Are my remaining love handles made up of muscle or fat? Can I get rid of them? (photo)

Question

34 yo, Vaser lipo to flanks. I was recently told by my dr that my love handles are muscle, not fat and he could not remove them; after recovering from Vaser to flanks and discovering I have a horrible body shape. My body before gaining some weight was not like this. Are these lumps muscle or fat and how do I get rid of them if my dr won’t?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether your remaining love handles are made up of muscle or fat and if you can get rid of them. Thank you for your history and your pictures. In examining your pictures, I believe your love handles are made up of muscle. It doesn't appear that you have much fat in this area. Mainly if your doctor has performed VASER liposuction and says your love handles are made of muscle, if they are made of muscle, I would not suggest removing them. You need those muscles to keep your intestines and other organs in place. Regarding your body shape, you may consider further liposuction of your hips or possibly fat transfer or hip implants to get you more of an hourglass figure. You may also consider injections of Sculptra to grow areas of soft tissue. Please seek a board-certified plastic surgeon. Good Luck. I hope my answer helps to answer your question regarding whether your remaining love handles are made up of muscle or fat and if you can get rid of them. 
Sincerely,
Dr. Katzen

Jerimiah Mason, MD · Answer

The love handles seen in the photo can almost definitely be improved with additional liposuction. I would consider finding a different surgeon. Also, while Vaser is a nice tool, it wouldn't be necessary to give you a better result.

Thomas Wright, MD · Answer

Gregarious  Thank you for sharing your photos.  They show very your hip bones and rather slender flanks.  I don't recommend more surgery for you.  At least not on your flanks.  Wishing you the best of health, Dr Wright

Kelvin Eusebio, MD · Answer

I'd suggest you to get the fat lipoed and some transfer to hips depending on the body shape you expect

George Marosan, MD · Answer

Thank you for your question and photo. Based on this single view photo you have plenty of fat which was irregularly liposuctioned by a surgeon who does not understand body sculpting. Muscles do not ripple! You do have a square buttock shape which should've been addressed with the liposuction. Realistically, the waist needs to be approached from the back and front to give the thinnest waistline.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Kenneth Brito, MD · Answer

Based on your photo, it looks like there are still pockets of residual fat. A good way to check if it is fat or muscle is by pinching test. If you can pinch the tissue, it is likely fat.
If it is fat, then revision vaser liposuction will be appropriate.

Karan Lal, DO · Answer

I would consider multipolar radiofrequency which can melt felt and tighten skin. It’s noninvasive and it is a nice alternative. It’s also very safe.

Darryl J. Blinski, MD · Answer

Based on only 1 posted photo! Either you requested only lipo reduction of the flanks or love handles or the surgeon was not experienced to offer lipo 360 with hip dip BBL (which is exactly what you needed!). Fee for redo lipo 360 BBL 9primarily for hip dips) $6,000. Best to virtual consult with...

