Weight loss surgeries may seem appealing for people who wish to lose their stubborn fat permanently. However, they can result in long recovery times, pain, and visible scarring. On the other hand, nonsurgical weight loss procedures promise permanent fat loss without having to go under the knife. But is this too good to be true?

The Skin Report is a podcast created to educate listeners on methods to improve skin health for people of all ethnicities and ages. On this episode, host Dr. Sethi talks about nonsurgical weight loss: what treatments are available, how they differ, and what they do. She educates listeners on subcutaneous fat and visceral fat and the best treatment procedures for each. In addition, Dr. Sethi covers the pros and cons of popular procedures like cool sculpting, laser therapy, radiofrequency, and Emsculpt NEO.

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This transcript was exported on January 9, 2023 -view latest version here.

Skincare can sometimes feel overwhelming, whether it’s finding the right products, ingredients, or treatments, there’s a lot out there. But, not always for people of African, Hispanic, Middle Eastern, and Eastern South Asian descent. That’s why I set out to educate myself and others so that we can all feel beautiful in our skin.

Hello and welcome to The Skin Report. I’m Dr. Simran Sethi, an internal medicine doctor, mom of three, and CEO and founder of Renew MD Medical Spas and Skin by Dr. Sethi.

Happy 2023. This is our second episode of the New Year. Last week we talked about different diets and their impact on our skin, so be sure to check that out. This week we’ll be discussing different aesthetic procedures that reduce fat permanently without having to go under the knife. Can this really be true? Stick around to find out more.

Before we get into the different treatments, how they defer, and what they do, I want to first talk about fat. There are actually two types of fat, or rather locations of fat and which area you want to target will determine what procedure is best for you. The two main types of fat in our body are subcutaneous fat and visceral fat. Let’s start with subcutaneous fat, which sits on top of your muscle, right underneath your skin. We all need some amount of subcutaneous fat under our skin, as it gives skin that taut and plump appearance. When we reduce subcutaneous fat, we can sometimes appear very lean with wrinkled skin on the body. However, an excess of this fat in the abdomen, legs, butt, arms, back, and other areas on the body can give a bulky appearance.,/p>

The second type of body fat is visceral fat, which is only found in our abdominal area, behind our abdominal muscles and surrounding our organs. Many non-invasive body sculpting procedures and liposuction do not address visceral fat, which is why it’s important to first determine what kind of fat is present when evaluating someone who comes in for reduction of abdominal girth. The general way to tell by just palpation is if the stomach area feels tight even though it’s enlarged. The fat in this case is likely visceral. Visceral fat helps hold our internal organs in place, but having too much of it is associated with increased cardiac risk and other health concerns. If you can grab and pinch fat on the stomach, then you are pinching subcutaneous fat, which does respond to liposuction and most non-invasive forms of body sculpting. So, once we can determine the type of fat using these parameters, my team and I can go forward in consulting the patient with the best treatment plan for their abdominal fat.

Once we understand the starting point of the patient, we can look to different sculpting procedures that accomplish fat reduction in different ways. I want to first talk about cool sculpting as it was the first non-surgical way to permanently reduce fat and has become a household name because of that. Cool sculpting uses a suction device to suction up the part of the body that needs fat reduction and exposes it to extremely cold temperatures.The result is, fat cells shattering permanently and then dissolving from the area through the lymphatic system.

What are the pros and cons of cool sculpting? On the pro side, we have that it’s permanent, nonsurgical; which means there’s no downtime, no cuts or scarring. The cons, however, include uneven results. Remember, we are warm-blooded, which means that the machine has to work very hard to freeze, and the freezing is generally a little uneven. This can cause a shark bite like appearance on the area treated and is the main reason why I prefer heat based body sculpting procedures. Because we are warm bodied and it’s difficult to cool fat to the levels needed for fat necrosis, we also need two to three times the number of sessions of cool sculpting to produce the same results as heat based procedures.

Another con is a paradoxical reaction. Although rare, some people can get the opposite reaction known as paradoxical hyperplasia or overgrowth of fat cells in the area being treated. The only way to get rid of this is by cutting the fat out of the area surgically. This reaction recently got a lot of media attention when the model Linda Evangelista came out with her experience and the scarring surgeries she has had to remove the hyperplastic fat tissue. Lastly, cool sculpting can only be used on subcutaneous fat.

Now, I want to turn to methods that use heat, particularly laser therapy, which can be very effective in targeting fat tissue. Lasers safely penetrate the skin to exclusively target fat cells by burning and permanently destroying them. Then, just like in cool sculpting, the lymphatic system will eliminate those destroyed cells.

What are the pros? In addition to the benefits that come with non-surgical procedures, laser therapy has a few leg ups on cool sculpting, including even results; just like melting butter, heating and destroying fat cells in the body produces even results that look more natural, fewer sessions; if you’re using a well-studied laser device, the number of sessions needed is cut down substantially than with cool sculpting. My favorite laser for body sculpting is a sculpture laser, which typically takes two to three sessions to permanently destroy fat compared to the five to seven sessions of cool sculpting needed for similar results. Now, this can vary depending on your goals and the size of the area being treated, but I found that most of my patients find success in two to three sessions. As I said, this is because we are warm blooded, so heating the body to temperatures needed for fat destruction is generally easier with fewer sessions compared to cooling the body.

