Positively Skin Newsletter

All About Body Contouring

Struggling with body fat in unwanted places? This time of year can bring frustration as you sift through your wardrobe trying to figure out what to wear. For those who saw their face in a different light due to video conferencing, Zoom meetings, and selfies, the double chin might be even a bigger nemesis. It’s difficult to hide and easy to get fixated on once you realize it’s there. Both men and women struggle with these issues, and as you age, even diet and exercise may not resolve it.

Types of Body Contouring Treatments

It wasn’t long ago that liposuction was the only option, but now we have more sophisticated liposuction techniques, non-invasive devices that destroy fat cells, via ultrasound or freezing, and, an injectable solution.

Liposuction is Still the Most Effective Solution

We want to start here, not to discourage other options but get straight to the point.  Liposuction works. It’s why it is still one of the most performed cosmetic procedures today. Why? A larger volume of fat can be removed, the area can be sculpted more seamlessly, and there will be a visual difference immediately.  It can also treat more areas than its non-invasive counterparts. The chin/neck is a great area to treat this way and can be really satisfying for patients wanting a more contoured, youthful neck. The most popular areas are upper, lower abdomen, “love handles,” back, bra area, and the thighs. Any areas that has the right kind of subcutaneous fat can be treated as long as there is enough.

How Does Liposuction Work?

The most popular form of liposuction is tumescent liposuction. Tumescent means a solution is used to inflate the area, followed by an instrument called a cannula to remove the fat via suction. The solution is a mixture of sterile water, anesthetic, and medication to constrict blood vessels. This allows for a safe, pain free treatment. It is not necessary to put patients to sleep for this procedure. You can expect to be up and around immediately, then back to work in a few days. There can be soreness, and bruising but the solution administered will help minimize bruising. Like all procedures there can be some variables from patient to patient, but all of this will be discussed in your pre-op appointment.

 The Most Common Question: Will The Fat Come Back?

The answer is yes and no. We are all born with a fixed number of fat cells. Liposuction removes cells permanently in the treated area so they cannot come back however some cells can still remain. The rest of your fat cells grow larger if you gain weight. You will have less expansion of cells in the treated area with less cells to begin with, but the body has to accommodate for weight gain somewhere.

 Tumescent Liposuction in Dermatology

Tumescent Liposuction was introduced into dermatology in the 80’s after now well-known dermatologist Jeffery Klein, M.D. invented the technique. It became safer by eliminating general anesthesia and associated blood loss. The size of the cannula has also greatly improved, minimizing to almost eliminating scars. Dr. Michalak was trained by Dr. Klein in the 90’s and has been offering the procedure ever since. It’s important to point out that Dr. Michalak is also a Cosmetic Surgery Fellow in addition to being a board certified dermatologist and MOHS Surgeon. Dr. Klein is still practicing in California.

 Cost Too Benefit Ratio

Cost is usually a factor when patients are trying to make a decision. It’s often compared against the other options available especially when there is a price concern (whatever is less). We wanted to share this, because there are variables when making any decision and every patient is different. Non-invasive treatments like the UltraShape device are GREAT for the right patient. Someone who has a stubborn area like love handles, but is otherwise in good shape, is a perfect candidate. Non-invasive fat destruction has on average 20-25% reduction but there is always a risk it could be less. Liposuction is more effective as we’ve discussed but costlier (not always). To give you an idea of what the cost is, liposuction fees start around 3,500, UltraShape, $1,000. Both treatments vary by size of the treatment area and how many areas are being treated. UltraShape requires 3 treatments on average or more.


UltraShape is a non-invasive device that uses ultrasound cavitation to destroy a percentage of fat cells each treatment. Think about it like applying pressure through ultrasonic vibrations. The pressure is enough to break down fat cells into a liquid form that is then eliminated through your lymphatic system. For the treatment to be successful, it needs to be repeated 3 times and results take about 90 days. Most patients comment on seeing a reduction in inches, this is not a weight loss treatment. UltraShape can be used to treat the abdomen, inner and outer thighs, love handles, back and bra area. We do not use this on the chin. As mentioned this is a great procedure for someone who is the right candidate. Just a few of the reasons are spot reductions, someone averse to invasive procedures, on an active exercise program and wants to accelerate it. Patients often get more motivated as well, especially if they’ve reached a plateau. You will need a consultation to determine if you’re a candidate.  Dr. Michalak offers complimentary UltraShape consultations, and the treatment is performed by Leslie Carney, Licensed Master Aesthetician.


Kybella is a non-surgical solution administered via injection. Fat cells are permanently destroyed gradually in a series of treatments. The solution contains the active ingredient deoxycholic acid, a naturally occurring substance within our bodies that break down fat.

It is FDA approved to treat submental fat of the chin, and has been used to treat other smaller areas on the body off label.

Some important things to know about Kybella: there can be downtime in the form of swelling and tenderness from the injections.  We start with 3 treatments, but it can take more, and seeing results takes time. Of the procedures we offer, liposuction is the most predictable, while Kybella could be the least. A frame of reference for this is that your body has to do the work here, and some bodies do it better than others. For the right patient however, it’s great, just like UltraShape. Dr. Michalak will discuss the pros and cons of all procedures related to your area of concern.

We’ve expanded a second Botox Week, August 9th-13th due to the schedule being full in July. Don’t wait to book it, we’ve been busier than usual this summer.

  • Specials expire July 31st.
  • You can book for the August Botox week now. Spots go fast so don’t wait to schedule.
  • Cannot combine offers
  • Use your Alle account to redeem or build points
  • Must be a patient to purchase skincare

Sunscreen Recall Follow-Up

In last month’s newsletter we discussed the proposed sunscreen recall due to small amounts of the benzene found, mostly in spray sunscreens. 78 Sunscreens were on the list tested by the company Valisure.

Johnson and Johnson announced on July 14th that it is voluntarily recalling select Neutrogena and Aveeno aerosol spray sunscreens out of caution.

The following products are affected:

  • Neutrogena: Beach Defense aerosol, Cool Dry Sport, Invisible Daily Defense, Ultra Sheer.
  • Aveeno Protect: +Refresh aerosol.

We know sunscreen usage is at an all-time high right now. If you’re concerned, we carry EltaMD for the face and body available to all patients.

Give us a call if you have questions or are ready to book!