Fat in the trunk and extremities has a superficial and deep layer. The superficial layer is composed of small dense pockets of fat separated by vertical well-organized fibrous septa. The deeper fat layer is organized more loosely, with looser areolar fatty tissue interspersed with less regular fascial septae intervening between the pockets. Vertical septa originate from the fascia and extend upward toward the dermis [Figure 1]. These layers are important in avoiding potential complications during liposuction.

That’s because women tend to store more temporary fat in their bellies. “The fat stores are gained and lost,” says Lawrence Cheskin, MD, chair of the department of nutrition and food studies at George Mason University and director of the Johns Hopkins Weight Management Center. “By and large, belly fat comes off easier in the sense that it comes off first. That’s where a good amount of the fat is lost from.”

Cannulae used today are extremely small, typically less than 6 mm, some are very small with an inside diameter of less than 0.6 mm. Blunt-tipped cannulae are standard as they decrease injury to blood vessels and reduce bleeding. The use of multiple side ports allows for efficient evacuation of fat. Manual systems consisting of syringes and canula tips have also been developed as some surgeons prefer the use of quiet and disposable instruments, they are more popular in small local aspirations of isolated fat bulges. They also became popular as a back-up system. Over time, aspiration units developed by manufacturers in consultation with surgeons have gradually become more powerful as well as quieter and allow for an efficient, pleasant surgical environment.
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]

The liver uses triglycerides, cholesterol, and protein to make triglyceride-rich very low-density lipoproteins (VLDL). In the blood, an enzyme removes triglycerides from VLDL to first produce intermediate density lipoproteins (IDL) and then low-density lipoproteins (LDL - the "bad" cholesterol). LDL is not all bad; it is an essential part of lipid metabolism and is necessary for the integrity of cell walls and for sex hormone and steroid production. However, in excess, LDL can oxidize and accumulate, eventually leading to fatty deposits in artery walls and to hardening and scarring of the blood vessels (and to cardiovascular disease and blood clots).
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
Do you even lift, bro? If you’re serious about getting rid of that belly fat fast, resistance training might just be the key. A study from the Harvard School of Public Health found that adding weight training to adult male test subjects’ workouts significantly reduced their risk of abdominal obesity over a multi-year study period, although doing the same amount of cardio had no such effect. Research from the University of Maryland even found that just 16 weeks of weight training boosted study participants’ metabolic rates by a whopping 7.7 percent, making it easier to ditch those extra inches around your middle.
A diet that’s low in fat and carbohydrates can improve artery function, according to a 2012 study by Johns Hopkins researchers. After six months, those on the low-carb diet had lost more weight, and at a faster pace. But in both groups, when weight was lost—and especially when belly fat shrank—the arteries were able to expand better, allowing blood to travel more freely. The study shows that you don’t have to cut out all dietary fat to shrink belly fat. For heart health, simply losing weight and exercising seems to be key.

That's why I co-wrote the "Fat for Fuel Ketogenic Cookbook" alongside renowned Australian celebrity chef Pete Evans. This book combines research-backed medical advice with delicious, kitchen-tested recipes that will help make shifting to fat-burning much easier. Whether you're just a budding cook or a master chef, there's a delicious meal waiting to be prepared that'll take your health to the next level.


Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >
"Depending on your approach, [keto diets] can contribute to significant lean body mass loss along with fat loss," said Melinda Manore, a professor of nutrition at Oregon State University. (Typically, dieters want to shed only fat, not lean body mass, which includes muscle.) And as with other fad diets, people typically regain the weight once they go off the diet.
Micropigmentation, or permanent makeup, is a procedure in which iron oxide pigment is injected into the dermis. This procedure can improve the appearance of thin eyebrows and lips and may be beneficial for those with makeup allergies. Swelling is common after the procedure. The patient may be instructed to apply ice and/or ointment to the treated area.
Research published in the Journal of Nutrition, Metabolism and Cardiovascular Diseases concluded that following the Mediterranean diet could help to mitigate the harmful effects of belly fat on your heart. Better yet, it boosts the number of healthy bacteria in your gut – a study published in the journal Frontiers in Nutrition saw levels rise by up to seven per cent, compared with a western diet.
In my book "Fat for Fuel," I sought to educate readers about the benefits of using healthy fats as a catalyst to bring about improved mitochondrial function, thus allowing you to achieve better health. In essence, the book answers WHY it is important for you to consume healthy fats. However, you still need to know HOW to prepare the right ketogenic foods in an appetizing way.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
Board Certification in Cosmetic Surgery: all ABCS board certified cosmetic surgeons have had specific training performing liposuction as part of their American Academy of Cosmetic Surgery certified cosmetic surgery fellowship. Also, by choosing a board certified cosmetic surgeon, you can take comfort in knowing your procedure will be performed in an accredited surgery center.
Grains get a bad rap when it comes to weight loss, but that's because refined grains (read: processed foods!) are linked to wider waists. 100% whole grains are bloat-busting superstars, however, as they're packed with minerals and de-puff by counter-balancing salt. Stick to brown rice, quinoa, wheat, barley, millet, farro, sorghum, and amaranth for the biggest benefits.
You don’t have to go low-carb to ditch those extra pounds around your waist in a short period of time. In fact, opting for more whole grains might just get you there faster. Researchers at Tufts University have linked eating three or more daily servings of whole grains to as much as a 10 percent reduction in visceral body fat, the kind that ups your risk for chronic diseases, like diabetes, heart disease, and high blood pressure.
As of the moment, there is no industry standard as to how many calories should be consumed in a restricted ketogenic diet, but there are published studies that provide estimates. In one example, a 65-year-old woman who was suffering from glioblastoma multiforme (GBM), an aggressive type of brain cancer, was put into a restricted ketogenic diet that started with water fasting and then proceeded to consuming 600 calories a day only.
It’s impossible to target belly fat specifically when you diet. But losing weight overall will help shrink your waistline; more importantly, it will help reduce the dangerous layer of visceral fat, a type of fat within the abdominal cavity that you can’t see but that heightens health risks, says Kerry Stewart, Ed.D. , director of Clinical and Research Physiology at Johns Hopkins.
A daily run or Spin class is great for your heart, but cardio workouts alone won't do much for your waist. "You need to do a combination of weights and cardiovascular training," says Sangeeta Kashyap, MD, an endocrinologist at Cleveland Clinic. Strength training increases muscle mass, which sets your body up to burn more fat. "Muscle burns more calories than fat, and therefore you naturally burn more calories throughout the day by having more muscle," says Kate Patton, a registered dietitian at Cleveland Clinic. Patton recommends 250 minutes of moderate-intensity exercise or 125 minutes of high-intensity exercise a week.
Your parents weren’t kidding about how important veggies are for a healthy body. What they probably didn’t tell you, however, was that snacking on veggies is also one of the easiest ways to shed unwanted belly fat, too. According to a study published in the Journal of the Academy of Nutrition and Dietetics, opting for non-starchy veggies, like cauliflower, broccoli, and cucumber, as snacks helped overweight kids shed 17 percent of their visceral fat while improving their insulin sensitivity over a five-year period. Think snacking on veggies will leave you hungry? The 20 Most Filling Fruits and Veggies will have your belly satisfied in no time.

Insulin is a hormone that allows glucose to move into tissue cells, where is it is used for energy production. Insulin then prompts the liver to either store the remaining excess blood glucose as glycogen (for short-term energy storage) and/or to use it to produce fatty acids (which then become triglycerides). In people with insulin resistance, additional insulin must be released by the pancreas to overcome the tissue cells' resistance and allow glucose to enter the cells. This resistance and response to resistance can lead to increased insulin and glucose concentrations in the blood. Over time, increased glucose levels can harm blood vessels and organs such as the kidneys. Increased insulin levels can increase sodium retention by the kidneys, resulting in increases in blood pressure (which can lead to hypertension).


It’s a habit to enjoy a brie cheese for desert instead of a piece of chocolate cake but each are favored deserts in France. I’m personally more satisfied after a 350 calorie sized wedge of brie than the same number of calories of cake.. which will give me sugar crash and .. really I’d like two slices of cake(I’ve got a sweet tooth that once I get going it wants to keep being fed)
[Guideline] Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20. 120(16):1640-5. [Medline].

You’ll find lean, satiating protein in every single bite you take on Zero Belly Diet. The muscle-building macronutrient is fundamental to the plan, and eggs happen to be one of the easiest and most versatile delivery systems in the universe. Not only that, they’re also the number-one dietary source of a nutrient called choline. Choline, which is found also in lean meats, seafood and collard greens, attacks the gene mechanism that triggers your body to store fat around your liver. One Zero Belly Diet recipe—a breakfast hash with sweet potatoes and fresh farm eggs—became test panelist Morgan Minor’s go-to breakfast, and after just 3 weeks on the program, the female firefighter lost 11 pounds and 4 inches from her waist! The more eggs you eat, the less egg-shaped you get.


Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.
You may be given a diary to record the number and type of seizures you or your child has while on the diet. As food can affect how we feel or act, you may be asked to note any changes in your or your child’s mood, alertness and overall behaviour. It usually takes at least three months to see whether the diet is effective. The length of time the diet is followed may vary, but if an individual remains seizure-free, has fewer seizures, or maintains other benefits, such as improved quality of life, they may consider (with their medical team), slowly coming off the diet after two years.
Kids who have a family history of heart disease or diabetes are at greater risk for metabolic syndrome. But, as with many things in life, the lifestyle habits a child adopts can push things in one direction or another. So kids who are active, fit, and eat a lot of fruits and vegetables may drastically decrease their chances of developing metabolic syndrome — even if a close relative already has it.
Arteries (are-te-rease): The blood vessels that carry oxygen-rich blood away from your heart for delivery to every part of your body. Arteries look like thin tubes or hoses. The walls are made of a tough outer layer, a middle layer of muscle and a smooth inner wall that helps blood flow easily. The muscle layer expands and contracts to help blood move.
I’m happy to say that aggressive and heart-healthy lifestyle changes are typically the main treatment for metabolic syndrome, which I fully support since lifestyle changes are the natural approach and get to the root causes of the disorder. Recommended lifestyle changes typically include heart-healthy eating, good stress management, losing and maintaining a healthy weight, more physical activity, and quitting smoking.
Liposuction, also referred to as Lipoplasty, is a procedure to remove the unwanted fat deposits from certain areas and contour the body. It can be performed on  men and women. Common sites for liposuction include the neck, arms, back, hips, thighs, and buttocks. Liposuction is best suited for patients who maintain a healthy weight and exercise regularly but continue to have certain problem areas.
If you don’t have an established exercise routine, simply walking is the best first step toward weight loss. “Walking is a pretty good entry point for people,” says Gagliardi. This is particularly true if you have been out of the gym for a while and want to ease back into a workout routine. One small study published in The Journal of Exercise Nutrition & Biochemistry found that obese women who did a walking program for 50 to 70 minutes three days per week for 12 weeks significantly slashed their visceral fat compared to a sedentary control group.
A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence was inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]
Dr. Schlessinger will then do the SmartLipo part if you are doing that procedure in addition to the tumescent liposuction. This part takes about 30 minutes, and then Dr. Schlessinger will proceed to perform the tumescent liposuction part, which involves suctioning the additional fat. This part takes about 45 minutes. Then you will be taken to the recovery room to relax and eat the lunch of your choice prior to being discharged to a friend or family member, who will take you home to rest for the remainder of the day.
Studies have shown that post-natal and post-menopausal women have seen significant reductions in visceral fat stores when adding yoga to their workout and health regimens. Yoga is a wonderful way to reduce stress and eliminate excess stress hormones from your body, namely cortisol. Dr. Janice Kiecolt-Glaser, an eminent psychologist from The Ohio State University, carried out a study in which she found yoga fastened an individual’s physiological recovery. Furthermore, it also stated that there’s a direct link between chronic stress, cortisol levels, and belly fat. Thus it is important to clear your mind, calm down, and keep that visceral fat at bay!
Lean protein like fish is a great way to fight fat and boost your metabolism. But the farmed salmon you get at the local market might not be the best bet for your belly. The cold-water fish has a well-deserved reputation for packing plenty of heart-healthy omega 3 fatty acids—1,253 mg of the good stuff, and just 114 mg of inflammatory, belly-busting omega 6s. But the farmed variety—and 90 percent of what we eat today is farmed—has a very different story to tell. It packs a whopping 1,900 mg of unhealthy omega-6s.
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
Glucose. Usually a fasting glucose test is performed but, in some cases, a healthcare practitioner may also order a post prandial glucose (after a meal) or a GTT (glucose tolerance test – several glucose tests that are taken before and at timed intervals after a glucose challenge). The goal of glucose testing is to determine whether a person has diabetes or a decreased ability to process glucose (impaired glucose tolerance), which can eventually result in diabetes.

It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]
Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >
You will need to wear a snug elastic dressing, girdle, or body stocking over the treated area to aid healing. These are provided free of charge for patients at Skin Specialists. Dr. Schlessinger purchases these garments from the inventor of the tumescent technique, Dr. Jeffry Klein, because they are the best garments possible. Some patients prefer to have a second pair on hand, and this extra pair may be purchased for a small extra charge if so desired at the time of surgery.
If you've tried exercise and dieting and still have areas on your body that won't respond, you should consider the newest method of liposuction, SmartLipo, which is performed by Dr. Schlessinger along with tumescent liposuction, which was invented by a dermatologist. Before you select a physician and undergo the procedure, it's important for you to know that all liposuction - even tumescent liposuction - is not alike.
The prevalence of metabolic syndrome increases with age, with about 40% of people older than 60 years meeting the criteria. [26] However, metabolic syndrome can no longer be considered a disease of only adult populations. Alarmingly, metabolic syndrome and diabetes mellitus are increasingly prevalent in the pediatric population, again in parallel with a rise in obesity. [50]
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