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Kybella and Other Fat Removal Options

Fat. Ever since Charles Atlas and Johnny Weissmuller introduced American men to the idea of "body insecurity" a century ago, an industry of aestheticians has existed to get rid of it — promising to vibrate, massage, beat or suck it out of you, if starving it off hasn’t worked for you.

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For decades, fat-removal technology fell into two camps: invasive surgery (liposuction, requiring general anesthesia and painful recovery time) or scams (remember those vibrating ab belts?). The great news: That has changed. In recent years, technology has advanced rapidly, bringing forth new procedures that make eliminating stubborn love handles or a bothersome belly easier than ever.

Now, we're not talking about major weight-loss surgery here — these minimally invasive and noninvasive treatments are best suited for a bit of extra pudge or areas of stubborn fat that aren't responding to regular workouts. Read on to find out which might be right for you.

Minimally Invasive Liposuction

Liposuction used to be major surgery, requiring a stay in a hospital or surgical facility and going under general anesthetic while fat was sucked out of your body with a tube the approximate size of a garden hose. The procedure has gotten considerably more sophisticated, evolving into minimally invasive liposuction. Fat is injected with a numbing solution, then melted with ultrasound waves.

"Once it's melted, I can take something the size of a coffee stir stick to remove it," says Dr. Ryan Neinstein, a New York City plastic surgeon who performs the procedure frequently. "What that means for the patient is smoother results, less downtime and less trauma to the body." The procedure takes about an hour; recovery involves just two days off work and a two-week break from working out.

Who's a good candidate? "This minimally invasive procedure can help people overcome barriers that they can't at the gym," says Neinstein, whose practice is about 40 percent men. "We work with doctors, lawyers, accountants — professionals who eat well and exercise but have some stubborn stuff. They're not looking to overhaul their life; they're just looking for a little bit of help. We're really an extension of the wellness/fitness sphere," he says. Most of his procedures run from $7,500 to $12,000.  

TruSculpt

TruSculpt is a noninvasive radio-frequency machine that heats fat, causing selective apoptosis (or programmed cell death) of the fat cells so they can be naturally excreted by the body, says Dr. Marnie Nussbaum, a New York City dermatologist who offers the treatment. One 15-minute session can reduce fat in the treated area by an average of 24 percent.

"It feels like a hot stone massage," says Nussbaum. "It delivers heat to the entire fat layer, while maintaining a comfortable skin temperature. You can do it on virtually any area, and the great thing is, you can do multiple areas at the same time." The cost: about $3,000 a session. It takes about 12 weeks to see the full results, after which the procedure can be repeated if desired.

Kybella

A sharp jawline is one of the most desirable masculine attributes. But with age and weight fluctuations, things can soften up. A relatively new, somewhat sci-fi-seeming treatment for "submental fullness" — a.k.a. the dreaded double chin — is Kybella. It's an injection of deoxycholic acid, which melts fat cells so they're naturally eliminated by the body. Nussbaum says a few treatments of Kybella are necessary: between three to five, spaced every six weeks. The results are permanent.

One factor to consider: a common side effect of Kybella injections is bruising or swelling, which lasts about four to five days after each treatment. Although it's temporary if you need several sessions, you could be looking at quite a bit of downtime. If that's not doable, you might get more bang for your buck by doing liposuction instead. "The science on Kybella is real, and the results are real," says Neinstein. "But to get results similar to surgery, it requires so many treatments that downtime quickly becomes much longer than a 25-minute surgical procedure that causes four days of bruising. So Kybella doesn't make a lot of sense for a lot of patients."

If your budget doesn't cover surgery, or you want to stick to totally noninvasive procedures, there are options. In some cases where patients want to remove a significant amount of fat from under the chin, Nussbaum says she'll do an initial debulking with Kybella, then follow up with TruSculpt.

EmSculpt

During an EmSculpt session, electromagnetic paddles are attached to your abs or butt, delivering energy that stimulates the muscles to contract. "Electromagnetic muscle stimulation of Type 2 muscle fibers is the next extension in body contouring," says Neinstein. In 30 minutes, you'll undergo the equivalent of 20,000 crunches or squats. It's more of a muscle-sculpting than a purely fat-removal device, although MRI studies show that patients can lose about 20 percent of the pinchable fat above the muscle.

Nussbaum says she'll often perform EmSculpt and TruSculpt together. "I love doing these in tandem, because they're both noninvasive, you sculpt the muscle and reduce the fat, so you're getting the best of both worlds," she says. She recommends four 30-minute sessions over a two-week period for optimal results.

Plasma Skin Tightening

Some of Neinstein's patients who see the best results will stack procedures as well, either following up minimally invasive liposuction with EmSculpt sessions — which can have the bonus of speeding up healing by breaking down scar tissue — or chasing lipo with a procedure called plasma skin tightening. It doesn't remove fat by itself but makes liposuctioned areas look firmer and smoother after the procedure, which was previously only possible with surgery and a risk of scarring.

How it works: A device that emits plasma energy heats the area under the skin, tightening the collagen from the inside. "It's similar to tightening the knot on a loose shoelace," says Neinstein. "I tell people, we're going to turn back the clock, but the clock keeps ticking. We can put your skin in the dryer, but we're not sending it to the tailor. Things will stretch out in time. But patients I find are happier. People are looking for these types of options versus major surgery with big scars and risks from downtime."

So science marches on, giving us tighter jawlines and better abs. But, fortunately or unfortunately, these new procedures don't come with a get-out-of-the-gym-free card. It's important to support your investment with a healthy lifestyle, including regular workouts and a sensible diet.

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Michael Martin, DMT.NEWS