Body
What is Body Contouring?
Body contouring is an umbrella term for procedures intended to change body shape. The right category depends on whether the goal involves fat, loose skin, muscle definition or added volume. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, compares surgical, minimally invasive and noninvasive approaches.
In this episode.
Episode summary
Body contouring is an umbrella term for procedures intended to change body shape. The right category depends on whether the goal involves fat, loose skin, muscle definition or added volume. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, compares surgical, minimally invasive and noninvasive approaches.
He also explains two terms patients may encounter: high-definition liposuction and contouring after substantial weight loss. These labels describe different goals and do not identify one standard operation.
Key takeaways
🔬 Skin-removal surgery addresses excess tissue.
The episode includes tummy tucks, arm lifts, thigh lifts and lower body lifts, with different incision and recovery tradeoffs.
🔬 Liposuction and fat grafting serve different purposes.
Liposuction removes localized fat; fat grafting transfers a person's fat to add volume elsewhere. Both require a procedure-specific assessment.
⏳ Skin elasticity affects the plan.
Dr. Smith explains why removing fat does not automatically address loose skin and why selected cases may prompt discussion of additional treatment.
🔬 Noninvasive devices target different tissues.
The recording discusses fat freezing separately from the muscle-conditioning goal of original Emsculpt. Device treatment is not interchangeable with surgical skin removal.
🔎 Contouring after major weight loss can be more extensive.
Substantial excess skin may require an operation designed for its location and distribution, rather than assuming a small-incision treatment will suffice.
Questions this episode answers
What does Lipo360 mean?
Dr. Smith describes it as a broad term often used for liposuction around the torso. He prefers naming the exact areas, such as the abdomen, flanks or portions of the back, so patient and surgeon agree on the treatment plan.
Can liposuction remove loose skin?
Liposuction targets fat. The recording emphasizes evaluating skin elasticity and the amount of excess skin separately. Some patients may need a different or additional procedure to address that concern.
ℹ️ Current context for this 2020 recording
The discussion includes buttock fat grafting, or BBL. Small incisions do not imply low risk: an ASPS-led joint safety statement highlights serious risks, including fatal fat embolism, and supports real-time ultrasound and fat placement above the muscle. These measures do not eliminate risk. The episode's device preferences and comparisons are historical opinions, not guarantees of superiority or current treatment availability.
🔗 Related information
Explore body-contouring procedures, liposuction, tummy tuck surgery, or request a consultation with Dr. Smith in New York City.
Originally released September 10, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Original show notes
New options to enhance the shape of your body seem to be appearing at an ever-increasing pace. Board certified NYC plastic surgeon Dr. Darren Smith offers an overview of the constantly evolving world of body contouring.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon Dr. Darren Smith and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures news about trends in aesthetic medicine and candid sessions with industry insiders. We hope you enjoy today's episode. What is body contouring? This is a term that gets thrown around a lot so I just wanted to take a little while to go through exactly what body contouring is and also to describe the various procedures that are available that fall under this bigger umbrella term. So a straightforward definition of body contouring is that a body contouring procedure is a procedure that is designed to change the shape of your body.
[00:57] There are several categories of body contouring and these are surgical procedures, minimally invasive procedures which are surgery but tend to have much less scarring and much less downtime and recovery than surgical procedures, non-invasive procedures, and finally there are two special categories of body contouring that we'll cover at the end and those are high definition body contouring and body contouring procedures after massive weight loss. So surgical procedures are exactly what you are imagining they are. They involve incisions and usually general anesthesia, which means that you are completely asleep and you're breathing with the help of a machine and you'll wake up a few hours later and you'll have had your procedure performed. Common examples of surgical body contouring procedures include tummy tuck or abdominoplasty, an arm lift, a thigh lift, and also things like a lower body lift. And what all of these procedures have in common is that they tend to be the most powerful option available to change the shape or the contour of the part of the body.
[02:13] under consideration. So for example, with a tummy tuck, we can remove a great deal of excess skin, treat excess fat, and also tighten the abdominal muscles to treat erectus diastasis. Similarly, with an arm lift and a thigh lift, we are removing the most amount of excess skin possible with these surgical procedures. So while they do tend to have the most scarring, the most downtime, and the most cost associated with them, They also tend to be the most definitive options available for a given body area. Minimally invasive body contouring procedures are technically surgical. However, they require only very small incisions, usually three to four millimeters in length. They tend to have a very straightforward, more comfortable recovery than surgical procedures with a lot less downtime.
[03:10] and they also often are less expensive than their maximally invasive surgical counterparts. The other thing to know about minimally invasive procedures is that they can often be performed under other local anesthesia which is where you are wide awake but you have numbing medicine so you are feeling only minimal if any discomfort and also twilight anesthesia, which is where in addition to numbing medicine, you have some IV medication to relax you, but you really are a lot less concerned with what's going on. And with these options, where you're not completely asleep, as with general anesthesia, the process right after surgery, the recovery, is often faster and more comfortable.
