In aging people, it is the culmination of a slow process of deteriorating changes occurring interdependently in multiple structural layers in the face: in the skin, in the fat, in the muscle underneath the skin, and in the bony structural support that's holding all that soft tissue. As a result you got a jaw line that is slipping and a pooch under the chin. The melting look is made worse by the accumulation of localized fat under the chin.

In younger people, the appearance of double chin is typically due to excess adiposity all over the body. When they lose weight correctly, losing more fat and preserving lean body mass, the double chin usually disappears.

People who have the genetic predisposition to accumulate fat under the chin, they have double chins despite a lean and muscular physique.

For the saggy double chin seen that usually occurs with aging and for the genetically predisposed to have excess fat under the chin, the best way to deal with it is to liposuction the excess fat. To create a more sculpted look, the excess fat along the jaw line should also be removed and the skin overlying the chin and its contiguous areas tightened by a laser. Laser fiber, threaded into a cannula, is fired sub-dermally underneath the skin to heat up the tissue. Old collagenous bands are melted and ruptured.. An inflammatory cascade ensues followed by neocollagenesis (new collagen formation) and tissue contraction, clinically resulting to a tighter chin and jaw line.

Not everyone is a good candidate for neck liposuction. Most people who have excess fat in the neck are also overweight. Normal neck circumference in women is less than 34 cm (13.4 in) and less than 37 cm (14.6 in) in men. [Obesity Research (2001) 9, 470–477; doi: 10.1038/oby.2001.61]

Neck girths identify risk of obesity. Increasing neck girths increase the risk for obesity-related medical problems.

The best strategy for fatty neck is to lose weight with a sound program of exercise and nutrition. The fat in the neck will go down as weight goes down. When there is still extra fat once body mass index goes down to 30 (BMI=30), then go for liposuction of the neck. At least the bigger picture of obesity-related problems have already been taken cared of first.

Gynecomastia is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly. Boys going through puberty may develop gynecomastia as a result of normal changes in hormone levels. In some cases, gynecomastia can persist through adult life.

Generally, gynecomastia isn't a serious problem, but it can be tough to cope with. Men and boys with gynecomastia sometimes have pain in their breasts and may feel embarrassed. Gynecomastia may go away on its own. The fatty tissue in gynecomastia can be mostly fat or can be mostly fibrous tissue. If it is mostly fat and it persists persists, liposuction will help. If it is mostly fibrous tissue with little fat, liposuction will not help at all. It is imperative therefore to have a mammogram or ultrasound prior to liposuction to determine liposuctionability of the gynecomastia.

Obese abdomen is not a candidate for liposuction. Obese abdomen has fat located inside the abdomen, called visceral fat. It surrounds the internal organs. This is left alone. You can't just go in there and cut out visceral fat. It will be dangerous to do that. However, you can go in underneath the skin to remove the excess fat called subcutaneous fat. The only problem here is that after liposuction, your abdomen is still large, but instead of triple X, now it's double X. It might not be worth your time and money to have the liposuction.

Patients with body mass index (BMI) over 30 are better off losing weight with a sound exercise and nutrition program. As you lose weight, your belly fat will also go down to a certain extent. Once you get down to a BMI of 30 or below, then liposuction of the stubborn belly fat that will not go away with exercise and dieting makes sense.

Dr. Cynthia Lopez considers the terms love handles, flanks and spare tires interchangeable. These are not medical terms. The name chosen is subjective based on the eyes of the beholder. Anatomically, these are bulges of fat covering the external oblique muscles at the side of the waist, making the midsection appear larger and undesirable. These fat bulges lie between the lower ribs and the top of the hips. Absence of this fat in women will give them a curvaceous, hour-glass shape versus a ripped look in men. To keep it simple, the term love handles will be used to refer to all three terms.

Love handles remain a highly targeted area when it comes to fat reduction for both men and women. Despite hundreds of side crunches and meticulous diet watching, the bulge just won't budge. Results to efforts ratio is very low, which leads to a lot of frustration.

Many people believe that spot exercises - exercising a specific muscle or area of the body -will burn fat at the desired location. This is a myth. Spot exercise will stimulate the specific muscles to become bulkier and stronger but it has little effect on fat in that area of the body.

Shrinking these unloved handles take a whole lot than most people are willing to take. It means taking on a global physical activity effort balanced correctly with a sound nutritional program.

Liposuction of this stubborn fat is highly rewarding to most patients. Results are instant and patients' motivation to maintain it through diet and exercise, now becomes highly justified.

It is best to subdivide the upper back into 4 fatty areas:
1. Buffalo Hump: Excess fat on the middle back near the neck.
2. Upper Back: unsightly rolls of fat spilling from under the bra straps.
3. Lower Back: excess fat above the hips
4. Tail Bone Fat: Excess fat just above the tailbone.

Liposuction of the upper back region is more challenging than liposuction of other areas such as the tummy. Not only because the skin of the upper back is densely adherent to the underlying muscles, but also because it contains numerous fibrous tissue that holds the fat cells in place.