But, can laser therapy warm your skin? What if you have skin types four to six? Lasers are selective based on their wavelength, which is why most lasers for body sculpting are safe in all skin types. I say this with caution because there are thousands of lasers on the market, and you as a consumer need to be educated about how many clinical studies and safety studies have been done on the laser before it came to the market. Again, this is very dependent on your provider, and this is also why I only use the sculpture laser as its safety and effectiveness are very well supported with clinical data. The con of laser therapy is that like cool sculpting it doesn’t work on visceral fat.

Now that we’ve compared cold versus heat therapy on fat dissolution, I want to turn to other methods such as radio frequency. We’ll dive into that when we come back.

Welcome back to our episode on permanent fat reduction treatments. Everything we’ve mentioned so far is a nonsurgical procedure, and so is our next one. Radio frequency. Just like lasers, radio frequency devices produce heat to destroy fat cells permanently. As a result, they have the same advantages and disadvantages as lasers, with the added advantage of promoting more skin tightening. Radio frequency is just another way of delivering heat energy to break fat down, but radio frequency also promotes skin tightening at the same time, which lasers do not. In my practice, I choose devices that use radio frequency when there isn’t as much fat volume and more skin tightening is required.

The last device I want to discuss is called Emsculpt Neo. This unique device uses HIFEM or high-intensity focused electromagnetic field to cause intense muscle contractions in the area being treated, most commonly the abdomen. When treating the abdomen with Emsculpt, you are inducing what is equivalent to 20,000 crunches or sit-ups in just 30 minutes. To power this high intensity of contractions, the body breaks down fat around the abdominal muscles, and so much energy is taken, that the fat cells actually get permanently destroyed. On the pros list, we can see that Emsculpt is painless, takes four to six sessions that are spaced one week apart each, produces even results, and most importantly, it breaks down visceral fat. Remember, visceral fat is the fat that is found behind the abdominal muscles and cannot be targeted by any lasers or cool sculpting. Emsculpt is the only device that breaks down up to 16% of visceral fat on each treatment. It also strengthens muscles in treatment areas. For the abdomen, it will strengthen the core muscles. And can be used in any part of the body.

Now, on the con side, as this is a magnetic field producing device, it can’t be used on anyone with any metal implants in the treatment area. This is generally not a problem, but if a woman has an intrauterine device, it may get displaced, and IUDs are quite popular, so we do have to turn down women from the abdominal treatment area ever so often.

Before we wrap up this episode, let’s go over a few final things to consider about body sculpting. All of the procedures mentioned in this episode are non-invasive and don’t require anesthesia, surgery, or any downtime. You essentially get the procedure done, and can get up and go about your day, like normal. Body sculpting and surgical liposuction will not remove all fat as the body will always need a small layer of fat between the muscles and skin. If we removed all the fat underneath your skin, the skin would look very loose and wrinkled. This means that there is no way to destroy or remove all or hundred percent of fat cells in a treated area.

Are the results of non-surgical body sculpting permanent? The results are only permanent if you don’t gain excess weight and generally have a healthy lifestyle. We stop making new fat cells in our late teens. And after that age, any increase in fat volume is due to an increase in the size of our existing cells. If you have permanent destruction of fat cells in an area, there will be less fat cells to grow larger when you do gain weight. If you gain weight, fat cells would first start growing in non-treated areas, and if you were to gain a lot of weight, the body would run out of places to grow fat cells and the remaining fat cells in the treated area would also start to expand. This is why if you do not gain excess weight, your results will be permanent.

Another thing to consider is that abs are made in the kitchen. Just like surgical liposuction, getting results with body sculpting requires some work from you. Eating a healthy diet and regular exercise will help maintain a normal weight, which will improve results. These procedures will not get the results you may hope for on their own, but they’re meant to be done in conjunction with a healthy lifestyle approach.

Do these procedures hurt? Pain is certainly subjective, but all these procedures have a moderate to low amount of discomfort. Emsculpt Neo is the most comfortable procedure. However, none of the procedures require anesthesia or topical numbing.

Who cannot get these procedures? While these body sculpting procedures are generally safe, some groups should stay away from them. Including, those who are pregnant, those who have hernias; like umbilical hernias in the areas treated, and those with metal implants, including IUDs, for those doing Emsculpt Neo.

Thanks for listening to this episode of The Skin Report. Be sure to subscribe to the channel or weekly content, and until next time, love the skin you’re in and celebrate your beauty.

If you’d like to learn more about science backed skincare or medical aesthetic treatments, please subscribe to and turn on notifications for The Skin Report, so you can always know when a new episode is up. We have a newsletter that you can sign up for on theskinreportbydrsethi.com, so that you can stay up to date on all our new episodes, blogs, products, and more. Additionally, if you have a skincare question or want to make an episode topic recommendation, please message me at theskinreportbydrsethi.com, which is linked in my show notes, and I’ll be sure to answer your question in an episode soon. We’ve received some great questions so far, so keep them coming.

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