Can You Lose Weight From Your Couch?

We’ve all entertained some version of the same fantasy: skipping the gym in favor of a Netflix marathon while still losing weight. Well, what was once dismissed as a daydream is increasingly becoming a reality. Recent advances combined with new applications of existing technology have turned non-surgical body contouring into big business, providing both plastic surgeons and patients with a range of alternatives to traditional subcutaneous fat removal. While surgeons universally agree there is still no substitute for liposuction surgery, several technologies do deliver subtle results with significantly less recovery time.

Let’s be clear: non-invasive body contouring treatments are not a substitute for significant weight loss or maintaining a healthy, active lifestyle. According to board certified Beverly Hills plastic surgeon Payman Danielpour, MD, good candidates for these cosmetic fat reduction treatments are “those who diet and exercise but who have resistant fat deposits. If they’re in shape, a non-invasive option is fantastic.” On the other hand, he says, “Sometimes I end up telling patients that they’re not going to get the results they’re looking for. If they are overweight or they have loose skin from losing weight, then surgery is the more realistic option. It all depends on the amount of fat being targeted and their goals. Each individual is different.”

Still, plenty of people fed up with their stubborn fat pockets are flocking to doctor’s offices and treatment centers for these body ‘tweakments’. They also pair well with other non-invasive treatments and/or surgical procedures. “We have clients who come in for CoolSculpting® on their love handles and we treat their six-pack with EMSculpt® as well,” says Dr. Danielpour. Multitasking frequently extends to facial treatments, too. “We’ll do HydraFacials® while body contouring, or PRP microneedling," he says. "The beauty of this is they just walk right out afterwards. The discomfort that you have with surgical treatment is far more than doing a non-invasive procedure.”

Fantasizing about shedding fat from the comfort of your couch? While we can’t make any promises, here’s the skinny on three of today’s most popular fat-blasters.

Freeze It

Since 2010, the Food and Drug Administration (FDA) approved CoolSculpting® and it has been helping patients eliminate excess fat from the belly, flanks, thighs, back, upper arms, and most recently, double chin. The machine, which requires “enough fat to pinch,” according to Dr. Danielpour, works by suctioning the skin that surrounds the fat cells, then cooling the area until the fat cells freeze and die – a process known as cryolipolysis. “In terms of non-surgical fat reduction, there is nothing better than CoolSculpting® on the market," he says. "You can take the probes and put them just about anywhere on the body, and on average, 25 percent of the fat will be gone in three months.”

The Skinny

• Cost Per Session: $750 per area per treatment. “The love handles are two areas,” says Dr. Danielpour.

• Treatment Sessions Required: According to Dr. Danielpour, “Most people require two sessions per area.”

• Duration: About 30 minutes to an hour per area.

• Pain/Discomfort: Patients with sensitive skin may be uncomfortable as the machine numbs the skin, but after that, there is usually no pain. In Dr. Danielpour’s experience, “Sometimes there can be a little bit of nerve pain that will resolve in a couple of weeks," but it's usually temporary.

• Downtime/Side Effects: None.

• Results: Noticeable changes as soon as a few weeks; full results develop over two to six months as the body flushes out the dead fat cells.

• Fat Reduction: According to company data and Dr. Danielpour’s estimates, around 25 percent.

• Muscle Increase: None.

• FDA-Approved: Yes.

• Risks: Temporary nerve damage that generally resolves in a matter of weeks, as well as something called paradoxical adipose hyperplasia (PAH) – a phenomenon that actually causes the fat cells to grow and harden in response to the extreme cold. Also known as the “stick of butter” effect for its rectangular resemblance to the machine’s suction probe, the complication occurs in fewer than one percent of CoolSculpting® cases. Fortunately, the problem is completely solvable, according to Dr. Danielpour. “I’ve never had a case of it in my practice, but I was referred to a patient who had it. I performed liposuction, and the patient was fine," he says.

• Maintenance: None.

What It's Like

“I was concerned about stubborn fat on my flanks and lower abdomen,” says Athena, who got CoolSculpting® from Dr. Danielpour. The treatment itself was “very cold, but tolerable. The cold feeling eventually subsided and became numb," she says. "The two-minute massage of the treatment area immediately afterward was not very comfortable. It feels tender and numb, almost as if your skin is thawing out.” Athena was able to resume normal activities right away, including a workout the next day, in spite of being slightly sore in the treatment area. She began to see results in about six weeks, “although full results did not take effect until the three month mark.” Athena was so pleased with her initial CoolSculpting® results that she opted to re-treat the same area as well as other areas like her flanks and inner thighs. "CoolSculpting® helped the bulge on my lower abdomen decrease, where now my abdomen is almost completely flat,” she says.

