A Smarter Approach to a Slimmer Waistline – Part 2

According to the American Society for Aesthetic Plastic Surgery, liposuction continues to be the number one leading cosmetic surgical procedure in 2016, and has seen a 134% increase in the number of procedures performed since ASAPS initiated in 1997. 1

The demand for body contouring is growing so rapidly and this has sparked many new non-invasive technologies to cater to people who are unsuitable candidates for surgery and downtime.

The devices that are available on the market deliver some form of energy that creates changes in the adipocytes (fat cells), which results in shrinkage, apoptosis or necrosis (fat cell death). Some of the energy sources are:

  1. Laser light
  2. Radiofrequency
  3. Acoustic shock waves
  4. Cold (Cryolipolysis)
  5. High-intensity Ultrasound

Many patients have asked me which method is the best for them, at the moment, there is no gold-standard procedure yet, and the methods highlighted above differ by:

  1. Mechanism of action
  2. Response rate
  3. Side effects
  4. Level of discomfort
  5. Number of treatments required


In Malaysia, to date, the top two non-invasive body contouring technologies being used are:

  1. Cryolipolysis – COLD
  2. Radiofrequency – HOT

Freeze the Fat


The device for cryolipolysis has an applicator which is applied to the targeted treatment area, allowing tissue to be vacuumed up between 2 cooling panels for 30 to 60 minutes per treatment session. The current FDA-cleared market leader for cryolipolysis is CoolSculpting by Zeltiq.

An early animal study showed that subcutaneous fat exposed to cold had nearly 80% reduction in fat layer and temperature of -5 to -7 celcius had higher possibility of fat damage after 28 days.2

Some of the temporary side effects with cryolypolisis:

  1. Erythema (redness of skin)
  2. Bruising from the vacuum hand piece
  3. Clay-like skin
  4. Pain
  5. Nodular or diffuse infiltration at treatment area

This would be an ideal method to use for smaller, defined fat accumulation areas where one can benefit from shorter and fewer treatment sessions which will mean time and cost savvy!

Heat the Fat

There are various types of radiofrequency (monopolar/bipolar) device that can be used for body contouring. Heat generated by the radiofrequency device at the adipose tissue can cause apoptosis (cell death) of the fat cells.

Personally, I’ve always been more on the team ‘HOT’ because I find treatments using heat more comfortable, therefore in the past years I have tried many radiofrequency devices as part of body contouring regime, but what caught my attention in 2014 was Vanquish ME by BTL Aesthetics. The first non-contact radiofrequency machine that selectively targets fat cells and has minimal effect on other surrounding tissues.



The applicator is placed 1cm above the skin of targeted treatment area and duration of one treatment session is about 45 minutes.

Recommended treatment sessions depend on the targeted circumferential loss, but generally, 4-6 sessions can result in a reduction between 4-8cm in abdominal circumference.

Some of the temporary side effects:

  1. Erythema (redness of skin)
  2. Tenderness
  3. Panniculitis – (localised volumes of fibrosis-encapsulated fat)

Vanquish would be ideal for large body area in patients with high BMI, ie>25 as a single application can easily cover the abdomen and flanks (love-handles) bringing it close to competing with liposuction for those not willing to undergo surgical procedures. 3

In conclusion, there is no ‘one-method-fits-all’ when it comes to achieving that slimmer waistline. Different people have different targeted treatment areas and fat volume, therefore a full and thorough assessment is crucial to ensure treatment regime are the most optimal!


  1. International Society of Aesthetic Plastic Surgery. Global Statistics. Available at: http://www.isaps.org/news/isaps-global-statistics.
  2. Manstein D, Laubach H, Watanabe K, et al. Selectivecryolysis: a novel method of non-invasive fat removal. Lasers Surg Med. 2008;40:595-604.
  3. Chilukuri S, Mueller G. “Hands-Free” Noninvasive Body Contouring Devices: Review of Effectiveness and Patient Satisfaction. Journal of Drugs in Dermatology. 2016;15:11:1402-1406.

