Substantial weight loss, muscle weakness following multiple pregnancies, or heredity can all cause or contribute to loose, wrinkled abdominal skin and excess fat in the lower abdomen. If your only complaint is the appearance of a protruding abdomen, and if your skin tone is good, it may be that liposuction is the only treatment you’ll need. But if you also have loose skin and lack of tone in the abdominal area, then an abdominoplasty, commonly called a tummy tuck, may be recommended for you.
“Abdominoplasty has become one of the most popular procedures I perform,” says Chester Sakura, MD, of Albuquerque, New Mexico. “Today, the modern woman wants to regain her ﬁgure after childbearing, wear fitted clothing and look natural in her overall contour, both sitting and standing. The optimal results in abdominoplasty are achieved by careful attention to incision placement, skin and fat removal, re-creating a natural umbilicus (belly button) and proper but not excessive tightening of the loose stomach muscles.”
“This is a wonderful operation for women who, following pregnancy, have developed loose abdominal skin and abdominal wall weakness,” says Alexander G. Nein, MD, of Nashville, Tennessee. “Our patients appreciate the fact that we can help them get rid of the excess skin of the stomach that is unaffected by diet or exercise. The fact is that diet and exercise simply cannot remove the skin laxity that comes from pregnancy and/or weight ﬂuctuations. An abdominoplasty, on the other hand, can return the abdomen to a beautiful shape that looks great in slacks and swimwear.”
“Tummy tucks are very commonly requested following childbirth or weight loss,” agrees Otis Allen, MD, of Bloomington, Illinois. “This procedure is not a substitute for weight loss but is very useful for tightening muscles and restoring contours. Patients are often surprised to learn that the removed skin and fat usually weighs less than three pounds. Often this surgery results in clothing ﬁtting better, rather than a smaller dress size.”
Abdominoplasty is a major surgical procedure that tightens the skin and, when necessary, can reduce fat and modify muscles. A full abdominoplasty generally requires a horizontal incision just above or within the pubic area. The length of the incision and the resulting scar, which extends laterally toward the pelvic bones, depends largely on the amount and location of the skin to be removed. The contour of this incision will vary somewhat according to abdominal structure and personal preferences — such as the style of swimwear or undergarments that you typically wear. Based on these and other factors, your plastic surgeon will discuss with you the incision length and contour that he or she recommends for achieving the best result in your particular case.
Men and women who are not obese but are troubled by a bulging abdomen that won’t respond to diet or exercise and by loose skin in the abdominal area may be good candidates for an abdominoplasty.
“Patients for abdominoplasty range from those who just need some tightening of the skin, without any muscle plication, to those who have excess skin and fat, and considerable muscle laxity,” says William H. Huffaker, MD, of St. Louis, Missouri. “What we are able to accomplish makes a signiﬁcant difference in their appearance and their lives. The results of their abdominoplasty can often inspire them to take better care of themselves. Many of these patients begin to eat better and exercise regularly, which of course adds further improvement to their health and appearance.”
Women who have had multiple pregnancies are the most likely to have a condition called diastasis in which the muscles of their abdominal wall have separated vertically and cannot return to normal; this condition can be successfully treated at the time of the abdominoplasty.
“The effects of pregnancy on the abdomen are fairly obvious,” says James M. Nachbar, MD, of Scottsdale, Arizona. “The uterus is usually about the size of an orange. During pregnancy, however, the growth of the baby stretches the uterus, which then presses on the inside of the muscle wall of the abdomen. At the front of the abdomen, the two vertically oriented rectus muscles (the ‘six-pack’ muscles) get pulled apart, and actually separate. Once that has happened, nothing other than surgery can bring these muscles back together. Exercise can’t do it, since there is no muscle in the midline for you to exercise.”
“Tummy tucks are performed to correct problems with the abdomen resulting from pregnancy, weight loss, or weakened muscles. The muscles and skin become stretched and can’t return to their normal position. Unfortunately, sit-ups and leg lifts don’t correct the problem,” agrees Allen O. Guinn, III, MD, of Lee’s Summit, Missouri. “Weight loss helps, but usually the problem is an excess of skin and muscle length. The muscles need to be tightened and the excess skin and fat surgically removed. The operation is tailored to the individual needs of the patient, from where the incision is placed, to whether it is a mini, moderate or full tummy tuck.”
