As a fitness and wellness editor and regular contributor to Charlotte’s Book, people expect me to be in good shape. And I am—for a mother of three looking down the barrel of her fortieth birthday. I’ve worked hard for my toned legs and sculpted shoulders, but there’s nothing I can do about the excess skin on my abdomen that waves hello to me every time I get into plank position.

At least there’s nothing I can do in the gym, which is how I found myself seated across from Dr. Gervaise Gerstner one warm and sunny weekday last Spring. Dr. Gerstner, a dermatologist in private practice on Manhattan’s Upper East Side, is slim, blonde and has a reputation in the city for being the perfectionist’s dermatologist. Yoga and pilates toned fitness fanatics look to her to Coolsculpt (a procedure using cryotherapy to destroy fat cells) that bit of bra fat hanging over the top of their strapless size 2 Oscar de la Renta. “They are one percent shy of self-determined perfection but it really bothers them,” says Dr. Gerstner.

Related:  See my story here where I interviewed Robin Shobin on her Coolsculpting experiences.

When other doctors might turn these women away because the areas they want treated—though apparent—seem too small, Dr. Gerstner, contrarily, sees an ideal candidate. That’s because many non-surgical, body-contouring procedures intended for use on large pockets of fat but on small areas that need minimal improvement. We’re talking about the minuscule bulges that remain resistant to green juice elixirs and dance cardio classes, but that still manage to ruin the line of your Jason Wu.

Lauren Abramowitz, founder of Park Avenue Skin Solutions, which recently re-opened in an expanded space in Tribeca, says she sees plenty of perfectionist types in her office. Like Dr. Gerstner, Abramowitz has a great figure, and is herself a practiced yogi. (When I go in to see her, she’s sipping green juice and dressed in a flowy, bohemian-chic outfit that highlights her Chaturanga-toned arms.) “Areas such as the ‘bra’ fat, inner thighs, very small lower abdomen area, saddle bag and muffin top are amongst the most common areas that women find frustrating to reduce or get rid of with traditional diet and exercise,” says Abramowitz, a board certified physician assistant specializing in cosmetic dermatology and aesthetic medicine. She reaches for BodyFX, a suction-assisted radiofrequency procedure that destroys fat cells with deep tissue heating and also helps generate new collagen to smooth and tighten skin. Her other favorite spot reducer? Kybella, a fat-melting injection, which Abramowitz has been using off label on the body since it was approved for use on the fat below the chin by the FDA in 2015. (Treatment start at $1,500 a session; 2-4 treatments spaced 6 weeks apart are generally needed.) “Combining Kybella and the Body FX make for a perfect marriage in fat reduction, skin tightening and body contouring, she says.

Dr. Dennis Gross, a dermatologist and founder of 900 Fifth, a practice on the Upper East Side, meanwhile uses Ultrashape, a non-invasive ultrasound treatment for the reduction of fat, to attack those stubborn bulges on his patients’ bodies. The technology is different than other body contouring systems in that it doesn’t rely on thermal energy to destroy fat but instead uses hyper-targeted sound waves to shake and break open subcutaneous fat cells, the contents of which are later filtered through the liver and excreted naturally by the body. There is no downtime or pain, and the company recently introduced a smaller handpiece to address spots like the inner thighs in addition to larger areas such as the tummy, love handles and hips, which the original handpiece was designed to handle. (Treatment cost is $1400; generally three treatments, spaced 3-4 weeks apart, are needed.) “If you can grab it with your hands, we can destroy it,” says Dr. Gross, who says the technology, available in the U.S. since 2014, has “overdelivered” results for his patients.

I have a few small pockets of fat here and there, but they aren’t my chief concern. What really bothers me is the loose skin on my abdomen, which means I’m looking at procedures that can help tighten and firm the skin rather than treatments geared toward reducing fat deposits beneath the skin. The not so great news? “We are still looking for better and better skin tightening for the body,” says Dr. Robert Anolik, a New York-based dermatologist and member of the Charlotte’s Book advisory board, who prefers using Coolsculpting for body contouring because of its consistent results. “We’ve made tremendous advances in fat reduction over the last few years. For skin tightening I can treat people who have a little bit of skin laxity with Thermage, which is radiofrequency-based. More significant laxity and we still have to recommend plastic surgery,” Dr. Anolik says.

I wouldn’t call my tummy skin issues significant, so when Dr. Gerstner agrees to perform Thermage on my abdomen, I’m ready to celebrate. Gwyneth Paltrow, the mother of all wellness worshipers, credited Thermage for taking years off her face; maybe it can do the same for my midsection? We schedule an appointment for a couple weeks later.

Related: Does Thermage Hurt? Read this patient’s account.

On the day of my procedure, I opt to take a mild sedative to help with discomfort associated with the treatment and Dr. Gerstner’s medical esthetician Joanna Collado preps me by applying a grid to my stomach area. The lines help guide her during the procedure, which can take anywhere from an hour to two hours, depending on how many breaks you need to take between “pulses.” For each pulse, the hand piece is applied to the skin; you feel heat, almost like you are being touched by a small, increasingly hot iron. It’s not a comfortable sensation, but all patients respond to the treatment differently and experience different levels of pain (just like child birth). After the procedure, the skin on my abs felt a little hot, like I had a mild sunburn, but that completely abated within a few hours.

Then came the big wait. Because Thermage works by encouraging collagen growth in the dermis, which is the layer of the skin beneath the epidermis, it takes time to start seeing signs of change. “Most tightening as well as slimming body procedures take three to six months (to see results) regardless if it is one treatment like Thermage or sequential treatments like Sculpsure (a laser-based nonsurgical fat reduction treatment),” says Dr. Gerstner.

It’s now been three months since my procedure and I already see some change (most noticeably, less crepiness in the skin surrounding my belly button) so I’m excited to see where we end up in another three months.

Until then, I’ll be planking with my shirt on.

Images by Sasha Israel

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 Want to learn more about Dr. Robert Anolik, Dr. Gervaise Gerstner, or Dr. Dennis Gross? Read client reviews, book appointments, and get expert advice. Only the best cosmetic doctors, skincare gurus, nutritionists, fitness and wellness professionals make it into our book.