We may be in the midst of winter, but that won’t keep us from dreaming about the warmer months ahead and about shedding the cold-weather clothing we’re already getting sick of. But there is something that might keep us from looking forward to fewer layers—so what can we do about those soon-to-be-exposed flabby midsections, varicose veins and dimpling thighs?
[unpack those saddlebags]
Are your legs less than you’d hoped—or, rather, cellulite can ruin everything. Even if your weight you look bigger—and feel less satisfied—than more? Those pesky saddlebags and that dimpled is good, concentrated fat pockets will make you need to be.
no silver bullets
So, are you a good candidate? “The best candidate is somebody who is already at their ideal body weight and is ready to contour an area,” says Terry Myckatyn, plastic and reconstructive surgeon with West County Plastic Surgeons of Washington University.
There are two types of patients best suited for this treatment, he adds: those with a normal BMI (body mass index) who are in great shape but may have a stubborn thigh area and those who have had significant weight loss through diet and exercise or surgery, yet still have excess loose skin.
Dr. Sumesh Kaswan, a SLUCare plastic surgeon and assistant professor in plastic surgery at Saint Louis University School of Medicine, also recommends patients maintain a stable weight for at least six months before seeking treatment.
liposuction or thigh lift?
Both surgeons recommend a consult with a board-certified plastic surgeon to determine what type of procedure will achieve a patient’s goals. Kaswan says younger patients with good skin quality tend to choose liposuction for the excess fat on the upper and outer thighs. Patients with excess skin from significant weight loss through bariatric surgery or for some other reason may require a thigh lift.
“Usually, we do either liposuction or excision for a particular area, but not both at the same time,” Kaswan says. “There may be a small group of patients for whom you do liposuction and the skin does not retract or shrink as expected, and they are left with excess skin, which we can go back to excise.”
to cut or not to cut
Significant weight loss and loose skin on the outer thigh, or saddlebag area, will typically need a lateral thigh lift or lower body lift that may also address the lower back or buttocks area, Myckatyn says.
A medial or inner thigh lift can be used for people with moderate skin and/or fat excess, especially when limited to the upper inner thigh. This may result in a less visible scar at the groin crease, Kaswan explains. A third option, the vertical thigh lift, is for people with significant skin and/or fat excess along the inner thigh and involves a scar that extends down to the knee.
And there’s a nonsurgical option for excess fat in the saddlebag area, Myckatyn adds, known as cryolipolysis. It reduces fat by breaking it down via a cooling technology known as CoolSculpting®, by which a cool, flat instrument is placed directly on the patient’s thigh for approximately two hours per thigh.
“With this procedure, we hyper-cool the fat cells, which are more sensitive to cool temperatures. Patients may experience some tenderness for awhile following the treatment, but no scarring,” he says. “They typically have one or two treatments and notice full results in two to three months.” Depending on how many treatments are needed, the cost
could rival that of surgery.
“With any of these procedures, patients need a few months to see the full benefit,” Myckatyn says. “Patients need to be informed, have realistic expectations and understand that a clean, healthy lifestyle is most important.”
[get a leg up on veins]
Treating leg veins was once a major hassle. Not anymore. From simple compression to injection therapy, you can be in and out during an office visit or two, and on the beach showing off your new smooth, supple limbs.
treat your legs
According to the U.S. Department of Health and Human Services’ Office on Women’s Health, about 50 to 55 percent of women and 40 to 45 percent of men in the United States suffer from some type of vein problem. Half of those age 50 and older are affected by varicose veins alone.
The reason for problem veins can include everything from aging, genetics, pregnancy, hormonal changes, obesity, limited movement and sun exposure. And the ideal time to treat them is winter, when legs are mostly covered up. “This is an excellent time to consider varicose and spider vein removal, so patients have time for both treatment and recovery,” says Dr. Ricardo Rao, medical director of the Complete Vein Center of St. Louis. “It is more comfortable wearing compression hose under pants in the winter rather than during the heat of summer.”
