The Best Surgical and Nonsurgical Fat Reduction and Skin Tightening Procedures for Every Trouble Spot

We asked plastic surgeons to outline the best surgical and nonsurgical fat reduction and skin tightening treatments for every trouble spot.

With unparalleled transformative powers, fat reduction and skin tightening treatments yield some of plastic surgery’s most stunning before-and-afters. The more mind-bending changes we’ve seen are almost too surreal to process (you’re gonna wanna hit that link before reading on). 

So it’s no surprise that two gold-standard sculpting operations, liposuction and the tummy tuck (aka abdominoplasty), consistently rank among the top five surgical aesthetic procedures, according to annual statistics reports from The Aesthetic Society. As noninvasive fat reduction technologies—machines that shrink bulges less dramatically than surgery but without incisions and downtime—have multiplied and evolved over the past decade, they too have dominated the charts, most recently claiming the number four spot among nonsurgical treatments for 2019.

There’s also a burgeoning category of happy-medium type tools that melt fat and tighten tissue when used on their own or in conjunction with liposuction. Classified as minimally invasive, they work under the skin but don’t require lengthy cuts or garner obvious scars.

How do I choose between surgical or nonsurgical fat-removal treatments? 

As the contouring realm has expanded, the landscape has gotten increasingly trickier for patients to navigate. Beyond sussing out what’s what and what actually works, there’s the all-important question of: What’s best for me—my body, my goals, my lifestyle?

“This is one of the reasons that an in-person consultation is so crucial—it helps us determine whether someone is a better candidate for surgical or nonsurgical body contouring,” says Dr. Camille Cash, a board-certified plastic surgeon in Houston. “It allows us to clearly understand the patient’s goals and to physically assess their anatomy and skin quality, to give a realistic idea of what they can achieve through each approach.” 

While Dr. Cash has seen an uptick in folks seeking noninvasive body-sculpting treatments, she says that patients are often surprised to learn that surgical contouring solutions, like liposuction, may be a better fit for their busy lifestyles, “since they’re one-and-done options [and don’t] require multiple visits to achieve significant and predictable results.” 

According to Dr. Charles Galanis, a board-certified plastic surgeon in Beverly Hills, California, the nonsurgical body contouring contender fits a very specific profile: “If someone is looking for just a subtle change to a specific, targeted trouble spot and they don’t want to take time off [to recover], go under anesthesia, or have incisions—that’s your nonsurgical patient.”

Ultimately, anatomy trumps all, and certain aspects of it—namely, drapey skin and stretched or sagging muscles—can immediately take nonsurgicals out of contention.

We asked plastic surgeons to outline the best surgical and nonsurgical fat reduction and skin tightening methods for top trouble spots. While every case is different and influenced by myriad “uniquely you” variables, we hope this serves as a useful roadmap for your body contouring journey.  

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Trouble spot: submental (or under-the-chin) region

The rise of jawline sculpting has thrust the chin—and what lies beneath—into the spotlight. “It’s amazing what a tablespoon of fat [in this region] can do for a patient’s jawline and confidence,” says Dr. Galanis. And there are many ways to target that tablespoon. 

However you go about it, it’s important to prioritize chin projection when contouring the area, he adds, building it out with a chin implant or filler, when necessary, to enhance facial harmony.

Best nonsurgical treatments: Kybella, CoolMini, Evoke 

When Kybella debuted in 2015, the fat-digesting injectable was heralded as a game-changing alternative to liposuction. While it certainly works—and there are numerous studies to prove it—“it takes multiple treatments, it’s not without pain and swelling, and the total cost often ends up being not too far off from that of a one-and-done liposuction procedure,” Dr. Galanis says. 

CoolSculpting makes an under-the-chin attachment called the CoolMini, which kills fat cells via freezing to improve the profile. Company studies show that a single round can reduce fat in the area by about 25%, but results take several months to show, since the body first has to break down and flush out crystallized fat.

While “Kybella is intended for smaller amounts of fat, mainly in the central submental area, CoolSculpting can be used to debulk fuller necks that have excess fat extending laterally,” beyond that A-shaped pocket directly under the chin and into the jowls, says Dr. Umbareen Mahmood, a board-certified plastic surgeon in New York City. Kybella is more limited, because injecting it into the jowls risks injury to the marginal mandibular branch of the facial nerve, which helps to move the lower lip.

Having a moment on Instagram right now is a new no-downtime device called Evoke, which applies radiofrequency (RF) energy to the lower face and neck, to lift and define. Unlike older noninvasive RF technologies, like Thermage, Evoke is supposed to be pain-free.

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Best surgical skin tightening treatments: submental liposuction, FaceTite, neck lift 

Using three tiny entry points—under the chin and behind each ear—surgeons can slide a liposuction cannula along the jawline, chiseling it out in a precise and predictable way, in about 30 minutes. “Patients are typically awake during the procedure and have only a few days of downtime before they’re back, doing their thing,” says Dr. Galanis.

