Pregnancy leads to many changes in a woman’s body, mainly through the interaction of steroid hormones, lactogen and cortisol on the underlying tissues and structures. The growing foetus itself causes mechanical change also by stretching skin, muscle and fascia and demanding an increased calorific supply. The amount of extra weight gained during pregnancy varies among women.

1. 64
BABY WEIGHT www.aestheticmed.co.uk
Aesthetic Medicine • May 2016
B O D Y/ D E V I C E S
Shape
shiftersDr Patrick Treacy on devices for
dealing with post-pregnancy baby weight
P
regnancy leads to many changes in a woman’s
body, mainly through the interaction of steroid
hormones, lactogen and cortisol on the underlying
tissues and structures. The growing foetus itself
causes mechanical change also by stretching
skin, muscle and fascia and demanding an increased
calorific supply. The amount of extra weight gained
during pregnancy varies among women. The
National Health Service recommends
that the overall weight gain during
the nine-month period for women
who start pregnancy with normal
weight should be in the region
10 to 12 kilograms (22–26 lbs.)
but as many British females
are already over weight these
figures may be downsized.
Physicians are aware,
insufficient weight gain can
compromise the health of the
foetus during pregnancy and
excessive weight gain can pose
risks to the woman and the baby.
For women who have gained weight
between pregnancies, even a relatively
smallgainof1-2BMIunitscanincreasethe
risk of high blood pressure or diabetes
during their next pregnancy and may also increase
the chance of giving birth to a large baby.1
New advice has
just been published by the National Institute for Health
and Clinical Excellence (NICE) as part of its public health
programme. It states that women who are obese (with a
BMI over 30) when they become pregnant face an increased
risk of complications such as diabetes, miscarriage, pre-
eclampsia, blood clots and death. Obese women are also
more likely to have an induced or longer labour, post-
delivery bleeding and slower wound healing after delivery.
They also tend to be less mobile, which can result in a need
for more pain-relieving drugs during labour. These can be
difficult to administer in obese women, resulting in
a greater need for general anaesthesia with
its associated risks.2
PHYSIOLOGICAL TYPES
1. The ‘pre-baby’ or ‘mating’
body type with fat distribution
seen in more normal areas
of distribution. In this body
type breasts are again used
to ‘attract’ a partner rather
than being a functional
mammary organ. They
tend to be ‘firmer’ due to fat
distribution. Women prefer
this body type as it symbolises
health, vitality and beauty. Men
prefer it as it shows a female who is
ready to reproduce.
2. The ‘post baby’ body type with fat now
distributed subcutaneously especially in the
buttocks and thigh area. There are breast volume changes
with sagging, especially if the female has breast fed her
infant. Breast volume may increase but usually we get
shrinkage. In this physiological state the dermal tissue of
the abdomen has been distended and sometimes left with
long term ‘stretch marks’.
Pregnancy leads to many
changes in a woman’s body,
mainly through the interaction
of steroid hormones, lactogen and
cortisol on the underlying tissues and
structures. The growing foetus itself
causes mechanical change also by
stretching skin, muscle and fascia
and demanding an increased
calorific supply

2. 65Aesthetic Medicine • May 2016
BABY WEIGHT
B O D Y/ D E V I C E S
www.aestheticmed.co.uk
A number of newly
designed non-surgical
modalities have become
available to the consumer
recently, each employing a different
mechanism of action to reduce
the appearance of adipose tissue.
These devices use laser energy,
radiofrequency, ultrasound
or cold (cryolipolysis) to
reduce fat
We shall now look at the problem encountered by the ‘post
baby’ body type and what a patient can do to correct them.
