Abdomen and Flanks

The most common problem is accumulation of fat in following areas:

1. Extra abdominal means fat under the skin in the front, sides and back of the abdomen

This fat is stubborn, not easy to metabolize but easy to remove by liposuction technologies.

2. Intra-abdominal means accumulation of fat inside the abdomen around stomach and intestine.

This fat is more easy to lose, and can be easily metabolized by diet restriction and exercise. This fat cannot be removed by any other way noninvasive or invasive. The other problem is loss of muscle tone that is not able to hold the Intra-abdominal volume and it bulges out. Abdomen or tummy fat bulges are the most common problems that we see in our patients. Both males and females have this problem, and it can be present in normal weight, overweight, and obese people. There are two places where fat can accumulate in the tummy, in front of the muscle called as subcutaneous fat or “The Flab” and behind the muscle or visceral fat. Intra-abdominal or visceral fat contains beta adrenergic lipolytic receptors that is “mobile fat” and can be metabolized by exercise and diet management. On the other hand extra abdominal or subcutaneous fat is anti-lipolytic receptor enriched and more “stubborn fat”.

Distribution of Fat

• Normal weight people:  The fat is accumulated in front of the muscle and waistline known as “love handles” or “flanks”. This stubborn fat prevents the appearance of a muscular silhouette and “Six packs”, irrespective of regular exercise and controlled diet.

• Overweight people:  There is accumulation of fat over the rectus muscles, lateral oblique muscles, waistline, and flanks.

• Obese people:  The fat is accumulated all around the trunk causing significant bulge, pannus or hanging flab, folds, and tolls in the waistline and back.

What are the Options for Abdominal and Flank Contouring?

1. Healthy Nutrition and Regular Exercise

This is an extremely important part of life. You need to understand your calorie consumption and amount of exercise to burn the extra calories.

• Tips for Healthy Nutrition: Less carbohydrate and sugar,  More Proteins and Fibers, Small portions of meals not more than three hundred calories approximately few times a day depending upon your body weight.

• Tips of Regular Exercise: Incorporate lot of physical movement in daily life like climbing, walking, dancing Brisk exercise for thirty minutes at least three times a week so that your heart rate pumps to one and half times normal, Muscular toning exercise ate last twice a week- Muscle consumes more calories.

Limitations: This requires commitment and dedication. Many people cannot continue for many reasons they only know.

2. Non-Invasive Weight Reduction

There are scientifically documented results from technologies to burst the fat cells.

• High Intensity Focused Ultrasound (HIFU): This is also called as cavitation and it is capable of shattering the fat cells through the skin and release triglycerides and fatty acids.

• Cryolipolysis: Rapid cooling of the skin and subcutaneous fat is susceptible to apoptosis or fat cell death in a controlled manner.

• Low Level Laser: Can penetrate skin to some depth and lyse the fat cells due to thermal energy, and improve the blood circulation to release and transport the lipids. It also has the capability of collagen re modulation and contraction for skin tightening, firming, and cellulite reduction.

• Radio Frequency: Monopolar and bipolar radiofrequency penetrates the skin and helps in skin tightening by elevating the temperature of sub dermal collagen. It is also known to cause fat atrophy and reduction.

• Injection Lipolysis: It is performed by injecting a medication called Phosphatidylcholine. This helps in disrupting the fat cell membrane and fat breakdown that is discharged and transported to liver and metabolized by beta-oxidation.

These technologies have been combined in various machines such as PowerShape, triworks, regular, accent, cool lipo etc. The key to success is the right candidate, selective and effective combination protocol, and effective metabolization of fat with exercise.

Limitations: This is an unpredictable method of fat reduction – it may work in some, and may not work in others. It needs a certain amount of knowledge, qualifications, and skill sets to apply effectively for body contouring. It requires multiple sessions and frequent visits to the medical center.

3. Minimal Invasive Lipolysis

Laser assisted liposuction is a minimally invasive method to emulsify the fat under the skin followed by suctioning with a fine cannula. This is performed under local anesthesia. It can remove some amount of fat and also helps in skin tightening. Scientific literature says 10.5% skin contraction can occur with laser technology.

Limitations: It can have risks of pain, swelling, bruising, healing time, etc.

4. Liposuction

This is a surgical procedure performed under anesthesia, either local or general depending upon extent and area. It involves making small incisions and use of some technologies such as vaser, ultrasonic or radiofrequency to emulsify the fat and cause skin contraction. The fat is than removed by suction and cannula. It is a very effective and predictable way to remove the fat, and can make a dramatic improvement in the abdomen and flanks

What is the Procedure to Remove Unwanted Fat Bulges in the Tummy?

Liposuction is the best method to remove fat and for long term. Conventional liposuction is a procedure that involves removing the fat manually using a large bore cannula and high power suction device. Although it is the workhorse of body contouring, it can cause extensive brushing, swelling, and discomfort. The fat is removed by the avulsion method.

• Energy Assisted Liposuction:  In this method, devices such as laser, Vaser (ultrasonic device), or Radiofrequency is used to emulsify the fat. This fat can be easily removed by fine cannulas with low power liposuction. This results in less bruising, swelling, and discomfort.

• Laser Assisted Liposuction (Smart Lipo):  Laser liposuction is ideal for small volume liposuction in areas of tummy and flanks. It can be performed under local anesthesia and minimal sedation; however, the limitation is restricted fat loss, as it requires large amounts of energy to liquefy the fat that can be both time consuming, and may result in skin burns. It also has limited capability of skin tightening. Vaser or ultrasonic assisted liposuction is the best option to emulsify large volumes of fat in the abdomen and flanks. It also helps in better skin contraction and draping. It can be performed in local anesthesia and sedation, or general anesthesia in selected patients. Radiofrequency Assisted Liposuction or RFAL or BodyTite is a new technology that is predominantly useful for skin tightening. It is performed after conventional liposuction to tighten the skin in patients with loose skin.

• Power Assisted Liposuction: This is an automated machine that moves in various directions and allows surgeon to manure it under the skin. The fat is dislodged and vacuum suction device is required to remove the fat. The benefit is predominantly to the surgeon as it reduces the physical effort, so does the ultrasonic device.

What Can I Expect in Abdomen and Flanks with Liposuction?

If you have a small to moderate amount of fat in front of the muscle and waistline, removal of fat will give you an athletic look. Depending upon your requirement, you could get a narrow waistline or a so-called “Kim Kardashian waistline”.

A male patient can expect to have Six-packs by high definition liposuction using ultrasonic or Vaser device. If you are overweight or obese, you will have a significant reduction in the size of your abdomen, waistline and back; however, rule of safe limits is applied to the amount of fat removed. On the average, in healthy people, about 5-8% of the body weight fat can be removed. Eg: if you weigh 70 kg, the maximum safe limit is between 3500 mL to 5600 mL. Fat removal of more than 5000 mL is considered as “Mega Liposuction”, and requires due care and diligence.