Our body shape, with all its lumps and bumps, consumes many of our thoughts and insecurities. So how can we reign in our body concerns and achieve the svelte silhouette our heart's desire? By learning how to approach our curves from a number of angles and operate with a holistic lifestyle that simultaneously beats the bulge. It is as simple as understanding your options and how fat works. Educate yourself on diet, exercise, our body's physiology and your options for eradicating fat.

What is fat?

The human body contains two types of fat: white fat and brown fat. White fat is important in heat insulation, energy metabolism and mechanical cushioning. Brown fat actively burns calories for heat but has thought only to exist in childhood.

Fat tissue is made up of cells that hold the fat. When food that contains fat is ingested it goes through the stomach into the intestines, where the fat droplets get mixed with bile salts from the gall bladder. The mixture breaks up the large droplets into several small droplets, which increases the fat's surface area.

The pancreas then secretes enzymes that attack the surface of each small droplet of fat and breaks them down into fatty acids and glycerol, which then get absorbed into cells lining the intestine.

In the cells lining the intestine the parts are reassembled into packages of fat molecules with a protein coating, called chylomicrons. These are then released into the lymphatic system, which eventually merges with the veins so they pass into the blood stream.

Diet

There are a number of factors to consider for effective weight loss and management.

Anyone trying to lose weight is confronted with a large number of potential diet regimes and a confusing array of conflicting information and advice. There are a number of fundamental issues in weight control that are worth looking at, since these are at the heart of any weight-loss plan regardless of the label.

Caloric or energy intake

As weight loss only occurs when you consume less food than what your body uses, all programmes will seek to limit your energy intake. Your body will only use stored fat for fuel when it has no other choice.
Diets usually teach you nothing about real weight loss, so simply understanding what your intake and output of energy is and tailoring your diet accordingly, and for the long term, will yield you the best results.

Exercise

Although physical activity is important in maintaining health and in preventing you from gaining weight, it is often difficult for many people to exercise enough to lose a significant amount of weight.

A sustainable regime of activity is crucial to people wanting to improve their health and to prevent creeping weight gain. Gym-based exercise programmes that don't teach you to increase activity in your everyday life should be used as a last resort as they usually can't be done in a sustainable way, unlike simple methods like walking part of the way to work or taking the stairs rather than the elevator.

Metabolism

The way your body uses energy is incredibly complex. As you get older you need less ‘energy' per day to maintain your current weight, and there is no reliable way to speed up your metabolism other than exercising. Unfortunately weight loss, by any method, invariably leads to your body becoming progressively more efficient. As you lose weight the amount of energy that you burn off passively gets progressively less and less. This means that people who lose weight must permanently stay on a reduced calorie intake or they will quickly return to their pre-diet weight. This is the fundamental problem with all diets, as the changes that you need to lose weight need to be permanent. It is possible for someone who has lost weight to regain very quickly, even without ‘overeating'.

Nutrition

It is virtually impossible to become overweight or develop deficiencies eating a diet based on vegetables, fruit, and small portions of meat or fish. Food that you prepare yourself is usually best, and the only foods that are likely to lead to deficiencies are purchased or packaged foods. Nutritional supplements are only really essential for older people, those with certain medical conditions and people eating severely restricted diets.

Exercise

Don't place the emphasis on exercise only, because the main problem isn't likely to be that you don't exercise, it is probable that you can't burn off all your eaten calories. Did you know it is near impossible to exercise off a banana split?

To burn off the calories that you can eat with a big bowl of ice-cream with nuts and fruit and syrup on it, you would have to exercise vigorously for two hours or more. If you don't control the dietary intake, almost any amount of exercise is insufficient to lose weight and maintain a healthy weight.

When you exercise you use energy. Your body can get that energy from glycogen, which is stored in your muscles, or from your fat stores. When you exercise at low intensity, the proportion of fat burnt, compared to glycogen, is greater than when you exercise at high intensity. However, the amount of fat burnt in absolute terms is greater if you exercise at high intensity.

Therefore, you will consume the most fat if you exercise for as long as you can, as intensively as you can. Your body continues to consume calories after you finish exercising. The more intensively you have exercised, the greater the number of calories your body will consume in this recovery period. The amount you burn will depend on your BMR or basal metabolic rate. If you increase the amount of muscle you have, you will raise your BMR. The best way to put on muscle is through strength or resistance training three to four times per week

Options for body contouring

Fat won't budge?

It's inevitable that certain areas of the body harbour stubborn fat deposits that we can't shift with diet and exercise. This is where some surgical and non-surgical solutions can lend a helping hand.

Non-surgical body contouring

Over the past decade body contouring surgery has become one of the most popular surgical procedures. Advancements in the field of body contouring offer non-surgical body contouring procedures that can achieve noticeable results with a significantly shorter recovery period than liposuction.

As with liposuction surgery, for optimal results you should be in good health with skin that has sufficient elasticity. The best candidates are usually those with small to medium localised fat deposits that are resistant to diet and exercise, rather than those seeking large-volume fat removal.

