Weight training and cardio but still have stomach pooch. What should I do? (Photos)

Question

I already train 4x a week, and eat within my calorie intake, but this pooch has never left, even after 3 coolsculpting sessions! Not sure where to turn next? After so much weight training and cardio it’s a bit discouraging, I’d love to get a professional opinion. Thanks! (133 lbs, 5’8, 30 y/o, no kids)

Guray Yesiladali, MD, FEBOPRAS · Answer

What you are experiencing is very common, even in lean and active patients. The lower abdominal “pooch” often represents a small, genetically resistant fat pocket that does not respond to diet, exercise, or even non invasive treatments like CoolSculpting.
In situations like yours, liposuction is often the most effective option. It directly removes the fat cells in the area and can create the flat contour you have been working toward. If your skin has good elasticity, liposuction alone may be enough. If the skin is thinner or shows some laxity, it can be combined with skin tightening technologies such as radiofrequency or Renuvion.
A tummy tuck would not usually be advised in your case, since there is no significant skin excess or muscle separation.
I have also shared a detailed video where I explain why some fat pockets are resistant to diet and non surgical treatments, and how targeted liposuction can provide lasting results.
&mdash; Güray Yesiladali, MD

Ellen Ozolins, MD · Answer

Thank you for your question. The issue is likely diet- and exercise-resistant subcutaneous fat or mild skin laxity, rather than excess visceral fat or poor fitness. Surgical options will include a mini tummy tuck if skin laxity and diastasis are mild, with no stretch marks, or liposuction if skin quality is good and the issue is purely fat. An in-person consultation with a physical exam and possible ultrasound imaging will help clarify whether you’re a better candidate for liposuction versus a mini tummy tuck.

Brandon Lambiris, MD · Answer

Given your young age and presumably excellent skin elasticity I think a small amount of liposuction coupled with an adjunctive treatment modality like Renuvion could provide an excellent result. You appear to be an appropriate candidate for a mini abdominoplasty as well. A mini tummy tuck would better accomplish tightening of the lower abdominal skin when compared to the lipo+renuvion but requires a scar to do so. 
I encourage you to explore these options during an in-person consultation with a board-certified plastic surgeon to determine which treatment option is best for you. 
Dr. Brandon Lambiris Board-Certified Plastic Surgeon–Sarasota, FL

Ajaya Kashyap, MD · Answer

Thank you for your query. Based on your photographs, a mini tummy tuck may be your best option although another option will be invasive Radio-frequency (J-plasma or ThermiTight). Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. all the best.

Ira H. Rex III, MD · Answer

From your photographs, it seems you may be a good candidate for a limited or mini tummy tuck.  This is often hard to  determine without a good examination.  You should consider going to a plastic surgeon to see what your options are.  Good luck with things.

Leila Kasrai, MD, FRCSC · Answer

If this is loose skin, then a mini tummy tuck may be a suitable option. If you don’t have skin laxity issues and this is fat, then liposuction alone may be sufficient.

Gary M. Horndeski, MD · Answer

You may benefit from a mini tummy tuck where a very low incision is made, is small and can take in the slack skin.  At the same time, the area can be liposucted as well.

Best Wishes,

Gary Horndeski, M.D.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, you are a great candidate for VASER Hi Def Lipo and possibly Renuvion skin tightening (determined on physical examination). Unfortunately, CoolSculpting creates excessive internal scarring, besides not giving the results that patients were told that they'll get. Without VASER liposuction technique in well trained and experienced hands, you will not have a good result. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Camille Cash, MD · Answer

From the submitted photos your primary issue is skin laxity.  That is best addressed with a tummy tuck which removes excess skin and fat as well as corrects abdominal wall laxity.  If you are planning to have children in the near future you may wish to wait until you have completed your family as future pregnancies can impact your results.  See a board certified plastic surgeon near you to learn more.

Ahmet Bilirer, MD · Answer

Hello, when we examine your photos, we see that there is excess and sagging in the area close to the inguinal crease. Although paying attention to your diet and doing sports are very beneficial for a healthy life, this excessively sagging skin will not be of much benefit to your area. In my opinion, you already have a beautiful appearance, but if it causes you a lot of complaints, you can get rid of this excess with mini tummy tuck surgery. I think plasma-based tightening devices or cryotherapy will not be useful. Therefore, I recommend that you think about and research the mini tummy tuck issue.

Weight training and cardio but still have stomach pooch. What should I do? (Photos)

Answers (13)

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