4'11, 127lbs, Asian, female what can I do for cellulite/loose skin/body fat after CoolSculpting 3 times? (Photos)

Hello @rabbit4291, thank you for your question. Cool sculpting is an innovative, non-invasive way to reduce fat with subtle results. Although it may not be the most effective choice for every situation, additional steps such as liposuction can be taken afterwards. Best wishes. Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

Hi, thank you for sharing your question. You are a great candidate for liposuction. This will remove the unwanted fat and contour your shape to your desire.

I'm sorry you have had three failed attempts at Cool Sculpting. I recommend that you see a Board Certified Plastic Surgeon in your area to discuss what your options are now. If the cool sculpting has not caused scar tissue, you may still be a candidate for Vaser lipo sculpting which is more invasive but has gold-standard results. The Vaser heats the under-surface of the skin to stimulate the collagen for better skin contraction. I have had great success with it in my practice. Good Luck to you!!

Thank you for your question and photos. Based on these photos, you do have significant amount of fat on your torso. Coolsculpting is not truly "sculpting" it is mass fat cell necrosis by freezing. It is not precise, not reproducible, and can create PAH (paroxysmal adipose hypertrophy). It also makes liposuction more difficult due to the extensive scarring within the treated areas. I deal with this problem daily in my practice and I use the VASER liposuction technique and other advanced techniques for best results. To achieve a good result see a board certified plastic surgeon experienced in advanced body sculpting techniques. This is not a case to "shop" for the cheapest surgeon who will promise everything and deliver nothing except more scarring and inability to provide a future good result. Good luck.

Dear rabbit4291,
it is hard to tell for sure without an examination. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

From your photos you appear to be a candidate for liposuction which should yield more complete results than Cool Sculpting. Traditional liposuction in the hands of a skilled surgeon can help to contour the abdomen and remove excess subcutaneous fat. The first step is to visit with a board certified plastic surgeon near you for a consultation.

Dear Rabbit,
You should really consider liposuction as a more permanent and cheaper (yes, after 4 Coolsculpting procedures, it can be more expensive than a liposuction procedure). The cellulite should be better, but not gone completely. The belly and excess fat of your sides would be much better post liposuction.
Best wishes,
Dr. Taranow

Thank you for your photos. For persistent fat and loose skin of the abdomen and sides, I recommend liposuction and also would consider tummy tuck if needed. Cellulite cannot be treated by coolsculpting. The liposuction will directly remove excess fat in the areas of concern and allow your skin to tighten somewhat. Sometimes when enough fat is removed, the skin can only tighten so much before it begins to sag or appear more loose. If this is the case, then a tummy tuck will also address the extra loose skin that you have. It is best to have an in-office evaluation to determine which procedures will get you closest to your goal. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

