It's plastic surgery, without the surgery.
Doctors are turning to heat, cold, or sound waves to reach under the skin to reduce stubborn fat pockets - and with little or no recovery time.
"It requires no incisions," says plastic surgeon, Dr. Steve Davis of Cherry Hill, New Jersey.
Plastic surgeon Dr. Paul Glat adds, "You can go to the gym, you can do whatever."
Debbie Gruber of Cherry Hill, New Jersey, says she's ready for clingy, warm-weather clothes on her upcoming cruise.
She used to worry they'd give away a bulge.
"My upper back, the flaps that would hang over a bra strap," says Gruber.
So she had CoolSculpting, which destroys fat cells by freezing them.
"About 30 percent of whatever's in there is going to die, and it's permanently gone," says Dr. Davis.
Pleased with the results, she came back last fall to reduce excess under her chin.
Gruber admits the cold is initially a shock, but says she quickly got used to it.
"The most difficult part of it was the immobilization of that area for such a long period of time," she notes.
Dr. Davis says up till now, most CoolSculpting treatments are about an hour, though a new applicator shortens some to 35 minutes.
The price? About $400 per area.
Instead of a cold approach, Tony Robinson of Feasterville, Pennsylvania, is trying heat to trim an abdomen that defies diet and exercise.
"Crunches, planks - my core is really strong," he says.
Dr. Glat, of Bala Cynwyd, says SculpSure, which came onto the market last fall, is a laser that only damages fat cells.
Applicator heads hooked to a grid heat the cells for 25 minutes, causing them to burst and die.
Cooling elements prevent the skin from overheating.
"When you take the device off, the skin looks perfectly normal," says Dr. Glat. "In 6 to 8 weeks is when you see that 24-25 percent fat reduction."
After his treatment, Robinson said his muscles were a little sore.
"Like I did a lot of sit ups," he says with a laugh.
He hopes to see the results by late March.
SculpSure costs about $400 per applicator head - a full abdomen might be $2,000-3,000.
Ultrasound is another fresh option for reducing fat.
Dr. Manny Iyer, of Bethlehem, Pennsylvania, uses UltraShape.
"It makes the fat cells vibrate," he notes.
A camera maps the area, then a hand piece delivers ultrasound pulses, following body contours.
Skin, blood vessels and nerves aren't affected, because they respond to a different frequency.
After three treatments a few weeks apart, patients can expect to lose up to an inch and a half around the waist or hips.
But Dr. Iyer says just losing fat isn't enough.
"We have to be concerned about how much the skin can shrink. If the skin doesn't shrink, losing the fat is going to produce a lot of loose skin," he says.
Dr. Iyer believes skin tightening, with a technique like VelaShape, is important for a smooth look.
The combination treatment of UltraShape and VelaShape, costs between $4,000-5,000.
And after these treatments, you really have to watch your weight - adding pounds enlarges the remaining fat cells.
With all the options, doctors say you need to ask these questions:
-Does it eliminate fat, or just shrink it?
-What areas is it approved for?
-How much will it hurt?
-What results can you expect?
-How long, and how much, will it cost to do what you want?
Dr. Daniel Mills, president-elect of the American Society for Aesthetic Plastic Surgery, says potential patients must also have realistic expectations.
Body sculpting is not a replacement for weight loss, he notes.
Dr. Mills also says to be sure your doctor is board certified to do the type of procedure you want.
He notes that 70,000 doctors call themselves plastic surgeons, but only 6,000 are board certified.
He also noted that 'cosmetic surgeon' is not a specialty accepted by medical governing bodies.
Body sculpting: Using heat, cold, sound waves to reduce fat
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