The Distribution Of Abdominal Fat In Men And The Effectiveness of Non-Surgical And Surgical Fat TreatmentsWednesday, December 21st, 2011
There are several very popular non-surgical methods of fat reduction using external devices based on a variety of penetrating energies. One example is the Zerona device which uses a form of light known as a ‘cold laser’. While it is a fat reduction device that is associated with some level of controversy, it has generally been effective in my two practice locations over the past two years. By our own experience and post-treatment evaluations, we have an approximate 70% satisfaction rate.
However, this satisfaction rate is based on a patient population that is almost exclusively women. When asked by a husband of a patient that I was treating for another plastic surgery problem about how well the Zerona would work for him and his big belly, my answer was both hesitant and reserved. It was at this point that I launched into an explanation of the anatomy of abdominal fat.
Fat in the abdominal area is comprised of several very distinct anatomic locations or layers. When most people think of abdominal fat they are thinking of what exists in the subcutaneous layer, that fat that lies between the skin and the abdominal muscle wall. I would call this superficial abdominal fat. But deep to this on the other side of the abdominal muscles lies intra-abdominal or the deep fat. Technically, intra-abdominal fat is divided into either intraperitoneal and retroperitoneal sites. The more relevant intraperitoneal fat is distributed in the mesentery of the intestines and an abdominal organ known as the omentum. Depending on the size of the person, intra-abdominal fat can make up as much as 10% of one’s total body fat mass and high amounts of it are associated with increased risks of cardiovascular and metabolic diseases.
When men ask about methods to reduce the size of the stomachs, the issue of intraperitoneal fat becomes very relevant. In andromorphs, fat is commonly stored intraperitoneal. So men with a big ‘beer belly’ have a considerable amount of intraperitoneal fat and much less, by comparison, of fat in the superficial or subcutaneous layer. This can be felt by examination in how the belly feels to the touch. The big belly in a man will usually feel very firm and hard like a watermelon. This is the intraperitoneal fat underneath the muscle pushing the abdomen out and explains why it feels so firm. In contrast, women have a much higher percentage of their belly fat in the subcutaneous layer. This is why a woman’s big abdominal area will feel much softer and jelly-like. (although this is not true for every big-bellied woman)
So for most men, whether it is a non-surgical device or even liposuction, much of the target fat is too deeply located for them to be effective. This can led to disappointing results. An examination is needed of a man’s belly to determine if there is any significant thickness to the subcutaneous layer. If there is some softness and compressibility and a handful of skin and fat can be pulled off of the underlying muscle layer, then there is enough target fat that may justify non-surgical or surgical fat reduction treatment. Otherwise, only weight loss through diet and exercise will be effective.
Dr. Barry Eppley