How can I get rid of a tummy bulge that won't go away despite exercise and dieting?

The problem you are facing is not uncommon, as fat response to weight loss/gain and exercise differs amongst different anatomical parts of the body, even in the same individual.

Tummy bulges may be due to a number of causes, with the most common cause being excess fat and skin. This can be treated very effectively with either liposuction or a mini-tummy tuck, depending on the amount of excess skin.

The bulge may not only be due to fat excess; many of my post-pregnancy patients also have a bulge due to recti diastasis (widening of the tummy muscles). This can be determined in a clinic consultation, and has to be repaired surgically as it is akin to a hernia.

Often, these ladies are slim and have returned to pre-pregnancy weight, but are left with an unsightly bulge in the middle that is worse with strain, or after a full meal. This is not due to fat or excess skin, but rather due to a diastasis (moving apart) of the abdominal muscles.

Risk factors include:

• Multiple pregnancies
• Heavy birth weight of more than 3.5kg
• Caesarean section delivery

In these cases, surgery is required to repair the muscle diastasis. Many also have concurrent umbilical hernias, resulting in an “outie”, which can also be repaired at the same time. This is a medical issue, rather than simply a cosmetic problem.

Although non-surgical methods exist for fat reduction, the response by patients is extremely variable. Furthermore, repeated treatment is often required as the results are not sustained.

Liposuction is the only sure method of removing the excess fat. Results are almost guaranteed and are sustained in the long term, particularly with a healthy diet and exercise.

It is a simple surgery and very safe when performed by a qualified surgeon. It is a day surgery procedure, and patients are able to return to office-based work in a couple of days.

The surgery is done under general anaesthesia or deep intravenous sedation. My patients all go home on the same day with minimal assistance. Post-surgical pain is very manageable with oral painkillers.

There will be a need to wear a compression garment or binder for the first 3-4 weeks, which can be easily hidden under regular clothing. Return to active exercise and gym work is recommended only after 6 weeks.

The key question is whether you prefer a Non-surgical or Surgical method of localised Fat Reduction.

Both methods have their Pros & Cons.

To make an informed decision, the main considerations are:

1. Post-procedure Recovery time

2. Need for Anesthesia (General anesthesia/ Sedation)

3. Experience of doctor

4. Risk of Complications

5. Need for Repeat treatments

6. Price

Based on the information that you have given about yourself, one suitable treatment is Cryolipolysis.

This technology was made famous by the patented medical device named Coolsculpting.

I feel that this treatment is ideal for you because you have small to moderate areas of fat.

Pros:

• This technology can achieve up to 20% reduction in fat cells per treatment.
• There is no need for general anaesthesia/deep sedation and there is minimal post-procedure recovery time needed.

Cons:

• Multiple treatment sessions might be needed to achieve your final desired result.

Hope that you find this useful. Please contact a doctor for a detailed consultation to find out more!

Best regards,

Dr Justin Boey

Many people have areas that no matter what t they can't seem to lose fat from these stubborn areas. These patients are very good candidates for liposuction or liposculpture. Sculpting of the stubborn areas can be performed by sucking out the fat in these areas and shaping your body into a more athletic and appealing shape. The fat can even be used to make other areas bigger!

Other causes of a bulge in your tummy would need to be excluded first by a clinical examination. Things such as intraabdominal visceral fat, hernias or muscle separation could be the cause of your stubborn bulge.

Other options include non-invasive methods of fat reduction, the good thing about them is that they are non-invasive, however, they are not as effective as liposuction to permanently remove fat. A clinical examination is also needed to assess your suitability for these treatments.

For localized fat bulges, there are surgical and non surgical methods.

Non-surgical methods are as follows:

1. Heat based machines eg. Liposonix: they deliver targeted heat to the deeper fats (around 1.3 - 1.5 cm below the surface of the skin where the fats are), killing the fat cells located at that depth.

2. Cryo based (cold based) eg. Coolsculpting, Cooltech: they subject the fats to temperatures of -3 to -5 degrees which sends a signal to the fat cells to die off.

The non-surgical methods will take 2 - 3 months for the dead fat cells to be removed by your own lymphatic drainage, and only 20% of the fats that were treated will be reduced. There’s zero downtime for such treatments.

3. Kybella is an injection treatment that is currently approved only for double chin fats by FDA, but it may be also useful for tummy bulges in the future.

For surgical methods , the main one is Liposuction, which involves a small incision(s), and then a laser or machine assisted tube to suck out fats. This has to be done in an operating theatre by a plastic surgeon, due to higher risks involved. It has much more instant and immediate improvements of course. Around 1.5 kg of pure fats can be removed via this method. You will need to wear compression garments for 3 months after liposuction, and there’s downtime for a few days.

Hope that helps !

There are various methods as well as with regards to fat reduction for stubborn areas. Your concern is certainly not uncommon and I too, face this too!

In summary, what is currently available fpr fat reduction in Singapore: Cryo-based energy devices eg Coolsculpting vs Liposuction

Cryo-based energy devices:

1. Non-surgical / non-invasive.

2. Lunch-time / Clinic procedure. Done without the need for general anesthesia / deep sedation.

3. Reduces stubborn bulges.

4. Excellent for small to moderate areas of fat.

5. Best for abdomen, flanks, hips, thighs and bra-roll.

6. No downtime.

7. Permanent results.

8. Up to 20% reduction in fat cells per treatment.

Liposuction:

1. Surgical / invasive

2. Has to be performed in the Operating Theater. Requires general anesthesia / deep sedation.

3. Creates contour change.

4. Good for larger deposits of fat.

5. Good almost everywhere.

6. Generally, 1 week downtime. Avoid exercise for 6 weeks.

7. Results are permanent.

8. Up to 70% reduction in fat cells per treatment.

It is important to note that Cryo-based energy devices and Liposuction are for body contouring and not weight loss. Having a healthy, balanced diet and regular exercise will compliment weight loss and therefore body contouring with the above medical treatments.

Body contouring has 2 options:

1) Invasive, which uses Liposuction either by Needle method or Laser-assisted. These are currently the most popular and effective, but the downtime such as swelling and bruising can be an issue. They can last up to 6-10 weeks.

2) Non-invasive. These include HIFU (Liposonix being a popular brand), Radiofrequency, Fat-freeze or Cryolipolysis. These have minimal downtime and when used appropriately and in combination, the results can be quite satisfactory.

Winston

Body contouring has 2 options:

1) Invasive, which uses Liposuction either by Needle method or Laser-assisted. These are currently the most popular and effective, but the downtime such as swelling and bruising can be an issue. They can last up to 6-10 weeks.

2) Non-invasive. These include HIFU (Liposonix being a popular brand), Radiofrequency, Fat-freeze or Cryolipolysis. These have minimal downtime and when used appropriately and in combination, the results can be quite satisfactory.

Winston