To make an assessment on the outcome of a procedure we always need to see proper before and after pictures. Hopefully your clinic took before pictures. We need to see what you look like before your first session with the cool sculpting to have a sense of comparison.
Cool sculpting rarely creates contour problems because cool sculpting is not effective enough to remove sufficient amounts of fat to create problems.
The majority of patients see virtually no results from cool sculpting. and some locations the procedure is effective and when it does it tends to leave an uneven fat distribution because how the fat was removed. when Liposuction is used surgeons can remove consistent amounts of fat and blend fat removal so that it transitions naturally from one area to the next. Cool sculpting removes fat in a very defined area that is determined by the shape of the device. Sometimes this can have the appearance of a cell phone imprint.
Which you have it’s not cellulite because cellulite is caused by a different process. Cellulite is caused by connective tissue pulling on the skin. The abdomen and midsection does not have a lot of connective tissue bands anchoring the skin to the underlying facia.
Cellulite can happen in different areas but it is almost exclusively a problem of the lower buttocks and back of the thigh. Those areas are both anatomic regions that have a lot of connective tissue and also are areas that can tolerate a lot of pressure like when we’re sitting.
Removing fat is never going to make your skin look better but when fat removal is done well and someone who has fairly good skin to start with it should not make it look worse either.
Without seeing proper before and after pictures or doing a proper evaluation with a physical examination it’s hard to make a good assessment or give you any quality recommendations.
Most likely the problem is that you have an uneven fat distribution which is not surprising using cool sculpting if the process actually removes fat.
The revision Liposuction is probably your only option but before warned that doing a revision liposuction is a technically advanced and difficult procedure to do well.
Most plastic surgeons think they’re a lot better at Liposuction and they actually are and the number of plastic surgeons who can do liposuction well enough to handle revision work and make patients look better not worse it’s probably relatively few.I do not believe there are non-surgical options in your case and one option should always be to accept the results the way they are, cut bait and not have more intervention.
Recognize that any attempt at trying to make this outcome improved can easily make it look worse.
For that reason I recommend you remain cautious and stay conservative.
Finding a sufficiently skilled provider to do liposuction revision work which is basically what this is even though your primary procedure was done with cool sculpting. The problem seems to be an uneven fat distribution and improving poor outcomes from fat removal treatments whether done via cool sculpting or liposuction is difficult.
It’s hard enough to take an even fantasy distribution reduce it in thickness and leave it even.Taking an uneven fat distribution and making it even as many times more difficult.
If you’re motivated enough to move forward to consider Liposuction as an option for revising your cool sculpting out, then I’ve included a basic description of my recommendation and how to find it the right provider.
It’s basically the same process someone would go through to find the best provider for Primary Liposuction. The biggest difference is that plastic surgeons will have less before and after pictures of revision work.
Simply choosing one local plastic surgeon with overall good reputation and asking them to correct the outcome is a risky proposition in terms of getting a quality outcome.
Do you need to find the best provider and that requires multiple consultations.
Here are some thoughts previously written to help others find excellent providers for Liposuction work.
How to find a provider liposuction
Here’s the process I recommend patient take.
Start by getting pictures of your body the same way plastic surgeons take before and after pictures.
Have someone else take the pictures or use the timer on your camera. pictures should be taken from about six or 8 feet away. Don’t take pictures using a mirror.
Pictures should be taken with the camera at the same height of what’s being photographed. For the abdomen the camera should be at the height of the abdomen. for the thighs the camera should be at the height of the thighs.
Quality pictures require showing your body. Wear loose revealing undergarments that don’t press into your skin. Take pictures of your front, side and back side standing in a neutral position with your arms down by your side.
Print copies of these pictures.
Whenever reviewing before and after pictures whether you’re doing it at home or during a consultation always have your own pictures by your side for a comparison.
Understanding candidacy is key and understanding with the procedure can or cannot accomplish.
When reviewing results look for patients who have similar body characteristics to your own in the before pictures.
If they have different characteristics then what you look like and those results don’t apply to you.
Make a list of all the local board-certified plastic surgeons in your community.
Go to each providers website and document the quantity and quality of Liposuction before and after pictures posted on their website. take a peek at other procedures like tummy tucks etc. for reference. if someone has 25 sets of before and after pictures of the tummy tucks but only has two pictures of Liposuction results and that is probably not The right provider.
This will give you a general idea if providers like doing Liposuction, do a lot of liposuction and get enough quality results to post them on their websites. next choose five of those providers and schedule in person consultations.
