How and where we store fat is genetically determined at birth as is the “body type” that we are destined to have throughout life. La Jolla, CA, plastic surgeon Lori Saltz, MD, says, “Some women are ‘apple shaped’ and carry weight in their hips and abdomen while others are ‘pear shaped’ and carry their weight in the butt and thighs. The distribution of fat remains fairly constant as our weight goes up and down. Areas that are problem areas will always be problem areas, regardless of how much weight is gained and lost.” Besides the butt, thighs and stomach, other common problem areas can include the knees and ankles, which tend to be more resistant to weight loss via diet and exercise because they are congenitally predetermined. “The only way to correct fat in these areas is with surgery,” says Beverly Hills, CA, plastic surgeon Randall Haworth, MD.

“I lost weight and now I’m left with all the excess skin that just hangs. Why does that happen and what can I do about it?”
When weight is lost and skin elasticity is poor, the skin can become saggy.”With age, the skin loses elasticity. When the skin is not elastic and able to ‘stretch’ and ‘contract,’ it won’t bounce back post-weight loss, leaving you with too much skin for your new body,” says Dr. Haworth. Pregnancy can also be to blame. “The skin expands during pregnancy, just like with weight gain, losing elasticity. Most times, the skin does not return to its former degree of tightness,” says Dr. Saltz. Minimally loose skin can be treated noninvasively to create new collagen. “When there’s significantly loose skin, it needs to be surgically tightened, removing the excess. Surgery doesn’t improve the physical quality of the skin we simply get rid of anything that’s extra that may not be ‘fitting‘ the body properly,” says Orlando, FL, plastic surgeon Armando Soto, MD.

The Benefit of Fat
It may seem strange to add fat to your body but in the case of volume toss or contour irregularities some doctors feel fat is the best way to correct the problem. “It sounds counterintuitive that fat can make the body look better but in many cases, adding fat to depressed areas can give smoother—looking skin,” says Dr. Soto. “Fat transfer is a good way to add volume–it works well and is permanent. But how the fat is treated [low pressure removal is best] determines how it will survive,” says Dr. Haworth. The Lowdown on Lipo
Before noninvasive treatments and fat-melting devices made their mark on the body-contouring front, Liposuction was the method of choice. While it’s still viewed as the ultimate way to eliminate fat and contour the body, the removed fat can now be used to better the shape of your body by removing it from one area and transferring it to another.

How it Works
Once fat has been suctioned out from the stomach, hips or thighs, your plastic surgeon will strain and wash it with saline, before drying and cleaning it [Dr Saltz says there are more sophisticated methods that include spinning the aspirated fat in a centrifuge or running it through a filtration system]. “If the fat is not rid of any fibers and blood products then more unwanted inflammation will be induced, which will result in more fat resorption,” notes Dr Haworth . From there, the fat is injected into volume-deficient areas. Body fat can also be used to plump up aging areas of the face, too.

Streamline Your Arms
Liposuction is probably the best way to get rid of unwanted fat on the arms. But in order to ensure successful results, the quality of the skin needs to be in good standing. “The more elastic the skin, the better the liposuction results,” says Dr. Haworth. “If there’s too much loose skin in relation to the amount of fat lost, the skin will be left flabby.”