In some instances the tissues have been distended and
sheared to such an extent that surgical repair
is the best if not the only option. We will
first look at non –surgical methods
for removing excess fat. I do not
put dieting and exercise as a
primary option because most
clients feel it is not effective
LIPOSUCTION
Liposuction also known as
lipoplasty (“fat modeling”),
liposculpture suction
lipectomy (“suction-
assisted fat removal”) or
simply lipo, is a cosmetic
surgery operation that
removes fat from many
different sites on the human
body. Areas affected can range
from the abdomen, thighs and
buttocks, to the neck, backs of the
arms and elsewhere. There are many
differing mechanism of liposuction including those below.3
Suction-assisted liposuction (SAL)
Ultrasound-assisted liposuction (UAL)
Power-assisted liposuction (PAL)
Twin-cannula (assisted) liposuction (TCAL or TCL)
Externalultrasound-assistedliposuction(XUALorEUAL)
Water-assisted liposuction (WAL)
Laser Assisted
Liposuction can be combined with other procedures (i.e.
radiofrequency) that involve a level of skin retraction. The
level of skin retraction following liposuction is affected by
theageofthepatient,qualityofskin,presenceofunderlying
disease or smoking and the presence of previous skin
damage such as caused by childbirth and surgery. Surgical
lifts are also used post-pregnancy to address massive
weight loss when the combination of large amounts of
skin and shrunken fat cause significant skin drooping.
Large volume Liposuction (SAL) in combination with other
surgeryiscommon,butmayhavehighercomplicationrates.
The author prefers VASER ® as this is the modality he is
most familiar with.
NON-SURGICAL LIPOSUCTION TECHNIQUES
A number of newly designed non-surgical modalities
have become available to the consumer recently, each
employing a different mechanism of action to reduce the
appearance of adipose tissue. These devices use laser
energy, radiofrequency, ultrasound or cold (cryolipolysis)
to reduce fat. Devices are applied directly to the skin of the
treatment area and do not employ injections (as in injection
lipolysis) or incisions (as in laser assisted liposuction).
Although fat loss is more subtle with non-surgical lipolysis
techniques compared to surgical liposuction, non-surgical
lipolysis techniques have several advantages including
reduced risk, reduced cost, and reduced healing time.
Laser, radiofrequency, and ultrasound techniques provide
additional advantages of tissue
tightening. Because there is no suction
involved, terms such as laser lipolysis,
cryolipolysis or body contouring are preferred
to non-surgical liposuction.
Cryolipolysis
Cryolipolysis is the non-invasive cooling of adipose tissue
to induce lipolysis - the breaking down of fat cells - to reduce
body fat without damage to other tissues. The principle
behind cryolipolysis exploits the premise that adipocytes are
more susceptible to cooling than other skin cells. The precise
application of cold temperatures triggers apoptosis of the
adipocytes, which invokes an inflammatory response and
leadstoslowdigestionbysurroundingmacrophages.Inclinical
studies, cryolipolysis was shown to reduce subcutaneous
fat at the treatment site by up to 25% after one treatment.
Improvements were seen in 86% of treated subjects.
At 73%, the patient satisfaction rate is higher than with other
technologies used for non-invasive lipolysis. Cryolipolysis has
been proven to be a very safe method for body contouring,
and is accomplished with only minimal discomfort.
Expected side effects are temporary erythema, bruising,
and transient numbness that usually resolve within 14 days
after treatment.4
Zeltiq obtained
FDA approval in 2010 for
cryolipolysis of
the flanks and additional
approval in 2012 for
cryolipolysis of the
abdomen. Strawberry
was approved by the
FDA in 2013. The author
prefers Zeltig’s Coolsculpt®
as this is the cryolipolysis device
heismostfamiliarwith.

3. Radiofrequency
BTL _Vanquish _
unit-with-logo_HQ
Radiofrequency
devices have traditionally been used for
tightening of skin laxity and rhytides, as
the thermal damage that ensues results in
contraction of collagen and remodeling. A clinical
study by Franco et al6 shows that radiofrequency
devices can be used to selectively heat
subcutaneous adipose tissue and induce lethal
thermal damage to adipose tissue while sparing
the overlying and underlying tissues. Thermal
exposures to 43°C–45°C over several
minutesmayresultinadelayedadipocyte
death response. This may have a role in
decreasing overall waist circumference
and fat removal as well. An average
decrease of 4.93cm was calculated using
BTL’s Vanquish®
. This study demonstrated
that selective RF system designed for
contactless deep tissue heating is a painless,
safe, and effective treatment for non-surgical
body contouring and circumferential fat
reduction.5
The author prefers BTL’s Vanquish®
as this is the radiofrequency device he is most
familiar with
Ultrasound
Focused thermal ultrasound techniques work by raising the
tissue temperature above 56 °C, resulting in coagulative
necrosis of adipocytes, with sparing of vessels and nerves.
