Battle of the bulge
	By Dr. Anthony Lockwood M.D., F.R.C.S.C. www.thefirstglance.ca View Dr. Lockwood's profile

I would like to dispel some of the myths surrounding the various means of reducing visible fat, including cosmetic surgery. At least 10 times a week, I see people looking for an easier way to lose weight. Unfortunately, weight loss greater than five to 10 pounds is not within the realms of most surgical and nonsurgical body contouring treatments available today.

A common myth is that liposuction will reduce a bulging waistline or reduce love handles. Well localized fat that is above the waistline is usually treatable, but visceral fat or “organ” fat below the muscle layer of our tummies is not, and will only respond to a common sense program of reduced food intake and proper exercise.

Love handles or flank bulges may have a significant layer of deep fat that is treatable, but often these areas represent “flab”. Flab is made up of excess skin with a thin layer of insulating subcutaneous fat and a lot of deeper fibrous material that contains relatively little deep fat. It is a normal part of aging, along with the inevitable loss of height as our spines slowly shrink. It is often worsened by yo-yo patterns of weight gain and loss, and is frequently seen in those who have lost massive amounts of weight.

Flab is best treated by surgical removal such an abdominoplasty (tummy tuck) or butt lift, if severe. If mild, flab will respond to newer, bulk heating technologies such as RF Waves — Thermage and Accent RF — and infrared light sources, such as Titan. Both cause collagen fibers in our skin and supporting structures to heat up and shrink.

Fat that is well localized to our thighs, such as the “saddle bag” areas and the outer layer of our tummies, is often resistant to diet and exercise. The most popular way to get rid of this fat is liposuction. There are many varieties of liposuction today: mechanical (SAL), power-assisted (PAL), ultrasonic (UAL, such as Vaser, Lysonix), external laser assisted, and laser fibers (Smart Lipo.)

Smart Lipo has received most of the media attention lately. Developed in Italy, it consists of a thin laser fiber that is inserted through a tiny incision. For very small areas, the fat will melt and it is not necessary to suction it out. In addition, there may be more skin tightening than is seen with the other techniques, making it useful for treating double chins and the back of the arms. Unfortunately, it is very slow and no substitute for the other techniques when treating larger areas.

With UAL, there is also a degree of skin tightening and it has been very useful for treating male breast enlargement ( Gynecomastia.)

After liposuction of thighs, buttocks and tummies, there is a period of swelling followed by gradual improvement of contour and minimal skin tightening. It may take eight months before you can see the final result. This means that if you want to look good for the beach in summer, you need to be treated in the early fall.

Following liposuction, we use compression garments, ultrasound, and Accent RF treatments to speed up the process and improve skin tightening.

Developed in Italy, a new technology called Ultrashape is awaiting approval by Health Canada. Ultrashape looks like a large X-ray machine. One lays down on the table, and focused high frequency sound waves blast away excess fat painlessly. Unfortunately, it really works best for smaller, well localized areas, takes multiple treatments, and doesn’t tighten the skin. Our clothes may fit better, but we still have flab.

All in all, there are no quick fixes for being overweight, and the gyms and the fitness centres are not likely to lose our business in the near future.