Treating Excess Skin and Fat Above Your Waist

By Constance M. Chen, MD, MPH

Love handles. Donut. Muffin top. Spare tire. Saddlebags. Whatever you call the accumulation of fat above or around your waist, it is one of the areas of the body most resistant to slimming strategies and a source of frustration for both men and women. Excess fat around the abdomen and hips is caused – as is all excess fat – by an imbalance between the number of calories taken in and the number burned off.

Where these fat cells accumulate is dependent on many factors, including genetics, but over time, particularly as we age, the midsection is a particularly common destination. A spare tire per se isn’t dangerous but it may be indicative of risk factors for a wide range of serious conditions including heart disease, diabetes, and liver disease. Getting rid of belly fat can provide an important boost to your overall health as well as your self-image.

Getting rid of that belly fat can be accomplished with a combination of lifestyle changes and either non-surgical body contouring or a surgical solution such as liposuction, abdominoplasty, or a lower body lift. I recommend lifestyle changes to achieve optimal weight and fitness levels before considering surgical intervention.

Contouring and surgery aren’t weight-loss measures. They will be most successful and long lasting on individuals who have achieved and maintained a healthy weight and level of fitness but still have stubborn pockets of fat around the hips and lower abdomen. Committing to maintaining a healthy diet and regular physical activity is the first step to making positive change.

Diet and Exercise

Fad diets aren’t the best way to reduce belly fat or to maintain a healthy weight over the long term. A more effective strategy is to concentrate on eating whole, unprocessed foods, primarily fruits, vegetables, lean protein (eggs, fish, and white meat poultry), nuts, seeds, and whole grains. Avoid highly processed foods, pre-made foods, sweets, fried foods, fast food, and any packaged food with a long list of unpronounceable ingredients. Replace refined carbohydrates like white bread, pasta, potatoes, and rice with nutrient-dense complex carbohydrates like beans, oats, whole grain bread and pasta, sweet potatoes, and brown rice. Add healthy fats from olive oil, avocado, nuts, and fatty fish. Reduce alcohol. If you are overweight, reduce your caloric consumption by 500 calories a day.There are exercises that target the midsection but spot exercises alone won’t get rid of love handles. Combine targeted moves with aerobic exercise to raise your heart rate and burn calories and resistance training to tone your muscles and build strength. Pilates is a beginner-friendly exercise that can be effective in toning the abdomen. High-intensity interval training (HIIT) that follows short bursts of intensive aerobic exercise with a recovery period can reduce body fat and improve cardiopulmonary fitness. Aim for five hours a week of moderate exercise.

Nonsurgical Body Contouring

Non-surgical body contouring is a nonsurgical procedure used to smooth and refine the body by reducing pockets of fat cells in targeted areas. Variations use different mechanisms to break up the fat cells which are then naturally eliminated by the body over a period of weeks or months. The fat cells may be broken up by freezing, by heating with lasers, or by high-intensity electromagnetic technology that induces thousands of muscle contractions. The advantage of body contouring is that it is non-invasive, a treatment may take no more than an hour, and there is no downtime following treatment. The disadvantage is that it may achieve only modest – if any – improvement. Some people consider non-surgical body contouring sham procedures.

Liposuction

Liposuction, abdominoplasty, and lower body lift are the most effective treatments for removing fat and smoothing the contours around the abdomen and hips. In the most common liposuction technique, the surgeon first injects a combination of saline solution, a local anesthetic, and a vessel-constricting agent which cause the area to swell and become firm. A thin tube called a cannula is inserted through small incisions and attached to an aspirator that draws out the fat and fluids. Variations may use a laser, vibration, or ultrasound to break up the fat cells and make them easier to remove. Treating a small area may take only thirty minutes but removing love handles and fat all around the torso may take several hours.Liposuction is surgery and while it may be performed on an outpatient basis under local anesthesia if only a small area is to be treated, a larger area would be treated in the hospital under general anesthesia and require a recovery period of a couple of weeks. The advantage of liposuction is that a single procedure produces more dramatic and immediate results than multiple non-surgical treatments.Liposuction is one of the most commonly performed cosmetic surgical procedures and has one of the highest satisfaction rates. If there is a significant amount of excess skin and fat, an abdominoplasty or lower body lift may be necessary. Dr. Chen emphasizes the importance of healthy habits both before and after treatment. A healthful diet and regular exercise may not eliminate love handles entirely, but adopting those habits before treatment and maintaining them after treatment are essential to achieving lasting results.Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com