Q. I have excess fat in my thighs and my lower abdomen.  I do not want to undergo anesthesia for liposuction and was wondering about whether Coolsculpting® would be an option for me?

A. Coolsculpting® is a non-surgical alternative for fat reduction in areas such as the abdomen, the outer and inner thighs, the flanks, under the chin, the upper arms, and the bra rolls.  Not everyone is a candidate for Coolsculpting®, so an evaluation by a practice that performs it is necessary.  Coolsculpting® is an FDA cleared technique that involves freezing fat which results in about 22% of the fat cells dying and being absorbed by specialized cells in the body and then eliminated.  It works best in a person who is close to their ideal body weight but has stubborn pockets of fat, such as the inner or outer thighs or the abdomen that will not respond to diet and exercise.  If there is a significant amount of loose skin that accompanies the fat, Coolsculpting® may not be the solution to the problem because the skin may not tighten up after the fat has gone away.  The procedure takes about one hour per site treated, and most of the time it takes two treatments per site to reduce the fat to a satisfactory degree.  Each site treatment is performed about 4-6 weeks apart and it will take 3 months to see the final result.  Complications include not removing the amount of fat that is desired, skin surface irregularities, temporary numbness of the skin, and a temporary nerve pain in the treated area that can last for 2-3 weeks.  These complications are rare but do occur in some people.  There is no anesthesia required and patients can drive home after the procedure and resume normal activities immediately. 

Q. I would like to have a breast enlargement but I do not want silicone gel implants.  I was told that I am not a candidate for saline implants because I am too thin.  Is there any alternative?  I read on the internet that there is a new saline implant that can be used in women with very small breasts.  Is this true?

A. Yes, there is a new saline implant that can be used in women who previously were not considered good candidates for the traditional saline because their breasts were actually too small (not enough volume). The reason very small breasted women are felt to be poor candidates for saline is that one of the negatives of traditional saline implants is the possibility of visible or palpable rippling that presents itself on the sides or bottom of the breasts after the implant is placed.  It is my experience that all traditional saline implants will ripple along the edge of the implant, but if there is enough natural breast tissue to camouflage the rippling, it will not be felt or seen.  In women who are very thin and who do not have very much breast tissue, this rippling can be felt or worse seen on the skin surface of the breast.  My rule of thumb is that a patient must have about 4 centimeters (just under 2 inches) of breast tissue thickness before I feel comfortable placing a saline implant.  Up until about 18 months ago, a patient with less than 4 centimeters of tissue had to either accept rippling as a risk or use silicone gel implants.  Then in 2014, the FDA approved a revolutionary new design of the saline implant which dramatically reduces the incidence of rippling. In September 2015, the new implant became commercially available.  The implant is manufactured in California by a company called The Ideal Implant Company.  I have placed this implant in 17 patients so far, who are like you. They did not want silicone but were not good candidates for the standard saline implant.  My experience in this fairly limited sample is excellent, although I do have one patient in the group who can palpate some ripples.  This implant is not available through all plastic surgeons, so it is best to ask whether your plastic surgeon has access to the Ideal Saline implant.