Fat Loss vs. Fat Reduction

What is the difference between fat loss and fat reduction? For the purpose of this discussion, fat loss refers to the natural ability of your body to reduce fat in certain body areas when you experience weight loss. We can all think of examples where a person lost a large amount of weight, and afterward was thin with no extra bulges anywhere.

On the other hand, many people who are 10-20 pounds overweight have areas in mind where they wish to “target” the loss, such as the neck, upper arms, abdomen, inner thighs, and hips, just to name a few. For the most part, when a lot of fat loss occurs, there may be an even loss of fat in all of these areas, and yet it is not so predictable. This is the reason that there are so many techniques and modalities available to help targeted reduction.

If you consider small areas such as the neck, arms, lateral thighs, and hips, it is possible to reduce these quickly, painlessly, and effectively by using small volume tumescent liposuction. This can usually be performed under local anesthesia. For larger areas, more aggressive or extensive liposuction may be performed, usually with general or IV sedation anesthesia. This procedure carries slightly more risks and is more expensive. If the liposuction technique is well performed, elimination of the bulge area targeted is usually permanent, although you may still gain weight in other areas if you gain more pounds.

Liposuction has been popular over the past 25 years, but now there are less invasive procedures available. These require minimal or no anesthesia and have a short “down time” with quick recovery.

The list of these procedures can be quite extensive, as there are many types of machines and other technology, but I will break them down into categories so that they are easily understood. The first of these—called “Cellfina”—is slightly invasive (like needles) and relies on a technique for cellulite reduction which utilizes suction to lift the skin over the cellulite depression, followed by the use of a sharp needle/small knife point to cut the band which pulls the undersurface of the skin down, and thus releases the depression of the cellulite dimple, smoothing the skin.

Another newly emerging technique is the use of kybella, a drug that causes dissolution of fat in the area where it is injected. By injection of measured amounts of this into the sub-dermal fat, the fat is dissolved and the area made thinner in a more-or-less controlled manner. This is a cytolytic drug that dissolves fat, which is in turn absorbed by the body over a few days time. Two to four localized injections over time may be necessary for complete success, and the results are usually good but not perfect.

In the field of instrumentation utilizing various machines and various energy sources, the most widely used of these is Zeltiq, a cold-based technology, which freezes and destroys fat cells. This technique calls for application of suction and cooling plates, which can treat the abdomen love handles, inner and outer thighs, and the neck. There is no down time and the treated area gradually shrinks over a few weeks.

Although this technique is useful, it does not give as quick or predictable result as liposuction would do. A smaller version, the cool mini treats smaller areas of fat. Another technology is by Sculpt-Sure, which is a hyperthermic laser for reduction of flanks, abdomen, thigh, etc. There is no downtime from this brief procedure, and a patient may return to normal activity immediately. Resolution of the fat takes two to four weeks.

One instrument similar to Zeltiq is the Endy Med, which uses radio-frequency (RF) technology and is capable of body contouring, non-ablative wrinkle reduction, and skin tightening. There are also more instruments including Eclipse Firma, Body FX, Vshape, and Tru-sculpt which all do well with RF energy. Information on these can be found on the Internet.

A new machine, which we are using, is the Thermi RF, and this can be used to remove some fat, tighten the skin, and improve skin elasticity in the neck. This is for those who want the neck tightened with a local anesthesia and a non-invasive procedure.

The use of ultra sonic waves to an area of tissue causes heat and burning of the fat and is done with a Syneron acoustic wave device. This technology, as well as other types, destroys fat by heat, freezing, ultrasound (heat), radio frequency (heat and cold).

Every practitioner has a “favorite” technology and you may different opinions from multiple consultations. It is important to lose some weight, do your research on which dermatologist or surgeon to consult, and ask to speak to a couple of patients who have been through the procedure in order to get a better idea of which direction to take. Good luck with your “target area.”

Dr. James Carraway is a plastic surgeon at the Cosmetic & Plastic Surgery Center of EVMS. Call 757-557-0300.

James H. Carraway, M.D.

Dr. James Carraway is a full-time academic and practicing clinical plastic surgeon.  He is Director of the Cosmetic & Plastic Surgery Center of EVMS, is board certified in surgery and plastic surgery, and is a fellow of the American College of Surgeons.  Dr. Carraway has been teaching and practicing for 30+ years and has been director and chairman of residency training programs and fellowship programs in plastic surgery.
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