Passive heating of the skin may also induce collagen
remodeling. Liposonix from Solta Medical uses thermal
focused ultrasound while UltraShape from Syneron Candela
uses non-thermal focused ultrasound. Ultrashape is FDA-
cleared to treat areas of fat on the stomach, hips, and thighs
that have been resistant to diet and exercise. The machine
delivers ultrasound technology through a hand-held device
placed on the targeted area, which causes fat to burst and
be eliminated through the body’s natural metabolic process.
The author prefers
Ultrashape®
as this
is the focused non
thermal ultrasound
device he is most
familiarwith.
66
BABY WEIGHT www.aestheticmed.co.uk
Aesthetic Medicine • May 2016
B O D Y/ D E V I C E S
>> Dr Patrick Treacy is chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative
of the British Association of Cosmetic Medicine. He is a fellow of the Royal Society of Medicine and
the Royal Society of Arts. (London) and chairman of the Ailesbury Humanitarian Foundation. He is on
the editorial boards of five international aesthetic and dermatology journals and has pioneered facial
endoprosthesis techniques for HIV facial lipodystrophy and radiosurgery thermocoagulation.
Low level light laser
Low level laser light reduces the stability of
adipocyte cell membranes, allowing cells
to release their stores of fat without
damaging the cell. Because the fat
is released into the extracellular
space, cardio based exercise is usually
promoted after the procedure. In 2010,
Zerona became the first non-invasive
lipolysis device approved by the FDA
following a randomized controlled trial
demonstrating circumference reduction
of the waist, hip, and thighs. The Verjú
Green Laser was 510(k) FDA cleared in
January 2014 for non- invasive
cellulite reduction
as well as for non-
invasive fat reduction
body contouring for
the waist, hips,
and thighs. The Verjú
Green Laser was
featured on “The
Doctors” TV show in
May 2014.
DIET AND EXERCISE
Healthy eating habits combined with regular
exercise also help people lose baby fat.
Weight loss via exercise and healthy eating
carries little risk compared to liposuction.
Walking may not sound like much of a
workout, but it is one of the simplest ways
to ease into a fitness routine after giving
birth. Bringing baby along in a front pack
will add extra weight that can increase the
benefits. Research shows that starting a
regular exercise program soon after giving
birth is not only good for your overall
health, but may also help reduce the risk of
postpartum depression. AM
REFERENCES
1. Changes in maternal physiology during pregnancy CEACCP, Jun 2003; 3:
65 - 68. Bernhard H Heidemann and John H McClure
2. Weight management before, during and after pregnancy http://www.nice.
org.uk/guidance/PH27
3. Nordqvist, Christian (8 March 2012). “What Is Liposuction? Liposuction
Risks And Benefits”. Medical News Today. Retrieved 15 January 2013.
4. Clin Cosmet Investig Dermatol. 2014; 7: 201–205.Published online 2014
Jun 26. doi: 10.2147/CCID.S44371 PMCID: PMC4079633 Cryolipolysis for
non-invasive body contouring: clinical efficacy and patient satisfaction
Nils Krueger, Sophia V Mai, Stefanie Luebberding, Neil S Sadick
5. Selective Radiofrequency Therapy as a Non-Invasive Approach for
Contactless Body Contouring and Circumferential Reduction. Kateřina
Fajkošová MUDr, Alena Machovcová MD PhD MBA,b,c Meltem Onder MD,
and Klaus Fritz MDd,e