“As we get older, the biggest change that we see in both men and women is that there’s a decrease in metabolism, especially as you start getting into your late 30s and early 40s,” says Pittsburgh, PA plastic surgeon Jeffrey Antimarino, MD. As our metabolism slows down, it becomes more difficult to work off the calories and lose the fat we accumulate. “The other thing is there’s hormonal changes,” he adds. For men it’s testosterone that starts to slow, and for women it’s estrogen that takes a dip, making it harder to lose weight. “Women, especially in their 40s, start becoming perimenopausal and menopausal, and they start to develop adipose tissue in areas they never had it, mostly in the upper part of the abdominal wall,” says the surgeon.
With many patients in the 30-and-up age group coming in to address these aging changes that occur in hard-to-lose areas, Dr. Antimarino chooses from his toolbox and combines surgical and nonsurgical techniques to eliminate the pinchable fat. While it’s not a one-size-fits-all approach, he often incorporates more than one modality to get the precise result he’s after, which is always a leaner, tighter, and more sculpted body.
Lipo AI
Based on the concept of laser liposuction, the Lipo AI device allows the surgeon to target small areas of fat in an office setting under local anesthesia. “That’s different than most of the liposuction that is done in a surgery center using either general anesthesia or IV sedation,” he explains. “This device is spectacular. It’s a small handpiece, it has a fiber optic cable that’s about two millimeters wide, and you basically can use it to liposuction anywhere on the body.” The laser energy breaks down or emulsifies the fat cells, followed by the use of a hollow cannula to aspirate the fat. “I’m using it on smaller areas,” notes Dr. Antimarino. “If I have a patient that comes in that just wants their upper arms treated or just a little bit on the hips, the banana rolls or the upper thigh, all those areas are perfect. I’m also doing it under the chin and jawline.”
VASER + Power-Assisted Lipo
While it’s not new—it’s been around for more than 15 years—VASER Lipo is a minimally invasive form of liposuction that uses ultrasound waves to destroy unwanted fat deposits. However, Dr. Antimarino is combining the ultrasound of VASER with traditional power-assisted liposuction to get precise, highly defined results. “I combined the ultrasonic cannula of VASER and follow that with the power assisted liposuction. I love using those two together and I’ve been doing it that way for years.” The power-assisted liposuction, or PAL, has a cannula that vibrates at a rapid rate, making it easier to eliminate thicker and larger pockets of fat, faster.
Renuvion + Liposuction
Using helium plasma and radiofrequency energy combined, Dr. Antimarino often combines Renuvion as an adjunct treatment for liposuction. He says with patients who have good skin elasticity, and who don’t need tummy tucks, this combination can get the flattest, tightest contours. “It’s not really skin tightening, but it’s tissue tightening,” says Dr. Antimarino. “After I’ve done liposuction, I’ll go back to the same incisions and make different passes in through the tissue. The energy targets the fibrous bands in the tissue and when it coagulates them it shortens those bands, so it actually tightens the tissue. The results are excellent, and the risks are low.”
The surgeon says he’s seen really great results on patients that are a little bit older who have lost a little bit of the elasticity of their skin. “When you’re doing a lot of liposuction on a patient, they run the risk of developing some laxity, so now we may not need to go on to an actual tummy tuck or arm surgery or thigh lift to remove the excess skin. That’s who I gear the Renuvion to, someone who was in the in-between place before, now we have an answer.”
Is the Fat Gone for Good?
The number-one question the doctor often gets from patients seeking liposuction or body contouring is, “Will the fat come back?” “Basically, everybody is genetically programmed to store fat in certain areas more than others,” he explains. “It’s sort of like safety deposit boxes. For some people it’s love handles, for others it’s the hips, the belly, or the thighs. It really just depends on our genetics.” Liposuction, he stresses, is not for weight loss; it’s for contouring.
“It’s targeting these problematic areas and removing the excess fat,” he adds, “so you don’t take out all of the fat, but you take out enough that now the contour is much improved.” While you might still gain weight in the future, you will gain weight more uniformly, he explains.
