28 While control of dietary intake and frequent exercise are the cornerstones of a healthy lifestyle as well as healthy weight loss programs that provide scientifically proven health benefits, there are cases in which limita-tions arise, particularly in spot reduction or resistant areas of fat excess. Massive weight loss of hundreds of pounds has also been achievable with low complica-tion relates through surgical approaches to the stomach including banding, stapling, resections and other tech-niques. In some of these cases as well limitations of the aesthetic result may be reached when recoil of excess skin laxity 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 accordingly. Medical weight loss is appropri-ate in some cases whether with a specific diet and/or pharmacological supplementation with amphetamine based or other supplement. Surgical approaches are considered in patients that are appropriate candidates for massive weight loss.After maximising benefit from these initial approaches, some common resistant areas causing 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 exercise including the inability to provide for spot reduction or targeted fat reduction. While aggressive continued weight loss beyond the patient’s desired aes-thetic could proceed, this may result in excessive thin- ning of body regions where further weight loss is not desired (such as breast volume loss or facial emacia-tion). The end result here could be smaller breasts or a more aged face with skin laxity in order to see a reduc-tion in fat in the above referenced resistant 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 pregnan-cies, large weight gains with pregnancies exacerbate skin laxity in women. Fortunately, the plastic surgeon has a toolset for assist-ing 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 painless. It is applied over the skin of the abdomen, flanks and thighs in six treatment sessions of 40-minutes each over a two week period. Mild reductions in overall circumference in the abdomen, hips and thighs have been achieved. The treatment is FDA approved. While extremely safe and a good consideration for patients who are not can-didates for surgery, the downside is its extremely limit-ed 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, the reduc-tion is circumferential and not spot reduction. Treat-ment cost is approximately $2,000 for six sessions.Radio frequency (RF) is a FDA-approved therapy for improvement of skin wrinkling. Here, the RF energy is applied to the target skin area. The sensation is of heat Dr. Raja Nalluri +1 941 752 7842www.nalluriplasticsurgery.com Treatment Options for Targeted Fat Reduction By Dr. Raja Nalluri usa