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These Skin Treatments Fix the "Trouble Spots" Your Workout Can't

Torkil Gudnason

Many of us have a small pocket of fat in a spot we wish we didn't—that bulge around your bra, the pinch of skin next to your armpit, an extra chin, love handles (who actually loves these?)— and seemingly no amount of calories reduced or burned gets rid of it. "No one is immune to trouble spots," says Paul Jarrod Frank, M.D., a dermatologist in New York City and the director of the Fifth Avenue Dermatology Surgery & Laser Center. "Despite my patient's work at the gym or smart dietary habits, they continue to struggle in certain areas."

That's where noninvasive contouring and skin-tightening procedures, available in doctor's offices, come into play. (Because it's okay to love your body but still want to improve it.) "They don't replace weight loss or diet control. They're used for parts of the body resistant to those efforts," Dr. Frank says. And this kind of shrinking is growing in popularity. According to the American Society for Aesthetic Plastic Surgery, from 2014 to 2015 nonsurgical fat-reduction treatments increased 18.7 percent and nonsurgical skin-tightening procedures jumped 58.2 percent. This is partially because these treatments require little downtime with no anesthesia or incisions. "They meet the demands of people who are active and don't want to miss work or skip exercising," says Jennifer Levine, M.D., a plastic surgeon with a private practice in New York City. "And they don't come with the dangers or complications of surgery or the obvious signs that you've had work done."

Of course, nothing is perfect. You may feel sore, and there can be bruising and swelling, temporary numbness, or nerve pain. Plus, there's a hefty price tag. Are the treatments worth it? Consult our guide to help you decide. Here, where the latest fat-melting, body-sculpting options can help. 

The Double Chin

If you have a double chin, you know it's impossible to hide and impossible to get rid of. "That's because a double chin is a result of genetics, aging, and gravity," says Elizabeth K. Hale, M.D., a clinical associate professor of dermatology at NYU Langone Medical Center. "As we mature, the structure that holds together our layers of tissue, combined with the effects of gravity, result in the descent of fat pads. Age and lax skin can cause us to lose muscle tone, collagen, and elastin, which collects under the chin." But last April, the FDA approved Kybella, a liquid injection that contains deoxycholic acid, a natural enzyme we already contain in our bodies. "This enzyme is found in the liver and bile duct, since that's where we typically break down fat," Hale says. "Injecting a highly concentrated solution of this enzyme has been proved to selectively destroy fat cells in small, confined, and specific areas, like the chin, without damaging surrounding tissue."

Kybella is quick, effective, and safe, not to mention the first fat-melting injectable of its kind. During a treatment, you'll receive 20 to 40 mini-injections into the area below the chin and above the hyoid bone, which is just above the thyroid. The treatment takes five to 10 minutes, and ice is used before and after to numb the area. Some patients experience bruising and what Hale describes as "bullfrog swelling, which is a result of inflammation and edema, which can last two weeks but will eventually fade away." You'll need up to six sessions, which are staggered a month or so apart. Percentages of reduced fat vary, Hale says, but many see positive results four to six weeks after their second treatment. Cost: $1,500 per session.

For some, once the fat is gone, sagging skin still remains. To make it taut and smooth, Hale recommends Thermage, a handheld machine that uses radio frequency to melt and strengthen collagen. "The device glides over the skin and delivers pulses of heat to raise the temperature above 40 degrees Celsius, which is the intensity needed to cause collagen to contract and retighten," she says. These two procedures work synergistically with each other, says Hale, who suggests having one Thermage treatment four to six weeks after your last Kybella session. Though Thermage doesn't wear off, skin continues to lose elasticity, so some patients repeat the treatment a year or two later. Cost: $2,500.

Your Upper Half

For little fatty places (like bra roll, bat wings, or the armpit area), there are new devices that can target small areas of tissue safely and don't require a specific amount of fat for them to work. (Combine this treatment with an rat-home workout to sculpt touble zones to double the benefits.) The newest is SculpSure, which although the FDA approved for use on the flanks and the belly, has become a go-to for the above-mentioned minor fat pockets because of its mini heated pads, which make it easy to reach these areas. The laser device damages the membrane of fat cells in order to destroy them—without harming or bruising the skin.

"Once damage occurs, inflammatory cells are sent to break the fat cells down," Dr. Levine says. Then they travel into the lymphatic system and are excreted months later. Bonus: Along with less fat, you'll see improved tightness and no increase in laxity. The machine also boasts a gradual dispersion of heat to surrounding areas. "Unlike other devices that leave a jagged bite-like mark or an abrupt demarcation, SculpSure gives you a smooth and natural result, so you can't see where work has been done," Dr. Levine says. Up to four heated pads can be used per 25-minute session, with patients seeing 24 percent fat reduction, and a noticeably smoother silhouette, after six weeks. One follow-up session is done almost two months later. Cost: $1,500 per session.

From the Waist Down

If you can pinch more than an inch, then you can be a candidate for CoolSculpting (sometimes referred to as cryolipolysis, which kills fat cells in the subcutaneous layer of skin by freezing them in a temperature range of 7 below to 10 degrees Celsius), says Julius Few, M.D., the director of the Few Institute for Aesthetic Plastic Surgery in Chicago. "The reason it works well on the lower abdomen and love handles is because CoolSculpting requires a certain amount of fat to suction into the machine." (If you're more concerned about cellulite, try this cellulite fat-blasting workout for your legs and butt.)

Cleared by the FDA in 2010, CoolSculpting has a patient satisfaction rate of up to 73 percent after one treatment, a study published in the American Society for Dermatologic Surgery says. But your ab definition could get in the way of a successful result. According to Dr. Few, muscle will fight the cooling processes. The goal is to pull away fat tissue and isolate it, so the device can suction it into the machine. The more the fat adheres to the muscle, the harder it becomes to kill. Those with sculpted abs are not good candidates because there is not enough skin to suction, Dr. Few says. Once the treatment is over, dead cells are eliminated through the lymphatic system and excreted over time.

CoolSculpting's applicators, which can vary in shape and are six to 12 inches in size, are connected to a suction device. A cold gel pad is placed over the targeted area to protect skin, and then intense, pressurized suction draws fat into the applicators, where they gradually hit the freezing mark for 60 minutes. "When the device is removed, don't be alarmed when you see a large red area and what many describe as a lump of butter," Dr. Few says. "It's the collection of now-dead fat cells. A technician massages the area to increase lymphatic drainage, deplete the lump, and minimize swelling and bruising." After recovery, the skin will look smooth, unlike with lipo, which carries a small risk for irregularities and bumpiness. It can take two to three months to see the expected 25 percent reduction from the first treatment, with a second session scheduled four to six weeks later, where another 25 percent reduction is obtained. Cost: $1,500 per area per session. 

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