30 March 2016 March 2016 31 Expert guide: Aesthetics & Cosmetology 2016 While control of dietary intake and frequent exercise are the cornerstones of a healthy life-style as well as healthy weight loss programs that provide scientifically proven health ben-efits, there are cases in which limitations arise, particularly in spot reduction or resistant areas of fat excess. Massive weight loss of hundreds of pounds has also been achievable with low com-plication relates through surgical approaches to the stomach including banding, stapling, resec-tions and other techniques. In some of these cases as well limitations of the aesthetic result may be reached when recoil of excess skin lax-ity does not occur. Patients of all varieties present to the plastic surgeon with varying complaints. A medical judgment occurs initially such that patients who have not adequately reached maximal benefit from diet and exercise are directed ac-cordingly. Medical weight loss is appropriate in some cases whether with a specific diet and/or pharmacological supplementation with am-phetamine based or other supplement. Surgical approaches are considered in patients that are appropriate candidates for massive weight loss.After maximising benefit from these initial ap-proaches, some common resistant areas caus-flanks and thighs in six treatment sessions of 40-minutes each over a two week period. Mild reductions in overall circumference in the ab-domen, hips and thighs have been achieved. The treatment is FDA approved. While ex-tremely safe and a good consideration for pa-tients who are not candidates for surgery, the downside is its extremely limited result, with typical results showing just 1 to 1.5 inch inches of circumferential reduction in each body area, as high as 3.5 inches in some cases. Further, ing patients to seek plastic surgery include the flanks (love handles), thighs both medically and laterally), buttocks, abdominal, neck and arms. The limitations in some cases of diet and exer-cise including the inability to provide for spot reduction or targeted fat reduction. While ag-gressive continued weight loss beyond the pa-tient’s desired aesthetic could proceed, this may result in excessive thinning of body regions where further weight loss is not desired (such as breast volume loss or facial emaciation). The end result here could be smaller breasts or a more aged face with skin laxity in order to see a reduction in fat in the above referenced resis-tant areas. Skin laxity is another side effect that is more pronounced in cases of weight cycling where repeated weight loss and weight gain cycles stretch the skin. Multiple pregnancies, large weight gains with pregnancies exacerbate skin laxity in women. Fortunately, the plastic surgeon has a toolset for assisting patient with these resistant areas and to target both localised fat depositions and skin laxity to effectively treat them to achieve a more balanced aesthetic result.Zerona is a non-invasive cold laser that is pain-less. It is applied over the skin of the abdomen, the reduction is circumferential and not spot reduction. Treatment cost is approximately $2,000 for six sessions.Radio frequency (RF) is a FDA-approved thera-py for improvement of skin wrinkling. Here, the RF energy is applied to the target skin area. The sensation is of heat and mild discomfort but not painful and tolerated by most patients. Heating the collagen fibres beneath the skin surface pro-motes collagen stimulation and realignment for Dr. Raja Nalluri www.nalluriplasticsurgery.com +1 941 752 7842 Treatment Options for Targeted Fat Reduction By Dr. Raja Nalluri USA