There’s no correct number of consultation someone needs to find the best provider but the more consultations you have the better you’ll get at doing consultations including the ability to properly vet plastic surgeons and the higher your chance of finding the best provider.
Considering that a substantial number of plastic surgeons simply aren’t good at Liposuction and the number of providers who are excellent at this procedure is rare you definitely need to have multiple consultations.
Personally I do not believe it’s possible to find the right provider using a computer or by having a virtual consultations.
Virtual consultations are better than no consultation but in my opinion in person consultations are needed to get a quality assessment and to properly vet the provider.
Take careful notes during each consultation. become familiar with what quality liposuction results look like on people who have bodies similar to your own. Create a rating system for Liposuction results.
Recognize that most pictures available on the Internet either represent some of the best results because that’s what the providers usually put out on their website or disastrous results from patients who are seeking help. most average liposuction results don’t end up as pictures on the Internet.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
Bring printed copies of your own pictures of yourself.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as they had hoped.
Ask providers to only show you pictures of previous patients who had similar body characteristics to your own.
Again, there’s no point at seeing quality results and somebody who had a different candidacy for the procedure than you do.
Providers may be apprehensive to do this and will generally prefer to show you preselected images representing the best results of their career.
Why this baby more impressive to look at it does not represent average results and it is in your interest to find out what the average results look like and to get a clear understanding of how many of these procedures each provider has actually performed.
For reference an experienced plastic surgeon and should have no difficulty showing you at least 50 set of before and after pictures of commonly performed procedures like liposuction. highly experienced surgeons will in fact have hundreds or even thousands of before and after pictures of commonly performed procedures.
Obviously there are those who are earlier in their career.
Personally I recommend staying with skilled and experienced providers.
When reviewing before and after pictures look very closely at all areas treated with Liposuction. Make sure there are no skin contour irregularities in any of the treated areas. ask the provider to point out exactly what areas were treated with Liposuction and what areas were not treated. then look carefully at transition zones between treated and untreated areas.In regards to Liposuction of the abdomen I view the torso as a single anatomic unit and generally prefer to treat the entire torso as a single unit.
By treating the entire torso as a single anatomic unit patients are left without transition zones between treated and untreated areas.
The concept of treating the torso as a single unit without transition zones is less important and low BMI patients. and chubby people with over an inch of subcutaneous fat the impact of liposuction is dramatic enough that it’s not possible to have a natural transition zone between treated and untreated areas even if the procedure is done well. most people simply get a better result if the entire torso is treated uniformly. A full torso includes upper abdomen, lower abdomen, love handles (all the way down to the top of the hip dip), waist, fall back, under arm (arm pit )all the way to the side of the breast.
You should also take careful notes about the overall thoroughness of the consultation including all aspects of a complete consultation like review of medical history, physical examination, assessment, recommendation of procedures, alternative procedures, risks and benefits, complications including what complications a surgeon is had and how they are managed, preparation for surgery, instructions for recovery, revision rates and revision policy etc.
Take careful notes about both the quantity and quality of before and after pictures any of the provider showed sufficient number of pictures of previous patient that look very similar to what you look like.
Most people don’t have a lot of experience consulting with plastic surgeons. On the other hand plastic surgeons typically have lots of experience giving consultations.
Recognize that you are the one paying for the procedure and you are hiring someone to do a service for you.
You have all the right in the world to ask for documentation including seeing a variety of results including results that were less than what the provider read hoped for.
If providers fail to cooperate then simply make a note of that and continue to the next provider.
I think you’ll find that the most talented and experience providers will be the most open minded in regards to showing you a variety of results and being truthful about what the procedure can and cannot accomplish in their hands.
Assessing patience for Liposuction candidacy is not easy or straightforward.
Even mild skin laxity can contribute significantly to contour and some areas simply don’t respond to Liposuction because of how the skin drapes especially in certain anatomic positions.
Lower extremity liposuction is technically difficult and often does not deliver the results patients had hoped for.
True saddlebags can respond well but other areas like the upper inner thigh Typically does not give the results patience and hope for and it’s prone to having contour irregularities if the procedure is not done with technical expertise.
If you have any doubts then simply slow down and schedule more consultations.
Nobody has to have liposuction.
Based on your description of yourself a question if the procedure is indicated in the first place.
Recognize that if provider selection is not done well the procedure can leave you permanently disfigured.
Good luck,
Mats Hagstrom MD