“Treatment with liposuction alone results in a degree of skin retraction under the chin,” explains Dr. Mahmood, “but for those who have persistent minor skin laxity, nonsurgical technologies such as Ultherapy or Thermage [which deliver heat through the skin’s surface] may be good follow-up treatments.” 

Dr. Cash has had success sculpting the jawline, neck, and chin with FaceTite, a minimally invasive instrument that uses RF to destroy small pouches of fat while firming things up a bit. 

If a slouchy platysma muscle is contributing to one’s wattle, surgeons generally recommend a neck lift, in which redundant skin can be tailored out through incisions around the ears and drooping muscles can be resuspended, for a more youthful, streamlined look.

Trouble spot: arms

“The arms are a common trouble spot—even for those who are in great shape,” says Dr. Galanis. “As with fat in any part of the body, some of this is genetically predetermined.”

That pendulous tissue obscuring the triceps is generally a confluence of pinchable fat and sagging skin. “Noting the degree of skin laxity here is one of the most important factors when sculpting the arms,” says Dr. Mahmood, as this steers doctors to the most appropriate fix.

Best nonsurgical fat reduction treatments: CoolSculpting, Vanquish, Emsculpt, CoolTone, Evolve

Dr. Mahmood prefaces all talk of upper-arm treatments by explaining that “nonsurgical technologies use an overall fat-reduction approach—they cannot define the musculature, in addition to debulking the arm, in the same way a skilled surgeon can with liposuction.” 

If you’re cool with that, several devices can treat upper-arm jiggle. Some, like CoolSculpting and Vanquish, take aim at fat alone; others, like Emsculpt and CoolTone, focus primarily on building muscles with electromagnetic energy, to sculpt the arms. The Evolve device, which Dr. Cash says is “one of the most popular procedures” in her office, can tighten skin and melt fat with RF energy and tone muscles with electrical pulses. 

As a rule, nonsurgical body contouring gadgets require a series of treatments, and “the results will rarely, if ever, match surgical outcomes,” notes Dr. Galanis.

Related: Thinking About Arm Liposuction? You Might Need This Procedure Too

Best surgical fat reduction treatments: liposuction with RF skin tightening (BodyTite or Renuvion), arm lift 

In Dr. Galanis’s office, “the arm lift is not entirely but almost exclusively reserved for patients who’ve had massive weight loss and have skin that is completely draping very low,” he says. 

The reason it’s not his go-to for garden-variety “bat wings” is primarily because “the scar can run the entire length of the upper [inner] arm, from the [armpit] to the elbow—and [this area] has a high incidence of hypertrophic scarring, meaning the scar often gets thick and unsightly,” he says.

For the majority of patients aiming for slimmer upper arms, he adds, “the ideal approach is usually a combination of fat removal—Vaser to break up the fat and liposuction to remove it—and some modality to stimulate skin tightening.” Dr. Mahmood seconds this statement, noting that traditional suction-assisted “liposuction alone will likely not be sufficient if the patient has moderate to severe skin laxity, as the arm skin will not retract adequately after lipo.”

Younger folks with decent snap to their skin and no stretch marks (a sign of laxity) may be able to get away with lipo alone, she adds. 

Radiofrequency-based skin tightening tools, like Renuvion and BodyTite, have become popular adjuvants to lipo. While not always essential, “they can take you from a good result to a really good result,” says Dr. Galanis. After removing fat, surgeons insert a RF-emitting cannula into the same incision they used for lipo and deliver heat along the underside of the arms, to boost collagen and contract the skin. 

“Every body contouring surgeon is going to have different technologies that they prefer,” Dr. Galanis points out. While he’s loyal to Renuvion, Dr. Cash leans on BodyTite. “I’m using it in conjunction with liposuction more and more frequently, to tighten the skin envelope and underlying connective tissue,” she says. “BodyTite studies have shown a reduction in the vertical hang of the arms of up to 50%.”

Trouble spot: abdomen

“When rejuvenating the abdomen, you really have to pay attention to all the different layers—skin, fat, and muscle—because each of them may be playing a part,” Dr. Galanis says.

During consultation, your surgeon will take a thorough history, inquiring about major weight fluctuations, which frequently leave skin loose and scarred, and previous pregnancies, which can do the same while also altering the structure of the abdominal muscles. They’ll then assess the elasticity of the skin, check for stretch marks, and evaluate the abdominal muscles by having patients lie flat on their back and lift their ankles into the air or raise their head and shoulders as if doing a sit-up. “This maneuver will accentuate the rectus diastasis [or muscle separation] and allow me to check for hernia,” says Dr. Cash. Muscle damage may present as an obvious bulging or a gap between muscles that can be felt upon palpation. “The exam may be more limited in patients who have a higher BMI and a thicker fat layer on their abdominal wall,” she notes.