Melt It

Promising shorter treatment times with similar results as Coolsculpting®, Cynosure's SculpSure® eliminates stubborn pockets of pudge by selectively heating fat cells through controlled, low-level laser energy. The body contouring treatment is currently approved by the FDA to address excess fat found in the abdomen, flanks, back, inner and outer thighs, and under the chin. According to company data, each 25-minute treatment permanently destroys up to 24 percent of targeted fat cells. The body naturally expels the dead fat cells through the lymphatic system over the course of six to 12 weeks.

The Skinny

• Cost Per Session: On average, $400 per panel per treatment. Most patients require a maximum of four panels to treat the abdominal area, for an average total of about $1,600 for that area.

• Treatment Sessions Required: According to SculpSure®’s website, patients generally benefit the most from a series of treatments.

• Duration: About 25 minutes per area.

• Pain/Discomfort: Most patients experience a strong warming sensation followed by periods of cooling. Because everyone’s pain tolerance is different, mild to moderate discomfort has been reported.

• Downtime/Side Effects: There are no activity restrictions, though patients have reported mild swelling and tenderness in the treated area for a couple of days.

• Results: Full results develop over six to12 weeks as the body expels the dead fat cells.

• Fat Reduction: According to company data, around 24 percent.

• Muscle Increase: None.

• FDA-Approved: Yes.

• Risks: While there are no known risks or complications, anyone pregnant should not use the technology.

• Maintenance: None.

Work It

“We’re very excited about EMSculpt®,” says Dr. Danielpour. “It’s the only technology that builds muscle using a high intensity focused electromagnetic field, which induces powerful muscle contractions that you can’t do yourself.” FDA-approved for use in the abdominal and gluteal areas, one session with this machine essentially provides more crunches and squats than humanly possible. “It’s like doing 20,000 situps in 30 minutes or more squats than you could ever imagine.” Those intense repetitions, known as “supramaximal” muscle contractions, build muscle and induce lipolysis, or fat cell death. The machine has variable settings, which the provider controls according to the patient’s tolerance level. Four sessions over the course of a couple of weeks are purported to leave a relatively fit person looking like they’ve spent the last six months toiling in the gym. But like any workout regimen, this body contouring treatment requires regular maintenance: one session every three to six months is recommended to keep that sleek physique.

The Skinny

• Cost Per Session: $1,000 per area.

• Treatment Sessions Required: Generally, four over the course of two to three weeks.

• Duration: About 30 minutes per session.

• Pain/Discomfort: While it’s not regarded as painful, the sensation has been described as a strange, slightly uncomfortable vibration by some.

• Downtime/Side Effects: Mild muscle soreness afterward, similar to that of working out.

• Results: Patients describe feeling more toned immediately following treatment; full results develop within a few weeks following the fourth session.

• Fat Reduction: According to company data, 16 percent average.

• Muscle Increase: 19 percent on average.

• FDA-Approved: Yes.

• Risks: While there are no known risks or complications, anyone with metal in their body (like rods, pins, copper IUDs, pacemakers, etc.) cannot use the technology.

• Maintenance: One session every three to six months is recommended.

What It's Like

CoolSculpting® patient Athena also opted for EMSculpt® sessions “to tone my abdomen in addition to reducing a small pocket of fat. You periodically feel your abdomen contract (I was able to tolerate it at the highest setting right away). The only uncomfortable part of this treatment was that the placement made it difficult for me to avoid feeling a contraction near my hip flexor.” Athena was able to resume her normal exercise routine the next day, with some slight soreness. “In comparison to CoolSculpting®, EMSculpt® treatment was definitely more comfortable. Immediately after the treatment, I saw a contraction of my abdomen with more definition of my muscles.” It took Athena close to two months to see the final results. “Initially, I did not think I saw any long term results. However, once I approached the eight-week mark, I noticed my abdomen felt tighter, and indeed the tiny pocket of fat on my lower abdomen had decreased.” Although she describes the results of EMSculpt® as significantly more subtle than that of CoolSculpting®, Athena recommends both, saying that EMSculpt® “provided extra definition to my abdomen.”

It’s important to remember that while these non-invasive body contouring techniques don’t carry the same risks associated with plastic surgery, they are medically regulated procedures best performed by highly trained professionals. When deciding which fat reduction method is right for you, it all comes down to the goals and expectations you discuss with your aesthetic surgeon.

And before you get excited about having your cake and eating it, too, remember: although these non-surgical treatments really do get rid of fat for good, they’re not a free pass from living a sensible lifestyle. For optimal results, patients need to stick to a healthy regimen. Says Dr. Danielpour, “We’re all born with a set number of fat cells. These treatments actually kill the fat cells. In the treated area, you won’t be able to gain weight. The one thing I tell people is if you maintain your weight, you will see a very nice result. If you gain like 30 pounds, your arms and legs will get bigger. If you gain weight, all bets are off.”