Abdominoplasty vs. Liposuction vs. CoolSculpting: A Critical Evaluation

Fat is a fact of life, and keeping it under control can occupy a disproportionate amount of time and energy. As we age and our metabolism slows, it becomes more difficult to battle the bulge.  In some cases, despite a good diet and regular exercise, stubborn areas of fat may persist.  In women, these areas are often localized to the inner and outer thighs and the lower abdomen.  Men tend to notice excess fat along their flanks and over both the upper and lower abdomen.  Whether you have small areas or large ones, and are ready for surgery or wouldn’t dream of it, there are now a number of good options for fat reduction.

The abdominoplasty, or tummy tuck, is a surgical procedure in which excess skin and fat are removed through a horizontal incision across the lower abdomen, within the bikini line.  The rectus abdominis muscles (also referred to as the “six-pack”) are tightened, and in some cases liposuction of the flanks is also performed.  The result is a firm, flat abdomen.  The procedure takes about 2 hours in length, and is performed in a hospital or in an ambulatory center under general anesthesia. Most patients are able to return home the same evening, and can expect about 5-7 days of downtime.  The best candidates are those with excess skin and fat of the lower abdomen, who are medically able to undergo surgery.  While an abdominoplasty is a big procedure, it provides immediate and dramatic results.

While nothing else can achieve the results of an abdominoplasty, liposuction is an excellent treatment for localized fat deposits.  Suction-assisted lipectomy is the standard form of liposuction, although there are variations including ultrasound-assisted liposuction, SmartLipo, power-assisted liposuction, etc.  Nonetheless, each method uses the same basic technique in which tumescent fluid (a solution containing saline, lidocaine, and epinephrine) is injected prior to the removal of fat.  A small cannula is inserted into the area to be treated, and then attached to a vacuum device to allow removal of the fat.  Surgery generally lasts from 1-3 hours, depending on the size and number of areas being treated.  I prefer to use general anesthesia for liposuction cases, as it allows me to be more aggressive while ensuring that the patient is completely comfortable.  Surgery is performed on an outpatient basis, and most patient return to work within 2-3 days.  Swelling is present for the first week, and final results begin to be seen at about 3 months following surgery.  While liposuction is not intended for weight loss and generally cannot tighten skin, it is ideal for patients who desire relatively rapid results.

CoolSculpting® is the newest and least invasive procedure for fat reduction.  Large applicators are applied to localized areas of fat, and each area is frozen.  There is a variety of applicators which allows for treatments of most areas on the body, including the abdomen, flanks, arms, inner and outer thighs, and beneath the chin.  Each treatment requires one hour, during which the patient is awake and able to read, work, or even sleep.  Following treatment, patients are able to return to work and normal activities immediately.  Approximately 20% of the fat cells treated will die, and are eliminated by the body.  Because we are unable to produce new fat cells as we age, the treatment is permanent.  Results begin to be seen 4 weeks following treatment, and are optimal by 3 months.  I have recently started to treat many patients twice, in order to fully optimize the results.  Although CoolSculpting® is not generally indicated for skin tightening, I have noticed some surprisingly good results in patients on whom I would have otherwise performed an abdominoplasty.

Each patient is different and will benefit differently from each procedure. For this reason it’s best to see a surgeon who is versed in both the invasive and non-invasive methods of fat reduction, and who can recommend the most appropriate treatment for each case.