Am I a better candidate for Emsculpt or a tummy tuck? (Photo)

Question

I have met with my trusted local doc. He recommends a tummy tuck with lipo. I’m hesitant because of scarring, time off and healing. I would like a flatter tummy, less fat under my breasts and less muffin top. Is this possible to accomplish with emsculpt? I’m a 40 year old with 2 full term pregnancies and workout with weights, yoga and cardio 5 days/week.

Daniel Barrett, MD · Answer

Dear gpi31,
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

Jason Emer, MD · Answer

if you have loose skin you need removal and tightening, you can use EmSCULPT (i think trusculpt flex is better) to maintain

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.

Scott W. Vann, MD, FACS · Answer

I agree with your doctor. You have some excess fat of the abdomen and "love handle" area which could be solved with liposuction. However, the most noticable problem I see with your abdomen is the stretched muscles or "pooch" that makes you stomach stick out when you are standing, but goes flat when you lay down. This is fixed with a tummy tuck and gives you tight skin too. Emsculpt would give almost no change. Liposuction would take care of the fat , but you need the tummy tuck with the liposuction to give you the waistline you had before kids. Good luck.

Dmitriy Schwarzburg, MD · Answer

CoolSculpting is a non-invasive procedure that uses a vacuum applicator to draw in skin and underlying subcutaneous fat to deliver controlled cooling. This penetrates below the skin causing permanent elimination of fat. It can be administered in a variety of areas on the body, including the jaw and chin area, lower and upper abdomen, back, arms, and thighs. You can do EMSculpt after to tone the muscles.

Mats Hagstrom, MD (license on probation) · Answer

Of the treatment options they are full tummy tuck vs liposuction.  Emsculpt is not on the list.  It’s a temporary treatment that in reality only gives muscle strengthening.  I don’t think having stronger abdominal muscles will be visible through your fat layer and mod skin laxity.

You could consider just liposuction if you just want contour improvements.  It will not give you tight skin so if you want that you should consider the full tummy tuck.

I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

Whenever possible schedule in person consultations.  
During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews.  Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles. 
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

Avoid scheduling for surgery or making a deposit on the day of the consultation.  Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats Hagstrom MD

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