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Woman’s World Asked Ice or Heat. Here Is the Surgeon’s Version.

Black and white photograph of a woman in a silk robe seen from behind at a tall frosted window, one hand on the glass, a glass of iced water on the ledge beside her and steam rising from a small bowl, no face. Illustrative image, not a patient. Commentary by Frank Agullo, MD, FACS.

Woman’s World, September 29. Ice or heat? I reviewed the piece. Yahoo Health and AOL picked it up the same day.

They were writing for sore muscles. I answer for people I just operated on. Same physiology. Tighter rules.

Ice first. It vasoconstricts.

“The first couple of days after surgery, ice is better, because it vasoconstricts, which decreases swelling and inflammation.”

Not ice, exactly.

“Usually we don’t actually use ice per se. We have little ice packs that have a gel inside, which you put in the freezer. They’re covered with silicone, and this protects the skin so that it doesn’t suffer direct contact with the ice. We like to use it as often as possible, every hour, for the first three days.”

Then heat. It vasodilates.

“After the third day, heat will actually vasodilate and help get more blood flow and oxygen to the area, as well as all the growth factors and repair cells that we need.”

The line I say in every consult.

“The patient should be able to hold the ice pad or heat pad in their hands comfortably. If it’s too hot or too cold to hold comfortably, it can burn the skin. You should be very careful, especially in areas that are numb, so that you don’t injure yourself.”

Numb skin sits under a pack that is burning it and never says a word. Your hand does.

Twenty minutes.

The one line of mine the magazine printed that I will repeat: “Longer than 20 minutes does not help. The skin can be injured, and the body starts pushing blood back into the area to warm it, which undoes the benefit.”

The day-two trap.

“But physically, on day two, day three, you’re gonna feel fine. There’s no pain. It’s just the feeling of swelling. But physically, you feel like you can do anything.”

Feel fine, skip the pack, overdo it, swell. Keep the cadence through day three. Then heat, then massage. Surgery somewhere else and nobody told you? Now someone has. The practice sheet is on swplasticsurgery.com, the version by procedure on agulloplasticsurgery.com.

Why Choose Dr. Agullo

I am certified by the American Board of Plastic Surgery and the American Board of Surgery, trained in plastic surgery at the Mayo Clinic, and teach as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has listed me as a Top Doctor for thirteen consecutive years, 2014 through 2026.

Ready to Talk?

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful

Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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The Fat I Cannot Remove

Black and white photograph of a flexible tape measure held at the waist, midway between the last rib and the hip bone. Commentary by Frank Agullo, MD, FACS.

BMI is the number I am required to record. It is not the number I use.

“I can have two patients walk in with the same BMI and a completely different body composition and health situation. One can be a former athlete still carrying dense muscle, and the other has lost muscle over the years and replaced it with fat, with visceral fat sitting deep in the abdomen. The visceral fat is really the bad guy, the one that drives up blood pressure, blood sugar, and inflammation.”

BMI was never built for this.

“BMI stands for body mass index, and it measures weight relative to height. That’s really all it measures. It doesn’t know whether the weight is muscle, fat, bone, or fluid, nor does it know where on the body the weight sits.”

“It was never designed as a personal health test, but it ended up being used in medicine because it was a simple calculation.”

Woman’s World asked me last month whether waist-to-height ratio is the better predictor of heart risk.

“Waist-to-height ratio is not really measuring anything new. It measures the same underlying problem more directly. Heart disease tracks with the fat around the organs, and waist circumference gets closer to that than total body weight does. So it’s not that it’s a new body metric. It’s just that we’re setting aside the old one.”

The rule:

“You should keep your waist to less than half your height. A ratio under 0.5 is the goal. 0.5 to 0.6 is where the risks start to rise. Above 0.6 is concerning, and patients should have a full workup with their primary care doctor to check blood pressure, blood sugar, and cholesterol.”

The surgical part, which the health coverage never gets to: liposuction and a tummy tuck work on the fat between the skin and the abdominal wall. Visceral fat sits behind that wall. No cannula reaches it.

This is also the fat that responds.

“It’s usually the first fat to arrive when your habits slip, and the first fat to leave when your habits improve. This is good news, because you can monitor your waist circumference as you’re dieting and often see more change than on the scale, which can be discouraging.”

One more thing, because it catches women off guard:

“Around and after menopause, the drop in estrogen changes where the body stores fat. It moves from the hips and thighs to the abdomen. So your BMI stays the same, but there’s more visceral fat than before, and the waist-to-height ratio rises.”

Get a tape measure. Stand up straight, find the space between your last rib and the top of your hip bone, measure there, snug, breathing normally, without sucking in. Divide by your height.

Under half.

Call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com. #StayBeautiful