Fat reduction – surgical and non-surgical

Body contouring remains one of the most popular fields in cosmetic surgery. There are several surgical and non-surgical options for reducing fat volume, removing stubborn pockets of fatty tissue and streamlining your overall body shape.

Over time, tried and tested procedures such as liposuction have become more refined and new, minimally invasive devices have been introduced to the market. Here, we guide you through the essentials in body contouring and outline the most popular procedures to create a slimmer, more balanced silhouette.

Surgical

Liposuction

Nearly 40 years since it was first performed, liposuction remains the gold standard for fat removal for those looking to rid themselves of localised pockets of fat. Liposuction is the best cosmetic option to remove large volumes of fat, using one of three surgical techniques: suction-assisted liposuction, the syringe technique and energy-assisted liposuction.

Suction assisted liposuction is where the surgeon removes the target fat using a small, hollow tube (cannula) connected to a vacuum pressure unit. The surgeon directs the cannula through tiny incisions into areas to be suctioned, moving the cannula backwards and forwards to break up the fat as it is removed. Because the surgeon has to manually dislodge the fat, this technique can be time-consuming and typically requires the patient to be under general anaesthetic during the operation.

Alternatively, the syringe method uses a syringe instead of a machine to aspirate the fat. This technique is typically employed if the patient has opted for fat to be reinjected into another area, such as the face, for volumisation purposes. Many doctors believe the syringe technique is more precise than machine-assisted suction and helps prevent extracting too much fat. However, it is not as suitable as other techniques for large-scale fat removal.

Recent advancements in liposuction surgery have seen the advent of different energy sources being used to assist in dissolving and removing fat. These techniques include ultrasound-assisted liposuction, radiofrequency-assisted liposuction and laser-assisted liposuction and water-assisted liposuction.

The role of the energy is to dislodge and break up the fat so it can be removed easily in an almost liquefied form. Reports of additional benefits such as a degree of skin tightening and reduced recovery time have been associated with different energy-based devices, however each technology can produce effective results in the hands of a skilled surgeon.

Doctors are increasingly using energy-assisted liposuction techniques for the reduced recovery time and, in some cases, their ability to target more superficial fat layers underneath the skin. Even though the recovery period is typically less than with traditional liposuction methods, patients should still expect to experience bruising, swelling and in some cases residual bleeding from the incision points post-procedure.

Liposuction in any form should not be considered an alternative to losing weight through diet and exercise. However, it may be a viable option for men and women who want to reduce bulges of fat that have resisted dieting and exercise. The ideal liposuction candidate is at or near their ideal weight, exhibits healthy skin elasticity and is seeking reduction of diet-resistant localised pockets of fat. Common sites include the hips, outer and inner thighs, abdomen, lower back, knees and neck.

In some more extreme cases, a body lift procedure may be performed in conjunction with liposuction to remove excess skin and help the skin conform to the body’s new contours. It should also be noted that liposuction does not improve the appearance of cellulite or stretch marks, as these concerns are not related to fat accumulation beneath the skin.

Depending on the size and number of areas being treated, as well as
the technique employed by the doctor, the procedure usually lasts around one
to three hours. After surgery, patients commonly experience swelling and bruising, with most patients reporting mild soreness and numbness in the days following treatment.

Patients are required to wear a compression garment for up to six weeks after surgery, but should be able to resume normal everyday activities in two to four weeks. It is typically recommended patients wait one month before resuming vigorous exercise. While the results of liposuction can be seen as the swelling subsides, it usually takes from six months to a year to see the final effect.

Non-surgical

While liposuction surgery offers a predictable method of removing fat deposits, non-surgical body contouring provides an option for those who don’t want invasive surgery and its associated risks and recovery time.

Although non-surgical body contouring devices offer an effective means for achieving a more streamlined body shape – commonly targeting treatment areas such as the abdomen and thighs – it’s worth remembering that no non-surgical device can achieve the level of fat removal possible with liposuction.