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you don’t have before and after pictures and ask your surgeon to forward the ones they took.
It looks like you had fairly aggressive liposuction that removed probably more fat than it should’ve been taken out and it’s slightly uneven.
It’s probably fairly typical or average quality work but could’ve been done much better.
In particular the transition from your buttocks to your waist is not smooth and continuous. It doesn’t follow an ideal feminine S-curve. The good news is that that could pretty easily be fixed. on your current picture if you just follow your body outline from your chest going down through the waist and acid transitions into the buttocks it bulges out. That bolt should not be there. It should be a smooth continuous concave curve which gradually transitions to a convex curve over the hips and buttocks. The procedure is best done with patients laying on their side not laying face down or on their back.
Delivering consistent quality liposuction results is far more difficult than most people believe and this definitely includes plastic surgeons.
The truth is most plastic surgeons really aren’t that good at Liposuction. This includes board-certified plastic surgeons with many years of experience who have an overall good reputation.
Some do it and some don’t. It is a procedure that is deceptively simple yet extremely difficult to master.
In other words simply putting in a cannula and removing fat requires very little skill. Creating quality outcomes on a consistent basis including the ability to make accurate assessments and predict accurately exactly what patients will look like afterwards and conveying that by showing numerous before and after pictures is a whole Nother story.
Liposuction is permanent an irreversible. If done incorrectly patients can be left disfigured and there is very few good options to revert back to pre-procedure contour.
In your case your surgeon simply didn’t go low enough with the transition of your buttocks especially on the lateral aspect.
Liposuction results have more variation and outcome based on who does the procedure than any other plastic surgical procedure I’ve ever seen.
It’s quite remarkable how different results can be.
Patients do not realize the importance of provider selection and how much variation there is among providers.
The key to getting consistent quality results including an accurate assessment in regards to candidacy is defined as sufficiently skills and experience provider.
Like I said earlier simply finding a board-certified plastic surgeon with overall good reputation is insufficient.
To find the right provider I recommend patients have multiple in person consultations.
Vetting plastic surgeons cannot be done accurately via virtual consultations so I recommend patients have in person consultations exclusively if possible.
Avoid traveling long distances for elective surgical procedures if possible.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures. Some providers may be apprehensive to do this but understand that seeing a handful of preselected pictures which most likely represent the best results of the providers career is completely insufficient to get a clear understanding of what average results look like or how many of these procedures the surgeon has performed.
Instead I asked the provider to simply show you as many before and after pictures as they have access to. If it’s a limited number then question how many of these procedures they’ve done and why they don’t have more pictures.
To put things in context and experience the surgeon should have no difficulty showing you at least 50 sets of before and after pictures. highly experienced surgeons will have hundreds or even thousands of before and after pictures of commonly performed procedures and Liposuction is one of the most common.Have pictures of your old torso printed and bring those with you to the consultation for reference. I asked the surgeon to show as many pictures as possible of patients who are very similar body characteristics to your owner. ask the provider to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as they had hoped for. You should also ask what the surgeon‘s revision rate is for Liposuction and what the revision policy is.
All plastic surgeons should do a certain percentage of revisions. If they don’t they’re not delivering the best results. Excessive revision rates indicates that could be a problem and those who claim to never do revisions are not taking full responsibility and delivering the best possible outcome. 
A healthy revision rate for Liposuction is probably five or 10%
When reviewing before and after pictures look very carefully for any contour irregularities in all areas treated. you should also ask the surgeon to clearly differentiate what areas were treated and what areas were not treated and look carefully at transition zones between treated and untreated areas.
Personally I view the torso as a single anatomic units and generally prefer to treat the entire torso if I’m going to do liposuction on any part of it. by treating the entire torso patients are left with an even natural thin fat distribution without transition zones to untreated areas. Spot treating the problem area will inevitably lead people to have an abnormal fat distribution and that never looks natural.
Do you not know firsthand what your surgeon was capable of. Recognize that revision work or secondary liposuction is far more difficult than primary liposuction so they need to find a really talented provider speaks for itself.
In the end your surgeon is responsible for the outcome and you are responsible for choosing that provider.
There are many times patients post liposuction results on this website where there is nothing positive to say and patients are simply left disfigured for life.
In your case there is substantial room for improvement. You simply need to find the provider who can do it for you.
It’s very obvious when I look at your picture but describing it in words it’s a different story. I could easily show it by reviewing before and after pictures because I have lots of people of looked very similar to what you do.
Continue having consultations until you feel very comfortable you find the most talented and experience provider.
Best,
Mats Hagstrom MD

Randy Dean, MD - Account Suspended · Answer

Hi and welcome to our forum!
From your photos, I note fullness of the lower flank / upper hip area, creating a "boxy" appearance. The resolution of the photo does not allow me to determine the integrity of the overlying skin (stretch marks, streaks, etc.) Without examination, one cannot determine the nature of the fullness...(skin laxity vs. residual fat).
If there is no skin laxity, you may wish to consider a secondary liposuction if you are totally healed from your previous procedure (12 months or so). If there is skin laxity, a lower body lift would be required to eliminate the fat and overlying loose skin.
Best wishes...

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