The fat on the upper back seems to contain a higher proportion of fibrous tissue than the fat in other areas of the body, which makes liposuction a challenge. To successfully treat this area, patience on the doctor's side is the key… which means longer procedure time is to be expected. The procedure will take longer because smaller cannulas (called microcannulas) are the only cannulas that can snake in in-between the fibrous tissue to get into the fat cells.

Interestingly, the best time to perform liposuction in the upper back is before weight loss, not after weight loss. Before weight loss, the fat cells are swollen with fat and are easier target than shrunk fat cells after weight loss.

Buffalo hump fat is better managed with weight loss.

Lower back fat and tail bone fat that is partially improved by weight loss are relatively easier to liposuction than the upper back fat rolls.

There are two major muscles of the upper arms: the triceps on the back and the biceps on the front. Notice that as a person gains weight or gains age, the biceps seem to remain the same while the triceps start to hang. This happens because we use the biceps much more often than the triceps. We carry out most of our arm activities with arms flexed in front. We hardly use our triceps - which are extend the arms. We don't carry our bags behind our back; we don't push carts backwards; we don't unscrew bottles backwards. People whose job involves strengthening their upper arms most of the time have firm triceps. Their arms don't wave. If the triceps are used as much of the biceps, it should be a little bigger than the biceps.

As the triceps thin out due to inactivity, the skin overlying it thins out too. Add the fat that accumulates inside and you get the dreaded jiggly, fatty, flabby, flapping arms… which is very resistant to exercise. Many people who exercised their upper arms become more frustrated than contented. Instead of getting the shapely arms they wished for, they got the bulky arms instead. Upper arms fat can be lost through a good program of diet and exercise but unfortunately, it is almost impossible to get back to the shapely arms you once had.

Liposuction of the upper arms is very satisfying. It is more liberating than liposuction of the abdomen. More people will bare their smaller arms than bare their flatter abdomens. The best candidates for upper arms liposuction are those with good skin elasticity. As the fat weighing in on the skin is removed, the better-toned skin will snap back and contract on its own. The lesser-toned skin will not and may look worse at least for six months to a year. If they embark on a good exercise program, the skin will become firmer as the triceps become leaner and more defined, even in your 60's. Otherwise, the other option for the excess hanging skin after liposuction is an arm lift, with its consequent permanent zipper scar which still requires clothing to hide.

Banana roll is the popular name that refers to loose skin–or a roll-like accumulation of excess fat–on the lower buttocks, below the butt crease (horizontal crease or gluteal fold) and just above the back thigh. The banana roll is a double edge sword in liposuction. It is unsightly and would be nice to be removed. However, over treating this area may lead to more problems.

The horizontal crease or gluteal fold is the natural boundary between the buttocks and the posterior thighs. The fold is formed by a meshwork of fibrous connective tissue strands that loosely connects the skin to the surface of the muscles in the buttocks. For the buttocks to stay perky, they need a small ledge of fat under the fold to support them. As the fat wastes away or is liposuctioned, the buttocks drop and touches the back of the back of the thighs. When the banana roll develops, it becomes an extra support to push up the buttocks. The difficulty here is that removing the fat in the banana will unpredictably cause the buttocks to drop, and by pushing down on the gluteal fold, it actually re-creates another banana roll!

This is an area where the adage "less is more" fits best. Banana roll liposuction is the holy grail of liposuctions. Liposuction in this area needs to be very minimal, no more than 50%. If additional liposuction is necessary, then a second procedure can be performed at a later date. The cost to satisfaction ratio in this area is too low that many patients are advised to leave the banana rolls alone.

Liposuction of the mons pubis is straightforward and can readily be contoured usually giving very nice results. Care should be taken not to take out too much fat or coitus might be uncomfortable. Expect longer swelling and bruising in this area than other areas.

INNER THIGHS
Similar to the flabby fat on the back of the upper arms, the inner thighs can become a site of flabby fat too... because we hardly use the muscles in this area - the adductor muscles. Adductor muscles control the movement of adduction or bringing the legs nearer to the center line of the body. We don't walk while squatting. Even younger women who have not lost weight can have flabby, wrinkly, saggy inner thighs. Liposuction of flabby inner thighs can lead to a more wrinkled skin. The best candidate for inner thighs liposuction is someone whose overlying skin has good elasticity so that it will snap back or contract.

Outer thighs (Saddlebags)
The outer thighs can also sag but they are more forgiving than the inner thighs - simply because the muslesare more

Hi! In fact, liposuction of the thighs can make the buttocks look MORE prominent, because they are not surrounded by so much fat, and so they stand out more.

A bulge over the knee cap due to the quadriceps and skin laxity and is best left untouched. Other less common collections of fat include the inner and outer and lateral infrapatellar pockets. The fat tissue on these areas are buttery soft and are readily corrected with liposuction. They are ideally performed together with the thighs.