A key difference between liposuction and non-surgical body contouring devices is the number of procedures required. Most non-surgical devices require a minimum of three treatments in order to achieve optimal results, and often it can take longer before those results are seen, as the fat cells take time to be flushed out through the body’s usual metabolic processes.

Usually, anaesthesia isn’t required for non-surgical body contouring and treatments are performed in an in-office setting. There is normally no downtime, minimal patient discomfort, and complications are rare. In conjunction with a healthy diet and exercise regime, results should be long lasting because, just as with liposuction, when fat cells are permanently destroyed they will not return.

As developments in non-surgical body contouring continue, it’s easy to become confused by the wide range of devices and technologies on offer. Most devices harness some form of energy – be it radiofrequency, ultrasound or freezing temperatures – to penetrate the skin and break down underlying fat. Here, we summarise the main technologies that underpin the most popular non-surgical body contouring devices available in Australia.

Radiofrequency body contouring

This non-surgical treatment uses radiofrequency (RF) energy to reduce pockets of fat. The energy is emitted via an applicator through the skin without damaging the outer layers, only targeting the underlying fat and tissues.

Treatment typically takes about one hour and patients generally experience a warm to hot sensation around the target area during the procedure. The heat generated from the RF energy causes microscopic changes to tissues and collagen fibres, with further collagen remodelling occurring over the subsequent months following the procedure. The broken down fat cells are drained via the lymphatic system and then excreted as urine.

Localised fatty deposits such as on the abdomen, hips and thighs are most suited to RF body contouring treatments, with patients also noting a reduction in the appearance of cellulite. Temporary side effects may include temporary swelling, redness or bruising around the treated area, which normally disappear after a week or so.

Depending on the device being used, results can be observed after a single treatment, although a series of treatments is usually recommended for significant results. The patient will gradually notice changes such as circumferential reduction of the treated area, a reduction in cellulite and a more streamlined body shape.

Ultrasonic body contouring

Ultrasonic body contouring treatments use targeted ultrasound frequencies to break down fat, particularly on the abdomen, hips, thighs and ‘love handles’. The best candidates are close to their ideal weight but have stubborn areas of localised fatty deposits that do not respond to changes in diet and exercise.

The focused ultrasound waves are delivered in short bursts of energy, or pulses, to destroy fat cells while leaving surrounding tissue, nerves and blood vessels unaffected. The ultrasound waves create a cavitation effect in the target fat cells – a process where the fat cell membranes are damaged with each pulse of energy so that the contents of the fat cells (triglycerides) are dispersed and processed by the body. The fat cell contents are then flushed out by the body’s lymphatic system.

Generally, a series of treatments per area achieves noticeable, measurable results, although some patients note a circumferential reduction in the area after the first treatment. It can take around four weeks for final results to be visible as the body gradually eliminates the fatty debris.

Cryolipolysis

Cryolipolysis uses almost-freezing temperatures to kill fat cells without traumatising the surrounding tissues or harming the skin. The treatment is most suited to patients of average weight with pockets of fat which don’t respond to diet or exercise.

A gel drape is placed onto the target area to protect the skin before the applicator head is placed onto the fat pocket, where it remains for approximately one hour. The applicator acts like a vacuum to suck the area into position and direct the cold temperature to the target fat cells under the skin.

Patients experience a gradual cooling sensation, similar to placing the area in iced water, but this subsides as the body gets used to the change. The initial suction may be uncomfortable depending on the laxity of the skin, but any discomfort usually subsides about 10 minutes into treatment. Post treatment, the target area feels stiff and cold, appearing squarish as if still moulded to the inside of the applicator. This can look strange immediately after the treatment, but it subsides after about 30 minutes as the skin and underlying tissues soften back to room temperature.

Generally, at least two to three treatments are recommended. The results of cryolipolysis take at least a couple of months to appear, depending on the size of the area treated.