Coolsculpt Cryolipolysis (Freezing Fat) Can Make You Fatter

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Studies freezing fat in order to remove it without surgery were first done in 2008. Since then Cryolipolysis has become the most popular noninvasive fat reduction procedure in the world. Cryolipolysis involves the noninvasive cooling of fat to selectively kill fat cells without injuring surrounding non-fat tissue. These cells slowly dissolve and gradually release the fat contained within them. It takes 2-4 months for this process to reduce the fat layer and the results of a cryolipolysis treatment become visible. A just published review of patients undergoing the procedure between 2013 and 2016 revealed that as many as 1 out of every 138 cryolipolysis treatments has the opposite effect. Those patients develop paradoxical adipose hyperplasia (PAH) i.e. the fat in the treated area grows larger becoming noticeable up to 3 months following the treatment. There have been no described cases of this resolving on its own.

The combination of suction and cold in #coolsculpting initiates an inflammatory response in some individuals most likely in response to dying fat cells resulting in enlargement and/or proliferation of the adjacent fat cells. It is currently unclear if this is mostly due to machine settings, genetic predisposition or technical aspects of the treatment. While inflamed the pinched fat feels hard and may be tender to pinch. It takes 6 to 9 months after the initial coolsculpting treatment for the inflammation to resolve and the fat to soften on pinch. The treatment for PAH is standard surgical liposuction but if the surgery is performed before the fat softens/inflammation resolves it will only stimulate the fat to grow even more. Unfortunately more than 1 liposuction treatment may be required, liposuction that employs heat (laser assisted liposuction, Vaser...) compound the problem and

paradoxical adipose hyperplasia after coolsculpting that has stretched the skin

if this occurs on the abdomen it can stretch the skin turning a patient for whom liposuction would have been sufficient before coolsculpting to someone who requires an abdominoplasty/tummy tuck after coolsculpting.

The incidence of PAH after coosculpting is high enough that it should be on the consent forms for the treatments to meet the definition of informed consent for the treatments.

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Liposuction and its variants tumescent liposuction, superficial liposuction, smartlipo, power assisted liposuction, microliposculpture, smartlipo
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Weight Loss After Tummy Tuck - Abdominoplasty

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Obesity is defined as a body mass index (BMI) of 30kg/m2 or greater. By this definition a third of men and a third of women in the US are obese. The prevalence of obesity in this country has doubled since 1980. This is a a major health concern because obestiy increases the risk of many diseases and health conditions, including but not limited to sleep apnea, diabetes mellitus, hypertension, osteoarthritis, dyslipidemia, certain types of cancers, gallbladder disease, stroke, and coronary heart disease. The associated health costs are quite high and have been estimated to be in the range of $75 billion per year. With more severity obesity of body mass indexes of 40kg/m2 or more the condition is considered morbid and weight loss surgery is usually recommended if dieting fails. Weight loss surgery has been proven to reduce the incidence and severity of medical conditions associated with morbid obesity.  The American National Institute of Health guidelines state that bariatric weight loss surgery should be offered to patients with a BMI of 35–40 kg/m² who have obesity related conditions such as diabetes mellitus or obstructive sleep apnea, or in those with a BMI of 40 kg/m² or greater regardless of weight related co-morbidity conditions.


A medical journal article just published revealed on retrospective review that patients maintained weight losses greater than the amount of tissue removed at abdominoplasty/tummy tuck more than a year after the surgery. This amount of maintained weight loss was greater in people who were heavier prior to surgery (24.5kg/m2 or more) and was proportional to the amount of tissue removed at surgery for 4.5 or more pounds of tissue removal. When asked why the weight was lost and the loss maintained these patients responded that they felt full after and between meals so they ate less. In my experience patients lose additional weight because they like and want to maintain their results. That involves lifestyle changes including exercise and eating a healthier diet. Abdominoplasty however should not be performed primarily to lose weight because the complication rates are quite high for patients with BMI over 40kg/m2 and the results are less than optimal with BMI of 35 to 40kg/m2. Nearly every patient I have ever seen who underwent abdominoplasty when morbidly obese (by surgeons other than myself) had complications including disruption of suture lines requiring months to heal. The best results and fewest complications are seen in patients who have stable weights, are not morbidly obese and have good quality skin without stretchmarks.

