I would go for plastic surgery (if I wasn't so afraid of needles and hospitals anyway!!)
I've got a bit of a pot belly (thank you Kahler women). Diet and exercise don't work. I've talked to many people about it and most have that one area (usually the stomach or the butt and thighs) that they cannot get rid of the fat. I wouldn't say that it was totally for self esteem reasons, just that you work your butt off to get rid of it, and it won't go away, so you just go to the next step.