When you are deciding on which body sculpting procedure is right for you, you have to accurately assess what your problem is, which treatment is the best to fix it, how much risk, down time, cost you are willing to accept, and what is the likelihood that you will be satisfied or disappointed with the results. Like many things in life, the answer may be different for different people, even if they have the same medical condition, because of the other factors involved.

Today I want to talk about how appropriate each procedure is for an individual based on the medical needs and expected results. Later we will look at the costs, number of treatments, risk of side effects. Then you can input all of the data into your little computer brain and decide what is right for you.

The first issue to look it is whether the area of fat is localized or generalized. This means are we looking at a localized collection of fat, for instance a belly fat bulge or is there fat from your jowls to your ankles. All of the methods were are talking about, with the exception of diet, exercise and gastric banding, are meant for localized collections of fat. Liposuction is not safe for use over multiple large areas at one treatment. You could do multiple sessions of liposuction to different areas, and some people do just that. But some areas, like the abdomen, respond better to liposuction than other areas, like the calves. And in certain areas, the risk of nerve damage and rippling is higher. Zeltiq Coolsculpting also can be done on multiple areas, as long as the treatment adapter will attach with sufficient suction to complete the treatment. But here again you are looking at multiple treatment sessions. Zerona claims to give fat reduction in areas not specifically treated. However, diet, exercise and supplements are also part of the treatment, and the mechanism by which one would get reduced fat in non-treated area based on the basic science of the laser technology is beyond my current comprehension, so, I remain skeptical.

So if you have generalized fat—it is diet and exercise or gastric banding (and it’s enforced diet) for you.

Next we look at where it is localized, both body site and whether it is internal or external. Some fat is inside the body cavity, around the organs like the heart and in the connective tissue that holds your intestines in place. Sounds lovely doesn’t it? Some is outside the body cavity. You can tell which is which by squeezing the fat in between your fingers. If you can bunch it up and pull it away from the body it is external, if not, it is usually internal. Fat inside the body cavity, or internal fat, can only be reduced just like generalized body fat: diet, exercise or gastric banding. External body fat can be removed by liposuction or treatments like Coolsculpting.

Liposuction can be used on more areas than Zeltiq Coolsculpting because smaller cannulas can be used on smaller places like under the chin. With the currently available heads, Coolsculpting can be done on abdomen, sides, flanks, love handles, inner thighs, and in some people outer thighs and arms. Lipo can be done on all of these places as well as on the upper neck, and calves. I expect new treatment heads for these smaller areas to be available for Coolsculpting at some point.

Then we have to consider skin elasticity and tone. When fat is removed and the skin elasticity is not good, then loose skin will result. Skin that has more natural elasticity will tighten more than skin that has less natural elasticity. Skin that is less stretched by larger fat deposits, in general, will spring back better than skin that is more stretched out. Some lipo methods which use laser or ultrasound to assist fat removal can give some skin tightening, but the degree of tightening is variable and along with that is some increased risk to the skin from the heat build-up involved. Coolsculpting does not tighten skin, however, the fact that the fat is lost over a 4 month period of time gives the skin a little more time to adjust. In most patients, cellulite is not improved with any of the methods of fat removal. There is no cream or treatment that gives reliable, noticeable improvement in cellulite. I need to invent it and retire to Fiji.

And finally is the question of how much improvement you want. Liposuction removes the most fat per area, although the amount removed and the number of areas treated at one session is limited by safety considerations. Liposuction also has the highest risk of rippling. And certain areas, like the buttocks, are very difficult to treat with any method because of the 3 dimensional nature of the area and the need to maintain those 3 dimensional contours.

Next: Body sculpting procedures—what’s it going to take? Cost, number of treatments for Lipo, Zeltiq and Zerona