[04:01] So there are three subsets of minimally invasive body contouring procedures, and they include liposuction, fat grafting, and skin tightening. So liposuction, and we've discussed this in other episodes, is a procedure in which we make a series of very small incisions, insert a long thin instrument called a cannula and still... numbing medication into the treatment areas and then come back and suction The fat out of the treatment area to achieve the desired shape one kind of liposuction that deserves special mention here is lipo 360 or 360 lipo and This is a term that in my opinion isn't a great one to use because it's just too vague but what it usually implies is liposuction of the entire torso, the front, the sides, and the back, or all 360 degrees. The reason I don't love this term is that I think that we need to be very specific in talking about the areas that we're treating with liposuction so that the surgeon and the patient can communicate goals and desires very clearly with one another to make sure that we're achieving the desired outcome. So instead of saying liposuction 360, I prefer to break this down into its component parts such as liposuction of the abdomen, liposuction of the flanks, and liposuction of the upper back or the lower back or the axilla or bra roll. So just a little word on terminology there. The next category of minimally invasive body contouring is fat grafting.
[05:46] And while the goal of liposuction is to remove fat in areas that it's not wanted, the goal of fat grafting is exactly the opposite, and that is to increase volume with fat in areas as desired to improve body contour or body shape. And the two most popular areas for fat grafting in body contouring are the breasts and the buttocks. And fat grafting for the breasts can be used on its own to increase breast volume or in combination with breast implants to achieve certain shapes. Specifically, fat grafting is often combined with breast implants to achieve an increase in upper pole volume. and the upper pull of the breast just as a reminder is the portion of the breast that is above the nipple areolar complex and the lower pull of the breast is the portion of the breast that is below the nipple areolar complex. So when we put an implant into the breast unless we're using a teardrop or anatomic implant and we discuss the differences between these two in an earlier episode with a round implant where more or less adding equal amounts of volume to the upper and lower pull of the breast. So if we want to selectively add volume to the upper pull of the breast, we can do that with fat grafting. And then the other very popular area for fat grafting is the buttocks. And this procedure is often called a Brazilian butt lift. And in this procedure, we are taking fat from elsewhere in the body and using it either to enhance the size of the buttocks or to give them a more pleasing rounder shape or in some cases to achieve both of these goals and fat grafting is a relatively straightforward procedure to perform and with this procedure we are harvesting fat with liposuction and then processing it to remove any excess lipids or blood or anesthesia fluid that we don't want to be re-injecting as part of the graft and then making essentially a paste out of the harvested fat cells that have been purified and then reintroducing that fat into the treatment area.
[07:58] And while fat grafting is relatively technically easy to perform, there is a lot of nuance and artistry that goes into achieving truly excellent results with this procedure. The last category of minimally invasive body contouring that I'd like to cover is skin tightening. And skin tightening technology is important because liposuction really is only a fat reduction procedure. It does not do anything to shrink the skin itself. And an analogy that I like to use here is that of a balloon. So if we think of the treatment area that we're targeting with liposuction as a balloon, if we go and remove a small amount of air from a balloon, the outside of the balloon, that plastic shell, will contract to a certain degree and everything will look just fine. But if we go and remove a lot of air from that balloon, the outside of the balloon will not be able to keep up in terms of how much it contracts and it'll start to look rippled and wrinkled and may start to droop. And the same thing is true in liposuction. So in that analogy, the air that we're removing from the balloon is fat and the rubber shell of the balloon is skin. And just like the balloon, if we remove a small amount or of fat from the treatment area, the skin can contract and you'll do just fine. But if we're removing large amounts of fat...
[09:23] the skin sometimes can't keep up, it can't contract enough. So you will get this kind of wrinkled or rippled or even deflated appearance. And really the amount of fat that we can remove without having that skin appearance largely depends on the skin elasticity, which has to do with a lot of individual health factors that range from age to smoking status. And this is a really important part of your evaluation with a body contouring expert. They'll be able to help you decide if you will have good enough skin elasticity to have liposuction without a skin tightening procedure at the same time. And they'll do that based on physical exam and also taking your health factors into account. So if it is decided between you and your surgeon that you're someone that if you remove a significant amount of fat, your skin may not be able to contract enough to get a great result, then you will be looking at these minimally invasive skin tightening procedures and there are several of these available that we've discussed in other episodes but the moral of the story here is that in general they involve the introduction of some kind of instrument through one of the tiny liposuction incisions and using that instrument to pass some kind of energy to the skin to generate heat which causes skin contraction and as I've mentioned in the past of all the available devices the one that I think works the best and that I use very frequently in my practice is body tight which is a bipolar radio frequency skin tightening device and I find that this does deliver very consistently excellent results for skin tightening in conjunction with liposuction.