A Swiss study published in Oct 2012 showed that patients who have abdominoplasty to remove excess skin resulting from weight loss surgery are more likely to keep the weight off after the procedures. These patients regain about a pound a year vs. a 4 pound annual gain for patients who have weight loss surgery without body contouring surgery to remove excess skin. The contouring surgery produces a second wave of elation that helps patients stay on track to lose more weight. The timing is usually 12 to 18 months after the weight loss surgery as the complication rate at that time becomes the same as for those who have never had weight loss surgery.

There is clearly a benefit to abdominoplasty or tummy tuck that goes beyond the initial look achieved by removing excess skin and tightening abdominal muscles. The procedure has a long lasting effect which is different from a facelift whose affect diminishes with time due to the unstoppable aging process.

The obvious weight loss in this patient after abdominoplasty surgery should be maintained.

Abdominoplasty
 Aaron Stone MD - Plastic Surgeon Los Angeles
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Mommy Makeover Abdominoplasty with Pelvic Sling for Urinary Incontinence

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Urinary incontinence (leaking of urine) can be problematic and embarrassing for women past their childbearing years. Pregnancy and/or the aging process weakens or damages nerves, muscles and/or their supporting structures in the pelvic area. This results in incontinence (inability to hold back urination). There are different types such as stress incontinence, urgency incontinence etc. After trials of non-surgical treatments such as injection of bulking agents around the urethra (tube extending down from the bladder that urine flows through) have failed sling or bladder neck suspension surgical procedures may be needed to treat stress incontinence.

Abdominoplasty - MuscleTightening + Diastasis Repair

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This is how much muscle tightening I was able to achieve from this week's abdominoplasty for a mommy makeover.

The placement of the vertical row of sutures is the repair of a diastasis and in doing this repair the abdominal muscles are tightened. In this case I placed an extra horizontal row of sutures at the belly button level to get even more muscle tightening.
Mommy Makeover Surgery - Abdominoplasty
Abdominoplasty - Tummy Tuck
Mommy Makeover Abdominoplasty - Tummy Tuck on Youtube
Aaron Stone MD - Plastic Surgeon Los Angeles
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Stretchmarks

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The medical term for stretchmarks is striae (stria for a single stretchmark). They also referred to as tiger stripes. Skin with stretchmarks has been studied under the microscopic as far back as 1889. Every adult knows what they look like. They can be caused by rapid mechanical stretching of the skin or by hormones made by the body or taken externally. They can most frequently be found on the abdomens of women of have been pregnant (striae gravidarum) and on the shoulders of teenage body builders (striae distensae). They are also seen in overweight individuals, after rapid growth during puberty and adolescence, in people with Cushing's syndrome, after topical or prolonged treatment with steroids and on the breasts after breast augmentation or pregnancy and subsequent breast feeding. The combination of rapid growth in the early teen years and excessive weight gain is sure to result in stretchmarks.

Cellulite - Cottage Cheese Thighs

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Cellulite (Gynoid lipodystrophy in medical jargon) is the only word we have to describe the uneven pitted surface or dimpling of the skin commonly seen on the thighs of women. The appearance often is described to resemble the surface of an orange peel or that of cottage cheese. The term cellulite was first used by Alquin and Pavot in France to describe this condition. It is common in women, rarely seen in men and begins at various ages depending on body habitus, genetic makeup, etc. Most middle aged women have it. The remainder thinks they have it. As sure as a woman will grow breasts after puberty, she will get dimples and lumps on her skin. Cellulite affects only the buttocks, thighs and legs to about four inches above the knees. I see many patients requesting correction of their cellulite and an equal number of proposed treatments. These include aminophylline wraps, liposuction, liposuction with forked metal tubes to cut fascial strands to the skin and combinations of liposuction with lasers. None are truly effective.

Abdominoplasty, thigh buttock lift and belt lipectomy

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Abdominoplasty - Tummy Tuck


Thigh Buttock Lift - Belt Lipectomy (mostly for patients after massive weight loss or bariatric surgery, gastric bypass etc.)


Abdominoplasty for excess skin and fat and loose muscle
Abdominoplasty for excess skin
Abdominoplasty after weight loss
Belt lipectomy 1
Belt lipectomy 2
Aaron Stone MD - Plastic Surgeon Los Angeles
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