Dr. Norman Bein of Vein Specialties agrees. “Summer is inevitable, and if you start early in the year, you have more time for several treatments, if needed,” he says. “One treatment may not solve these problems, and they must be done by specially trained surgeons and clinicians.”
vanishing the spider vein
Spider veins are the smaller veins in shades of blue, red or purple that appear close to the surface of the skin, often in clusters. Treatment can include a more conservative approach using compression therapy to slow their progression or the most common treatment, sclerotherapy, also known as injection therapy, Rao says.
“Spider veins are mainly a cosmetic problem for women who visually want to erase them,” says Maria Bein, R.N., clinical director of Vein Specialties. “We treat most patients with sclerotherapy, which is the gold-standard therapy for spider veins.” For those with very fine veins, Bein says they may also do topical laser treatments.
After patients receive sclerotherapy treatments, they are asked to wear compression stockings and avoid strenuous exercise for at least a week to achieve maximum benefits. They may also return for one or more follow-up treatments when needed.
varicose vein removal
Larger varicose veins can cause pain and an achy, burning feeling. It’s not something most people want to live with. Dr. Norman Bein says laser ablation is the most widely used treatment for this noisome problem. The procedure uses laser energy delivered through a thin fiber-optic probe to treat the underlying cause: a defective vein, explains Dr. Rao.
Patients undergo laser ablation, the closing off of the defective vein, under local anesthesia. Following the procedure, they are urged to avoid strenuous activity or exercise and are prescribed compression stockings to wear for several weeks. Most patients are able to return to work and normal activities within a day or two after treatment, Bein adds.
Both Rao and Bein stress the importance of customizing each patient’s treatment for vein removal, starting with a consultation to determine what is best for them. “Patients should do their research and find a board-certified surgeon who is experienced and has a well-trained and a professional staff,” Bein says.
[a happy medium]
So you don’t want to remove your cover-up on the beach. Whether you are struggling with stretch marks, have excess skin or fat from a significant weight loss or surgery, or your skin just doesn’t have the elasticity it used to, it may be time to get serious about the midsection.
out, damn fat!
“There are two ways to slim up the midsection,” says Dr. Judith Gurley of Judith Gurley Plastic Surgery & Medical Spa. “Patients may remove the excess skin and tighten muscles with abdominoplasty, also known as a tummy tuck, or remove fat with liposuction.”
When preparing for cosmetic surgery, you need to be as healthy as possible, Gurley says. “If there is a fair amount of fat between the skin and tummy muscles and not a lot of hanging skin—and the muscles are together—then liposuction is a good option for slimming down,” she says. “But if there is loose skin and separated muscles, or stretch marks are the issue, then a tummy tuck is the best option. If all of these things are present, your plastic surgeon can help you decide.”
Also keep in mind that the fat distribution and density in men and women are different, so different types of procedures and resulting scars would apply, says Dr. Michele Koo of St. Louis Plastic Surgery. “The principles of who is a good candidate for liposuction are similar, but men’s skin shrinks much better than women’s and, therefore, most men can achieve a flatter midsection with liposuction alone,” she says. “Most women could use a tummy tuck, especially after pregnancy, and it may also be appropriate for men who have experienced a large weight fluctuation with a significant amount of excess skin.”
no pain, no gain
Patients who undergo liposuction in the midsection often have several tiny short scars from the procedure, Gurley says, and they are encouraged to wait at least two weeks before returning to exercise.
A tummy tuck involves an incision along the lower abdomen, which allows for muscle tightening, removal of excess skin and liposuction, if needed. Tummy tuck patients require a longer recovery and are advised to wait six weeks before resuming exercise, Gurley adds.
Koo reports that men are showing a growing interest in cosmetic procedures for the tummy area. “Male patients who have liposuction or a tummy tuck feel a thousand times better and more motivated to eat healthy, stay active with exercise, and maintain a healthier weight and lifestyle,” she says. “Now more and more male patients undergo Botox injections, liposuctions and face-lifts. They are more willing to take the time to take care of themselves and appear their best professionally and personally.”
Regardless of the procedure, Koo urges patients interested in cosmetic surgery to talk to their friends, research by looking at before-and-after results on a boardcertified plastic surgeon’s website, and meet with the plastic surgeon. “They should develop a relationship with their surgeon and a trust that the surgeon understands and can deliver what their cosmetic desires are.”
