Ask Dr. Barber

Q. I have had two treatments of Coolsculpting® on my abdomen and although the amount of fat is less, I still have loose skin that overhangs my C-section scar. I had this loose skin before my treatments, but I thought it would tighten up. Why did my skin not get tighter?

A. Your skin did not get tighter because Coolsculpting® is not designed to tighten the skin. Coolsculpting® is a wonderful tool to freeze the fat in the treated area, reducing the fat by about 22%, but unfortunately, as you have discovered, it does very little to tighten the skin. You mentioned in your question that you had loose skin before undergoing Coolsculpting® and now you still have this roll. Since you had a roll of skin before the procedure, I suspect you were a better candidate for a skin reduction procedure such as a mini or full abdominoplasty rather than Coolsculpting® alone.

Whenever I am evaluating someone’s abdomen, there are three things that I look at: how much loose skin is there, how much excess fat is there, and what condition are the abdominal muscles in? If I find that there is a significant “pinchable” roll of skin in the lower abdomen and the patient is relatively close to a healthy weight, she is a better candidate for a tummy tuck rather than liposuction or Coolsculpting®. So, what is the difference between a mini and a full tummy tuck? A mini-abdominoplasty is best suited for a patient who has a limited amount of loose skin with well-toned abdominal muscles and who is close to her ideal body weight. The mini is a less invasive surgery that allows a faster recovery and return to normal activities, but will only remove about half of the skin (and fat) between the belly button and the lower hairline. The mini will only tighten the lower portion of the abdomen, below the belly button, and therefore if there is any loose skin above the belly button, it will not be improved. The incision runs from hip to hip, and is typically hidden within the pantie line. You can expect to return to work in a week and back to the gym in 6 weeks. 

A full abdominoplasty, on the other hand, is designed to address all of the loose skin of the abdomen, tighten the relaxed abdominal muscles (due to repeated pregnancies), and frequently carry out liposuction of the hip roll and waist area to fully reshape the abdomen. This surgery is obviously a more invasive procedure, but it does offer more correction to the abdomen and is best suited for patients with more excess skin and fat and patients who have more than one “pinchable” roll in the front of the abdomen. This procedure requires an overnight stay at the out-patient center. You can return to driving in 2 weeks, back to work in 2 weeks, to the gym in 6 weeks for cardio, and 12 weeks for core and weights. 

I would suggest that you see a board certified plastic surgeon to evaluate your abdomen and come up with a plan to solve the issue of your loose abdominal skin.

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