Written by Fulvio Urso-Baiarda co-founder and plastic surgeon at Eterno 360, Eton, Berkshire

Let’s be honest - very few of us past the age of twelve are not bothered by tummy fat. If you are one of the lucky few, I congratulate your healthy ways and salute your body confidence, and the rest of this article will probably be of little interest to you. But I suspect most of you are still reading. First things first: diet and exercise. Ok, I know I didn’t need to tell you that, everyone knows that. But seriously, none of the other options work for people who simply eat too much and do too little, so you’ve got to have this one nailed. I’m sorry, it’s not my rule. If diet and exercise are not giving you the results you want then it may be time to try something else.

People of windsor and berkshire - before you go ahead with a cosmetic treatment YOU NEED TO HAVE A HEALTHY BALANCE OF DIET AND EXERCISE

Here’s the key point to understand: liposuction, non-surgical fat destruction and even cutting bits out, cannot change your fat deposition in the long term. If you maintain the same diet and level of exercise, the chemical signalling going on in your bloodstream will be unchanged and your body will have the same need to store energy (aka fat). So even if hypothetically half of your fat cells are somehow removed, if the remainder are stimulated to enlarge to twice their previous size (by having the chemical signalling as before) then you won’t actually notice any difference.

Cosmetic treatments should be used to target stubborn areas that never slim down however trim you are. If you remove half of the fat cells in a relatively small area, then it will be more difficult for your body to deposit fat there in the future, and that small excess is shared throughout the rest of your body in a way that you don’t spot.

Imagine you are made of plasticine* (if you are about my age you have immediately thought of Morph) (*kids – plasticine is like putty, but without the mass destruction of upholstery). Most treatments squish the plasticine away from one area, but the total amount of plasticine stays the same. If you want to remove some plasticine you need diet and exercise.

WHAT CAN YOU DO IF YOU’VE TRIED DIETING AND EXERCISE BUT STILL HAVE STUBBORN EXCESS FAT?

If you’re like most people, your stubborn flabby bits are your flanks, love-handles, haunches, whatever you want to call them. Except haunches makes you sound like a horse. You know, the bits towards the back of where your waist should be, but maybe isn’t because you have flanks/love-handles/haunches there instead.

The second commonest resistant flabby bit, usually in women, is the outsides of the thighs, a bit lower than the actual hips. That’s where you’re likely to store your most stubborn fat if you don’t keep it in your flanks.

And in third place is a mish-mash of annoying-but-not-usually-that-severe fat pockets: the front of the tummy, the chest (in men – women also get it but don’t complain about it so much), the chin, the bra roll (where your bra makes a roll), the banana roll (the same nomenclature does not apply) and the insides of the knees. These are all common annoying flabby bits in people who are otherwise reasonably trim, and as such are good targets for treatment.

Which cosmetic Treatments work best - liposuction, fat freezing or a tummy tuck?

Ok. This used to be easy: the choice used to be liposuction, to remove fat, or excisional surgery, to remove skin and the fat underneath it. But then surgeons started getting fancy, and doing excisional surgery with liposuction. And then medical scientists started getting fancier, and created non-liposuction ways of destroying fat. Next the pharmacologists got in on the action and started to synthesise chemicals that dissolve fat. Then everyone started coming up with various versions of each of those, some of which worked better than others, and the whole thing became a bit confusing.

So let’s wind it back a little. A person can have too much fat with or without skin damage. People often talk about whether you have “too much skin”, but I prefer to think about skin damage instead, because it’s not how much skin you have that matters, it’s how good or bad the condition that skin is in. If the skin still has elastic recoil then when you lose weight (by diet, exercise, pushing out a baby, liposuction, whatever) it will re-contour to your smaller self. But if it has lost its elastic recoil then it will not and you will be left with loose skin.

Which begs the question: what damages skin? Again, you know this: the big things are sun exposure, smoking, skin stretch (meaning weight gain or pregnancies) and time. When I’m assessing someone for whether they need skin excision or just fat removal, before I even look at their skin I want to ask them about those risk factors. Then during the examination, I’m looking for things like stretch marks, skin plumpness, how quickly the skin recoils when pinched and the shape of the bulgy bits. I’ll try to explain the last one: have you ever noticed that a podgy teenager has a different shape compared to a podgy adult? The teenager bulges whereas the adult droops. That’s because the teenager still has undamaged skin holding everything in and up compared with the more damaged adult skin.

So how do you know which cosmetic procedure is the right choice for you?

If there’s not too much fat to remove combined with good skin quality, fat removal alone will work; whereas if skin quality is poor and there’s lots of fat still to remove, the skin would need to be retightened to get the best outcome. For cases in-between there’s an element of judgement for the surgeon and expectation management for the patient.

So what does this mean in practice for someone wanting to improve their tummy? If you’ve had four pregnancies, massive weight loss and spent your twenties chain-smoking underneath a sun bed, you’re unlikely to have a good outcome from anything except a tummy tuck.

On the other hand, if you’ve never smoked, maintained a healthy diet, have never been extremely heavy and completed your family young, you will do well with any of the non-excisional techniques – liposuction or fat freezing (each has its own pros and cons you’ll need to work through with your doctor). The same principle applies to whichever body part is the target of your own personal wrath. The take-home message: look after your skin.

Hopefully this explains our approach at Eterno 360° Clinic, where every patient is looked after by a team of professionals. Your assessment will lead to pre-treatment preparation with our Nutritionist, Lifestyle Personal Trainer, Dermatologist or Cosmetic Nurses, optimising your surgical or non-surgical treatment, which is then maintained with a post-treatment plan. You can find out about all of our surgical treatments and consultations here.

If you think we can help you with your journey, we’d love to do so - please get in touch with us today.