A Smarter Approach to a Slimmer Waistline ~ Part 1


“Lose the belly FAT and you will look FAB!”

“Oh he has a belly, he surely is married!”

Do you notice how much attention we give to the fat around our abdomen (tummy)?

In some certain way, a little stigma is somehow related to having that excess fat around the waist.

The subject of fat loss and body contouring have somehow always been brought up in my consultations since day one.

The patients who come to see me usually have already exhausted their options at achieving the ideal figure. Some have spent countless hours at the gym combined with healthy food options or diet supplements and despite all that, their love-handles remained the same.

Through the years, we discovered that when it comes to weight loss, the “one approach fits all” practice, does not actually fit it all.

We are of different genetic backgrounds with different lifestyle and eating habits and different daily calorie intake requirements.

Identical twin studies have proven that between 30% to 50% of the variation in human weight is due those factors.

Surely a multidisciplinary approach tailoring to individuals would be an ideal method for efficient weight loss.

So…what do we need to analyze?

  1. Nutrition

That input…can stay put!

Nutrition is the basis for all human form and function, the source of fuel that provides energy for all biological work.

Our weight is determined by the energy balance – if energy intake exceeds output, the excess calorie will then be stored in our body, therefore the weight increases.


A well-balanced nutrition is much desired and the understanding of one’s minimal daily calorie intake requirements and the energy expenditure used can prevent from rapid fluctuations in body weight.

Some studies show that vigorous-intensity aerobic exercise (with caloric restriction) do not lead to a preferential loss of abdominal fat and there are more practical exercises that can be prescribed to ensure higher patient compliance [1].

Choose a fun and enjoyable activity to increase that energy expenditure and make it a consistent routine!

Without commitment, you’ll never start.

Without consistency, you’ll never finish.

2. Hormones

Since early 1990, physiologists have discovered a ‘still-growing’ list of hormones (aka gut-brain peptides) and pathways that control short- and long-term appetite and body weight. The interactions of these hormones in the body, play a major role in overall body weight, and not forgetting that as we age, the fluctuation in hormones make it harder for one to lose that excess fat.

There is enough evidence in the existing literature for the association between increased abdominal adiposity and insulin resistance.

People with low DHEA levels, women with PCOS (Polycystic Ovarian Syndrome) and men with low testosterone will find that their efforts at losing weight especially around the abdomen can be a losing battle.

Therefore, a full blood and hormone profile are highly recommended to ensure proper diagnosis and optimal treatments are prescribed.

3. Lifestyle


There have been studies to show that excess sedentary time is associated with increased accumulation of central adiposity and other markers of cardiometabolic risk. [2]

In one survey in the USA, 65% of the population claimed to live an active lifestyle, however when people’s level of activity was actually measured, research shows only 5% of the population is living an active lifestyle [3].

In part 2, I will share on how non-invasive medical devices can assist you to go from belly fat to belly flat…stay tuned!



  1. Nicklas, B. J., Wang, X., You, T., Lyles, M. F., Demons, J., Easter, L., … & Carr, J. J. (2009). Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight.
  2. Wijndaele K, Healy GN, Dunstan DW, Barnett AG, Salmon J, et al. (2010) Increased cardiometabolic risk is associated with increased TV viewing time. Med Sci Sports Exerc42: 1511
  3. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometerMed Sci Sports Exerc 40: 181–188, 2008.



Health & Beauty has always been a hot topic among women and even men these days.

As a doctor who is currently practicing aesthetic medicine, I believe that this field is an ever-growing field and it is always exciting to learn new techniques and technologies being created that can be applied in this line.

With the rapid developments, many people may find the countless options available overwhelming, therefore it is essential to have full information to ensure treatments administered are safe and effective.

I hope via this blog, I can connect with those who are passionate about health & beauty and hopefully able to share some useful medical information along the way!

If you have any further queries, feel free to drop me an email at nurulain@alainnclinic.com