuction. I’m guessing though that those are not the areas that bother you the most.


Best,

Mats Hagstrom MD