[11:08] So that wraps up our discussion of minimally invasive body contouring techniques. So we can now move into non-invasive procedures and non-invasive body contouring procedures can more or less be divided into fat reduction procedures and muscle building procedures. The fat reduction procedures have been around for a bit longer than the muscle building procedures and the basic principle with the non-invasive fat removing procedures is that they use a applicator that will apply some kind of external stimulus that will pass through the skin and selectively affect fat cells to cause them to die, resulting in a reduction of fatty volume. Of all of these fat reduction procedures, the most widely known is probably CoolSculpting.
[12:00] And for reasons that I went through in an earlier episode, I do think that of the non-invasive fat reduction procedures, CoolSculpting is the best. However, these non-invasive fat reduction procedures really in general don't hold a candle to minimally invasive fat reduction procedures as they just don't have the same kind of precision or efficacy as these procedures. But for individuals that either can't have surgery or just very opposed to having surgery, these non-invasive fat reduction procedures like CoolSculpting can be a reasonable option as long as these treatments are designed by a true body contouring experts that understands the limitations of this technology and the best way to apply it. In terms of the other category of non-invasive body contouring procedures, we have muscle building treatments and these are a bit newer to the scene and the original non-invasive muscle building procedure is Emsculpt.
[12:56] And this is really the non-invasive muscle building procedure by which all other technologies in this genre are judged. And what Emsculpt does is use HIFEM, H-I-F-E-M, or High Intensity Focused Electromagnetic Energy, to create supermaximal muscle contractions or muscle contractions that are much more powerful than anything you could produce through voluntary exercise. and it induces up to 20,000 of these contractions in a 30-minute period, and this causes muscle growth by both hypertrophy and hypoplasia. So in hypertrophy, the muscle cells themselves are getting larger whereas in hyperplasia you're actually creating new muscle cells. So as a byproduct of this treatment you actually do burn a little bit of fat in the local treatment area but the main goal of Emsculpt and these non-invasive muscle building procedures is to build muscle.
[13:59] And before we get to the end of this episode, I wanted to touch on two special categories of body contouring. The first is high definition body contouring or high definition lipo. And the second is body contouring after massive weight loss. In brief, high-definition lipo or high-def lipo or high-def body contouring is essentially a marketing term that was developed to describe the use of liposuction instruments to create the appearance of specific anatomical contours as part of a liposuction procedure. So instead of reducing fatty volume with liposuction high-definition lipo, in addition to reducing that fatty volume, will often attempt to create the cuts or lines that are associated with muscle development. So high-definition liposuction can actually be used to create the inscriptions in the rectus diastasis to give the appearance of a well-developed six-pack.
[15:08] And while a true expert at this technique can create something that approximates the appearance of a well-developed six-pack using high-definition liposuction, in my opinion, it usually looks unnatural even at rest. And then as soon as you start to move your abdomen, if you bend at your waist or otherwise exert your core, I do think the appearance of these results of high-def liposuction do tend to look a bit unnatural. So it's important before you embark on one of these procedures that you look at a lot of before and after pictures to make sure that the result that can be achieved is something that is in line with your aesthetic goals. The second special category of body contouring that I wanted to touch on here is body contouring after massive weight loss.
[15:58] And massive weight loss by most plastic surgeons is considered a decrease in weight by at least 100 pounds, and this is often accomplished with the use of bariatric surgery procedures like a gastric bypass or a gastric band, but sometimes can be achieved with diet and exercise. with massive weight loss there is a dramatic decrease in the volume of fat and just like with our balloon analogy from earlier this skin has a very hard time contracting enough to keep up with this decrease in fatty volume so individuals that succeed in losing a great deal of weight often have a lot of skin excess and this degree of skin excess far exceeds anything that can be treated effectively with the minimally invasive skin tightening methods that we discussed earlier, and really require not only the standard surgical techniques that we went over earlier, like a tummy tuck, but they often require truly advanced surgical skin excision procedures and these might include things like extended arm lifts and various kinds of thigh lift or lower body lift or a floor to lie abdominoplasty, which is a tummy tuck that involves both a vertical and horizontal incision to allow for skin excision in multiple dimensions. So before considering having body contouring after massive weight loss, it's important that you go to someone who is truly expert in these procedures. So hopefully this overview of body contouring has been helpful and it allows you to make more informed decisions as you embark on your own body contouring journey. Thanks for listening and don't forget to subscribe, share the show, and head over to darrensmithmd.com for more real-world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-09-10. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS