It's a common refrain in Gia D'Anna's office: Extra inches that childbirth or time left around the middle are resisting diet and exercise.
D'Anna is the office manager for a Lutherville plastic surgeon, and, as a mother, she sympathizes with the patients.
She just got her own flat tummy back last year. Her boss, Dr. Ronald H. Schuster, had bought a machine that aimed to zap muffin tops and love handles via low temperatures. He was looking for volunteers on the staff before he rolled out the service to patients.
"I was not one to do surgery, so when I heard about this, I jumped in," said the 46-year-old D'Anna. "I ate right and worked out, but my belly just wasn't going anywhere."
D'Anna was the first in the office to undergo CoolSculpting, a new procedure that freezes fat cells, which in turn die and pass out of the body over time. Most members of the office staff, including Schuster, now have had the procedure, as well as many patients.
It's one of the latest methods approved by the U.S. Food and Drug Administration to tackle fat. Also on the list are lasers, liposuction and the most aggressive, the tummy tuck. And then there are the old-fashioned gym-based methods many doctors and trainers still prefer for losing belly and flank fat.
Each has advantages and drawbacks, including how much fat is removed, risks and side effects and the amount of personal commitment involved.
Schuster said CoolSculpting was becoming popular because it did not involve surgery or anesthesia. So far, patients have reported only a few minor side effects in studies, such as temporary bruising and numbness. But it only takes off about 20 percent of what the more invasive liposuction would take, meaning it's only for those already relatively fit and looking to get at those last few inches.
"People need to have realistic expectations," said Schuster, standing besides the new CoolSculpting machine one evening after seeing patients.
He pulled back his white coat and untucked his shirt to show how subtle one treatment can be: The small collection of fat formed atop his belted pants was slightly less pronounced on his right side than his left. He planned to give it a second try to see how much of a difference it would make. But, he said of the procedure, "It's not for obese people. It's not for weight loss. But it's a great alternative to liposuction if you just want to fit better in your clothing."
That's what Sherell Vucci wanted. The 52-year-old Ellicott City woman said she was getting "thicker around the middle" as she aged, and no sit-ups or diet seemed to make it budge.
She heard about CoolSculpting and figured she'd give it a try.
Liposuction, in which fat deposits are surgically suctioned out of the body, was too invasive and costly. (That didn't dissuade many others, who made liposuction the third most popular form of cosmetic surgical procedures last year behind breast augmentation and nose jobs, according to the American Society of Plastic Surgeons.)
Vucci came to the office this summer for a treatment. She sat in a chair, and staff attached the wide, flat head of a hose to her belly. Its power came from a boxy gray machine controlled by a computer screen. A fold of Vucci's belly was sucked into the hose, where panels held it firmly for an hour. Her skin grew cold, and then quickly, numb.
When the time was up, the hose release her skin fold and her belly was massaged to break up the crystallized fat.
For a few days, she was bruised and numb. After a month, she hadn't seen any changes in her belly, but she expected a flatter mid-section in another month or two, according to the machine's schedule. If she wants more reduction, she can have the procedure again in the same area.
"It's motivation for me," she said. "I'll continue watching my diet and exercising."
That's what officials with Zeltiq Aesthetics Inc., makers of CoolSculpting, say they hope all doctors are advising patients to do. Fat won't return to the treatment site because no fat cells remain, but weight gain would settle elsewhere and potentially cause a lumpy look. People who gain weight after liposuction experience the same effect.
The procedure was approved by the FDA for love handles in 2010 and for bellies in May, though it's legal to apply the treatment elsewhere, and some doctors had used it on thighs and other regions. It was created after researchers at Massachusetts General Hospital began looking into why subtle dimples formed in the cheeks of children who spent a lot of time eating Popsicles.
The found they could freeze fat cells and not harm skin or other tissue that froze at lower temperatures. No anesthesia would be necessary because cold is often used for painkilling.
More than 100 doctors nationwide have CoolSculpting machines. The company continues studies for safety and effectiveness so it can win FDA approval for thighs, upper arms, buttocks, men's breasts and backs, said Kristine Tatsutani, chief technology officer for Zeltiq, based in Pleasanton, Calif.
"It's really about body sculpting and not about massive weight loss," she said. "It's about taking away an unwanted bulge."
So far, the company has followed hundreds of patients treated with CoolSculpting machines for up to four months, so there is no longer-term information on safety and effectiveness. None had a serious adverse reaction in the time studied, Tatsutani said.
But long-term consequences are what concerns Susan Fried, an obesity researcher at Boston University.
She said some evidence indicates that removing or harming fat cells leads to fat deposits in more dangerous places — say, around organs in the abdomen. That kind of fat increases the risk of heart disease and diabetes.
That issue could also present itself with liposuction or with laser treatments, she said. Cold laser treatments burst fat cells and let fat flow out, potentially causing clots. And heat lasers emulsify fat and can cause burns, she and other doctors say.
She advocated for more old-fashioned methods of body sculpting.
"I think there is danger in all 'fat removal technologies,'" Fried said. "Diet and exercise is the much better approach — boring but known positive effects on health."
And a lot is possible with the right program, said Scott Thompson, a personal trainer at the Maryland Athletic Club in Timonium.
He said those who adhere to a regimen can see results, he said. A good program involves proper diet, regular exercise including weights and aerobic activity, and good sleeping habits. It also takes commitment, Thompson said.
"If they listen to you and really take your advice and own it, then yes, they'll get some results," he said. "It's not magic. People don't put on weight in a month or two, and they're not taking it off in that short of time either. They have to stick with it."
Eating right and exercising are still important for those seeking the aid of technology, say Schuster and Dr. Patrick J. Byrne, a Johns Hopkins University plastic surgeon. They say they turn away those with unrealistic expectations from a procedure and those unwilling to properly care for themselves afterward.
Byrne does not offer CoolSculpting but is considering adopting the technology, after rejecting others that he deemed unsafe or ineffective. Those heat lasers, for example, offer much more room for error than techniques involving cold, he said.
In general, consumers need to ensure that their doctors are properly trained in any procedure, said Byrne, director of facial plastic and reconstructive surgery at Hopkins and an associate professor.
Byrne said a tummy tuck, or abdominoplasty, which removes excess fat and skin, is the most invasive and has the highest chance of complication. It calls for a large incision under general anesthesia and significant recovery. Liposuction requires puncture holes but also sedation, and comes with the potential for infections, fat clots in blood vessels, nerve damage and punctured organs, according to the Centers for Disease Control and Prevention.
Because CoolSculpting is non-invasive, the potential for complications is lower, Byrne said.
Still, only some will be satisfied with the limited fat reduction it offers. They may be those frustrated by their lack of progress in the gym, which he says is sometimes a lack of commitment but is often a result of genetics. Some people just can't get the shape they want without technology, he said.
"Until now there's only been diet and exercise and invasive procedures," he said. "Now there is a third option. It could be a wonderful option for some people."
Losing the extra inches
•Freezes fat cells non-surgically
•About $1,300 for a belly treatment
•Reduces fat by about 20 percent
•Surgically sucks out fat deposits
•Removes most of the bulk in an area
•Surgically removes the most excess fat and skin
•About $7,500 and up
•The most dramatic reduction in body size
•Modest to dramatic reductions
•Varies in cost; involves time and sweat equity
•Varies in outcome
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