Best nonsurgical treatments: CoolSculpting, Emsculpt, CoolTone, Evolve

All the previously discussed nonsurgical devices, such as CoolSculpting, Emsculpt, CoolTone, and Evolve, can subtly trim belly fat in a series of treatments. 

Beyond fat reduction, two technologies also show potential for muscle repair. In a company sponsored study, Emsculpt was found to reduce the thickness of fatty tissue by 18.6% on average, two months after four treatments, while toning muscles. The study’s authors noted a 10.4% reduction in abdominal muscle separation. According to Dr. Cash, the company behind Evolve is currently investigating the device’s electrical muscle stimulation treatment as a potential remedy for rectus diastasis in postpartum women.

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Best surgical treatments: liposuction with RF skin tightening (BodyTite or Renuvion), tummy tuck 

“Despite all the advances in nonsurgical body contouring,” says Dr. Cash, “liposculpting continues to be the gold standard for precision and large-volume fat reduction.” Doctors can often flatten a paunch with a one-two punch of ultrasound-fueled Vaser liposuction and RF tightening. But when unwanted fat is compounded by lax muscles and/or folds of flaccid, stretch-marked skin, an abdominoplasty is the surest path to a tight, sculpted stomach—“either a mini tummy tuck, which focuses on the lower abdomen, or a full tuck, which addresses the entirety of the abdomen,” says Dr. Galanis.

Trouble spot: back

A common storage site for fat, back rolls can sabotage an otherwise stellar silhouette, says Dr. Galanis. “In the lower back and flanks, fat can affect the waistline, [muddling] the waist-hip transition.” In the upper back, he adds, it can make the bra line look lumpy. The good news? The skin of the back is thick and springy and rarely requires surgical tailoring.

Best nonsurgical treatments: CoolSculping, WarmSculpting with Sculpsure, Vanquish, Kybella

CoolSculpting, WarmSculpting with SculpSure, Vanquish—the majority of temperature-driven fat-squelching machines are made to work on bra rolls and love handles, gradually thinning out the fat layer over time, with repeat treatments. Kybella can also help “target small focal areas of fat,” says Dr. Mahmood, and is routinely used off label for bra rolls and axillary fat—that pinchable bulge between the armpit and breast. However, she adds, because fat on the back is rather firm and the dermis quite thick, noninvasive tools don’t always produce home run results. 

Best surgical treatments: FaceTite, liposuction, back lift 

To liquefy a modest amount of fat and give a bit of tightening at once, Dr. Cash relies on the FaceTite device, which she says is ideal for treating small, stubborn bulges on the body, like those that crop up along the bra line and the area adjacent to the armpits.

When going after larger quantities of fat on the back and sides, lipo is standard protocol. “With power-assisted lipo or Vaser lipo, we can more easily break up the fibrous fat, and since the skin of the back is thick, it retracts well with liposuction,” says Dr. Mahmood. 

RF skin-tightening devices can be used in tandem with lipo, but “we can get pretty great results even without RF, because the skin of the back tends to be higher-quality,” adds Dr. Galanis. 

Rarely, older patients or those who’ve quickly shed a ton of weight (usually due to bariatric surgery) may contend with lax skin on the mid-back. For these folks, “there is something called a bra-line back lift, where a wedge of skin is taken out.” The incision is made to follow the average bra line and can usually be well hidden under a bra or bikini top.

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Trouble spot: thighs

While we tend to talk about the upper leg as a singular unit—the thigh—surgeons regard its inner and outer aspects as two totally different entities. The skin of the outer thigh is thick and elastic, and the fat underneath is “very fibrotic and resistant to treatment with diet and exercise alone,” explains Dr. Mahmood. “These unique characteristics make the area more vulnerable to contour deformities with all types of treatments, both surgical and nonsurgical. I’ve seen what we call ‘shark bite’ deformities of the outer thighs, from both CoolSculpting and liposuction.”

When carefully treated, however, the skin here snaps back nicely once relieved of fat. The inner thigh skin is “thinner and looser and doesn’t retract well on its own,” Dr. Galanis notes.

Best nonsurgical treatments: Kybella, CoolSculpting 

Slow and steady use of fat-obliterating injections (Kybella) and devices such as CoolSculpting can streamline saddlebags on outer thighs and help carve out an inner thigh gap, if that’s your goal. (This would be an off-label use for Kybella.) Since the thighs are notoriously tricky to contour, you’ll want to seek out a board-certified plastic surgeon or dermatologist who’s had success getting smooth results with whatever technique you choose and can manage slack inner-thigh skin after the fact, if need be.

Best surgical treatments: liposuction with RF skin tightening (BodyTite or Renuvion)

Surgeons tend to prefer treating thighs with liposuction (plus RF tightening on the insides), as “it allows for more control and finesse over the contouring and how much fat we’re removing,” says Dr. Mahmood. The procedure must be well-executed to prevent lumpy, uneven outcomes.