I was at a children’s birthday party, my eyes trained on a thick slice of chocolate cake, when the woman next to me gestured at a tiny roll on her otherwise flat abdomen with a pink plastic fork. “Next week, I’m going to the dermatologist to get this taken care of,” she announced to a group of six of us.

“Details! Details!,” the six of us demanded. We were all healthy sized women who adhered to nutritiously balanced diets and got regular exercise, but not of us was without a body bête noir. Suddenly everyone was dishing about saddlebags and muffin tops, bra fat and underarms. I bemoaned how my favorite white jeans were fitting a little—okay, a lot—too snugly, while the blonde next to me fretted about how Instagram-unfriendly her thighs were.

We were nitpicking, granted, but its difficult not to when, thanks to many technological innovations in non-invasive body contouring procedures, there’s now a fat-blasting solution for nearly every trouble zone. These days, instead of it being a question of if I can have flat abs and a thigh gap, it’s a question of how.

All The Tools On The Bench

“What’s changed is all the different options we have,” says Dr. Paul Jarrod Frank, a dermatologist in New York City who offers a wide array of both non-invasive and surgical fat removal procedures in his Fifth Avenue office. He approaches each patient’s needs individually, aiming to give them the best results with the least amount of downtime, pain and expense. “I am a carpenter that has more than just a hammer. I have every tool on the bench,” says Dr. Frank.

One of those tools is CoolSculpting by Zeltiq, a much buzzed about procedure, sometimes referred to as cryolipolysis, which kills fat cells in the subcutaneous layer of skin by freezing them. The dead fat cells are then naturally eliminated through the lymphatic system, liver, and kidneys over the next two to four months.

Dr. Gervaise Gerstner, a Manhattan-based dermatologist, says she rarely performs liposuction procedures on patients anymore because of the good results she’s seen with CoolSculpting. The Food and Drug Administration has recently cleared applicators to treat the thighs (inner and outer).

Who Is It For?

“It’s really for someone in shape, who goes to Exhale or does a lot of similar core-based workouts, but no matter how many sit ups they do, they’re still going to have that little area,” says Dr. Gerstner. For Robin Shobin, plenty lithe at 5’6” and 116 pounds, that area was her lower belly. Although the procedure wasn’t a walk in the park—Shobin says she felt a significant amount of discomfort for the first 10 minutes as the CoolSculpting device suctioned her trouble spot as well as after the treatment when the doctor massaged what looked like “a frozen stick of butter” back into her body—she was happy with the pay off five weeks post-procedure. “Out of nowhere, it looked a lot smaller,” says Shobin, the founder of Charlotte’s Book, of her belly.

Still many doctors caution that CoolSculpting is only appropriate for patients who have small bulges of fat rather than a widespread, thick layer (as in you can pinch several inches) of extra padding. “CoolScultping works, but is fairly limited to small areas,” says Dr. Chia Chi Kao, a plastic surgeon in Santa Monica. “If the contour of that fat is not a bulge, just thickness, CoolScultping could potentially make an indentation,” he says. That’s why Dr. Kao favors liposuction for most candidates and iLipo, a low level laser that uses thermal (heat) energy to encourage cells to break down and release stored fat, for patients who don’t want surgery and are looking for less dramatic results. iLipo can treat larger areas, such as the entire surface of your stomach or thigh area. Five to six sessions of iLipo are required; and patients must work out for twenty minutes a day during the two-week treatment period to help flush fatty acids out of their system.

A Closer Look: UltraShape

UltraShape, recently approved by the FDA last April but long popular in Europe and Canada, is the latest non-invasive body contouring procedure to hit the scene, and shows lots of promise. Using sound waves rather than thermal energy, the device targets and kills fat cells 1.5 centimeters below the skin. Treatment time can take from 10 to 50 minutes depending on the size and number of areas treated and results can be seen in as little as 10 days, says Dr. Dennis Gross, a dermatologist in New York who is among the first doctors in the U.S. to acquire the device. “It is incredibly accurate,” says Dr. Gross about Ultrashape, which has an added safety feature that ensures cells aren’t zapped more than once, thus minimizing the risk of contouring irregularities. With the other fat-blasting machines, cosmetic doctors have to eyeball over-treating a section, which could potentially lead to irregular results. (Cost: $1200 for one treatment or $3000 for a package of 3.)

Yet as seductive as non-invasive body shaping procedures seem to be—no downtime, less expensive than lipo, I’m not really having plastic surgery—many doctors still consider surgical liposuction the gold standard and well worth the extra cost. Dr. Frank estimates that non-surgical treatments provide 25 percent of the results for a 30 to 40 percent discount in price. “I like to say the non-invasive thing is for tea cups, but if you need to remove soup bowls, liposuction is the way to go,” he says.

A Closer Look: Zerona

Lauren Wax, a mother who jaunts between a home on Long Island and a pied-a-terre in the city, says she initially lost 8 centimeters from her stomach, love handles, glutes and thighs after submitting to Zerona, a cold laser that claims to help temporarily shrink (not permanently kill) fat cells, but quickly regained her old shape. “They took a picture before and on my last day and you could see the difference, but then you get back into having coffee and your old eating habits and the weight comes back,” says Ms. Wax, who bought a voucher for the procedure on Gilt Groupe for $700.

Zerona usually goes for upwards of $1500—not exactly pocket change. “These non-invasive things are actually pretty expensive when they add up,” counsels Dr. Melissa Doft, a plastic surgeon in New York City who says she still prefers performing liposuction on most patients. In other words, you could either spend a couple thousand here and there for treatments that may or may not live up to your expectations, or save up for liposuction, which starts at about $5,000 and guarantees that a few litres of fat (depending on your personal reserves) can be removed within hours.

For all the buzz on so-called SmartLipo (aka laser or ultrasound-assisted) lipo received a few years back, Dr. Doft believes any “diligent” doctor working with a small cannula can yield good results. Most experts agree that only certain cases—such as male gynecomastia (enlarged breasts in men) where the tissue is more dense, and liposuction revisions where scar tissue may be present—seem to merit the use of lasers or ultrasound to help liquefy fat before the suctioning process begins.

But if there’s one thing all doctors agree on, its that there’s only so much they can do for a patient who isn’t also willing to cut calories and get more exercise post-procedure. “Plastic surgery should springboard lifestyle changes, not just quick temporary fixes, “ emphasizes Dr. Doft.

I guess that means I won’t be tucking into any giant pieces of birthday cake anytime soon.

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Tatiana also found that when she exercised a ton, she started to look, well, a little old. Here’s what happened. She also wrote this guide: Body Contouring For Perfectionists. 

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