While non-surgical body contouring can deliver significant results, you should have realistic expectations of what it can achieve for you. It should also be noted that, like liposuction, it is not a solution for weight loss or a treatment for obesity.

This type procedure typically does not require any anaesthesia or sedation and is usually performed in an in-office setting. There is normally no down time, minimal patient discomfort and complications are rare. In conjunction with a healthy diet and exercise regime, results should be long lasting.

There is now a wide range of non-surgical body contouring options available. Developments in this area are continual, however here is a brief guide to some of the most popular non-surgical body contouring technologies available in Australia today.

Radiofrequency body contouring

This non-surgical treatment uses radiofrequency (RF) energy to penetrate the skin - without damaging the outer layers - to contour the body and reduce the appearance of cellulite and fat. It breaks down fatty cells and stimulates collagen production, which improves skin tone and elasticity.

The RF energy provides deep, controlled heating of the targeted fat, tightening tissue and increasing blood circulation at the same time as it targets fatty deposits. The broken down fat cells are drained via the lymphatic system and then excreted as urine.

The heat generated from the RF energy causes microscopic changes to tissues and collagen fibres, with further collagen remodelling over the subsequent months following the procedure.

Localised fatty deposits such as on the abdomen, hips and thighs can be effectively treated with RF body contouring treatments. This technology can also reduce the appearance of cellulite and tighten sagging skin.

Depending on the device being used, results can be observed after a single treatment, although a series of treatments is usually recommended for significant results. Each treatment lasts for around one hour and is virtually painless (you may feel a warm or sometimes hot sensation on the area being treated) and you can usually return to normal activities immediately after the treatment.

The full effects may not be visible for several months as the improvements are cumulative. You will gradually notice changes such as circumferential reduction of the treated area, a marked reduction in cellulite and a more streamlined body shape.

Ultrasonic body contouring

Ultrasonic body contouring treatments use targeted ultrasound frequencies to break down fat, particularly on the abdomen, hips, thighs and ‘love handles'. The best candidates are close to their ideal weight but have stubborn areas of localised fatty deposits that do not respond to changes in diet and exercise.

The focused ultrasound waves are delivered in short bursts of energy, or pulses, to destroy fat cells while leaving surrounding tissue, nerves and blood vessels unaffected, as well as protecting the outside layers of the skin.

Each pulse breaks down the membranes of the targeted fat cells so that a layer of fatty tissue beneath the skin is eventually disrupted. The contents of the fat cells, called triglycerides, are then dispersed and processed through the body's vascular and lymphatic systems and eliminated naturally.

Generally one treatment per area is sufficient to achieve noticeable, measurable results, although results may vary. It can take around four weeks for the final result to be visible as your body gradually eliminates the fatty debris.

The treatment is generally considered to be discomfort-free, and side effects are uncommon.

Injection lipolysis

Injection lipolysis is a minimally invasive procedure that involves a series of micro-injections to ‘melt away' small amounts of unwanted fat and eliminate it from the body to create a more harmonious shape.

Injection lipolysis uses micro-injections of active ingredients called phosphatidycholine and deoxycholate directly into fat to break down the walls of the lipocytes, or fat cells. They are broken down into triglycerides, simple free fatty acids which are then carried to the liver where they are converted to glucose and burned off during exercise.

The formula is injected just under the skin and multiple injections are required to achieve an even result, using a device that allows several micro-injections to be performed simultaneously. While the procedure does not require any sedation, topical anaesthetic cream can be applied to minimise any stinging sensation.

The number of treatments depends on the size of the area to be treated and how well your body responds to the treatment, but generally two to four treatments at intervals of between six to eight weeks are required for optimal results.

While not a form of weight loss, laser lipolysis can achieve a noticeable circumferential reduction in the treated areas. As the unwanted fat is mobilised and used as energy, it is recommended you follow a simple exercise program and healthy diet to maximise the final results achieved.

Liposuction

There are numerous liposuction techniques available today, however each doctor has their preferred method, all of which offer effective, predictable results. As well as the technique employed, in every liposuction procedure the doctor takes into account the level of sedation administered, the type of cannula used and the patient's wishes.

No single technique, piece of equipment or instrument necessarily offers better results. Most doctors will adapt techniques and tools to each individual patient to achieve optimal results. Generally, the technique that the doctor is most skilled in will cause the least complications.

There are generally three techniques used in liposuction surgery today: ‘wet', ‘superwet' and ‘tumescent'. These are all dependent on the amount of fluid preinjected - predominantly local anaesthetic, blood vessel constrictors and saline - into the fat cells before the actual liposuction surgery.

Liposuction was originally performed with what is now referred to as the ‘dry technique'. It derived its name from the fact that it did not preinject any fluids into the fat before surgery.

While it was effective, it was for the most part abandoned because of its association with increased discomfort for the patient, excessive blood loss, increased tissue and nerve damage, as well as extensive bruising and a greater propensity for uneven or asymmetrical results.

The introduction of tumescent liposuction was a significant advancement in liposuction surgery and made it a much safer and more predictable procedure. Tumescent refers to a saline-based solution that usually contains epinephrine (which causes smaller blood vessels to constrict and reduces bleeding and bruising) and lidocaine (an anaesthetic that provides localised pain relief) which is injected into the area to be treated. Ironically, the dry technique is wet (lots of blood loss), while the wet technique is dry.

Performing liposuction surgery with tumescent helps to separate tissues, allowing easier movement of the cannula through the swollen fat cells.

The terms ‘tumescent', ‘wet' and ‘superwet' are used loosely. Generally, each doctor has their own preferred amount and composition of fluid to be injected and it has never been completely standardised. Doctors will usually adjust the amount of fluid used depending on the desires of the individual patient and their preference for local anesthesia only, intravenous sedation or general anesthesia.

There are generally three ways to actually remove the fat: the traditional cannula method, the syringe technique and the energy-assisted method, which can further be broken into numerous sub-categories. The method of fat extraction used is mainly dependent on the doctor's preference and their level of expertise.

Suction-assisted Liposuction (SAL)

This is the traditional method, by which the doctor removes fat by inserting a small, hollow tube (cannula) connected to a vacuum pressure unit, directing the cannula into areas to be suctioned through tiny incisions. One benefit is that traditional cannulae can be curved, bent and adapted as needed to reach multiple areas from each incision, whereas ultrasonic or laser probes are more fragile. In addition, ultrasonic cannulae are thicker than traditional cannulae so larger incisions into the skin are required. These days, traditional cannulae can be as small as 2mm in diameter; ultrasonic cannulae are usually 6mm.

Syringe technique

Dr Pierre Fournier introduced the syringe method, which uses a syringe instead of a machine to aspirate the fat. Many doctors believe using the syringe technique is more precise than machine-assisted suction and helps prevent extracting too much fat.

Energy-assisted liposuction

Recent advancements in liposuction surgery have seen the advent of different energy sources being used on the tip of the cannula to assist in dissolving and removing fat. These techniques include ultrasound-assisted liposuction, power-assisted liposuction, laser-assisted liposuction and water-assisted liposuction.

Generally, energy-assisted liposuction is less aggressive than traditional techniques and can be particularly beneficial for large-volume liposuction surgeries as the length of the procedure is usually reduced and the patient spends less time under anaesthetic. However, energy-assisted liposuction requires more technical skill as there is a greater risk of removing too much fat, resulting in unevenness. The heat generated during ultrasound- or laser-assisted liposuction can also burn the skin or damage the tissue under the skin.

Ultrasound-assisted liposuction (UAL)

With ultrasound-assisted liposuction, the doctor uses a cannula that produces ultrasonic (high-frequency sound) energy. The cannula is inserted into the fat through a tiny incision and then selectively destroys fat cells. The ultrasonic vibrations disrupt the fat cell membranes and liquefy the fat tissue, making its subsequent removal easier and quicker.

An ultrasonic cannula can usually move through firm fat tissue more easily than conventional cannulae. This technique allows the doctor to treat areas that have more dense fat deposits and to remove larger volumes of fat at one time. The tissue-selective ultrasound energy means only unwanted fat is targeted, preserving surrounding blood vessels, nerves and connecting tissue and promoting smoother contours with faster healing time. Ultrasonic liposuction can have the added advantage of tightening the skin during the process.

Power-assisted liposuction (PAL)

A cannula with a tip that mechanically vibrates in a back and forth motion breaks up fat cells with reduced effort for the doctor. According to professionals, each pass of the cannula achieves the equivalent of 40 or more passes with a traditional liposuction cannula, allowing the doctor to perform the procedure in a smaller amount of time.

Laser-assisted liposuction

Targeted laser energy acts to melt fat, coagulate blood vessels (to reduce bleeding and bruising) and simultaneously tighten overlying skin. The cannula used in laser-assisted liposuction is usually only 1 to 2mm in diameter, which further reduces bruising and healing time. Sometimes the energy is limited, so the procedure can take longer to perform. For this reason, some doctors believe it is better suited to smaller areas of the body, such as the neck, inside thighs and for ‘touch up' body contouring.

Water-assisted liposuction (WAL)

During water-assisted liposuction, a thin fan-shaped water beam is used to loosen the structure of the fat tissue for easier suctioning and removal. The jet has an impact power comparable to a powerful showerhead and is associated with less risk of shearing and trauma to the adjacent tissues.

During the procedure the water is continually added and almost immediately aspirated through the same cannula. WAL requires less infiltration solution and therefore produces less swelling. The movement of the cannula, aided by the water beam, is gentler and causes less trauma to the surrounding tissues, reducing the amount of bruising post-operatively. This method is particularly useful for larger volume liposuction procedures.

There is not a consensus among doctors as to which technique is superior. There may be slightly less blood loss and a greater ability to remove fat in difficult areas with, for example, ultrasound-assisted liposuction but it can be associated with greater complications than the traditional suction-assisted liposuction. Because there are only small differences between the procedures, the technique that the doctor is most skilled in will cause the least complications.

Australian Cosmetic Surgery Magazine