An abdominoplasty, or tummy tuck, can effectively remove loose skin and excess fat from the abdominal area, tighten the underlying structure, and restore a more youthful body contour. It can also remove stretch marks in the lower abdomen. By horizontally tightening the fascia (a sheet of connective tissue extending from the rib cage to the pubic bone between the layers of fat and muscle), an abdominoplasty may somewhat narrow your waist. The procedure will leave the skin tighter, effectively making the body look leaner and more youthful. An abdominoplasty will, however, produce a permanently visible scar. This scar can usually be positioned so that it remains completely hidden by your usual style of swimwear and undergarments.
“Body contour surgery has entered a new era in which the simple removal and ‘tightening’ of the skin is no longer the end point. What is critical is restoring contour and youthful fullness in the areas of the buttocks, hips and thighs,” says Lawrence S. Reed, MD, of New York, New York
“This understanding of form has been too long overlooked. As body sculpture continues to rise in popularity, we can expect an even greater appreciation of restoration of contour and volume, which is a critical part of the overall rejuvenation process.”
Any stretch marks in the upper abdomen, higher than the belly button, will not be improved by an abdominoplasty. A tummy tuck will not narrow your hips. If you have localized fat deposits in your hips, your plastic surgeon may recommend liposuction of these areas in order to improve your body proportions. In some instances, for safety reasons, it may be recommended to postpone liposuction and perform it separately from your abdominoplasty. The determination of when such combined procedures are appropriate will be made by your plastic surgeon after evaluating your medical history, current health and the extent of surgery required in your particular case.
“Very often, women who come in after their childbearing is ﬁnished need both a breast augmentation with some lift and some abdominal work,” says Peter Hyans, MD, of Summit, New Jersey. “If they are of relatively normal weight and their abdominal problem is mainly conﬁned to skin laxity, I combine the procedures. If they need a signiﬁcant amount of liposuction, however, I will not combine them. I usually keep these patients in the hospital overnight.”
“Abdominoplasty is an outstanding technique for restoring or improving the contour of the abdomen following pregnancy or massive weight loss. Because it most frequently involves dealing with changes of the abdomen as a consequence of pregnancy, I often combine it with other procedures — whether it is restoring the size and shape of the breast, or liposuction of the inner and outer thighs,” agrees Otto Placik, MD, of Arlington Heights, Illinois.
“Although I rarely suggest surgery on areas a patient does not mention, I feel it is very important in patients seeking an abdominoplasty to evaluate their upper outer hips or ﬂanks. For a number of these patients, liposuction of these areas is essential to achieve balance and proportion with their new ﬁgure,” says Eric Mariotti, MD, of Concord, California.
“Combining flank and hip contouring of the back with some liposuction in the front can give these abdominoplasty patients a beautiful outcome,” agrees John R. Moore, MD, of Franklin, Tennessee.
“Ninety percent of my patients undergoing abdominoplasty also have liposuction of the sides and around the back. This is by far the most signiﬁcant aspect in narrowing the waist,” says Steven K. White, Sr., MD, of Myrtle Beach, South Carolina. Liposuction of the abdominal region itself is often performed in conjunction with abdominoplasty and is considered by some surgeons to be an intrinsic part of the procedure.
“Many people require some liposuction as part of this procedure, and this can be done at the same time without doing two separate procedures. It’s less costly and the patients have one recovery period,” says David L. Abramson, MD, of New York, New York.
“The two most important questions about tummy tuck are: How much liposuction can we safely do with a tummy tuck procedure and still provide a safe operation, and what roles do factors like a patient’s age, hormonal replacement therapy, and weight play in the safety of tummy tuck procedures?” says George Sanders, MD, of Encino, California. “More and more patients in their 60s are requesting abdominoplasty. We want to provide the safest procedure possible and minimize the risk of blood clots. One approach I use is to avoid, as much as possible, tightening the abdominal muscles. Basically, the less surgery one does, the safer the patient is.”
“I will not do very much liposuction at the same time as I perform an abdominoplasty,” says Gene Sloan, MD
of Little Rock, Arkansas. “I place the patient’s safety ﬁrst, and I’m very conservative in my approach.”
“I think liposuction is an invaluable adjunct to abdominoplasty,” says D’Arcy A. Honeycutt, MD, of Bismarck, North Dakota. “I’ve had some great results by the judicious use of liposuction. I limit my undermining, however, so that I avoid any possible wound healing problems. I also may liposuction the anterior hips, the ﬂanks, and the waist. So that the mons pubis maintains its correct position, I always sew it into place before performing liposuction. These patients will often have back rolls and hip rolls, and I turn them from side to side on the operating table in order to effectively reach these areas with the liposuction cannula.”
“An abdominoplasty shouldn’t just be viewed as just removing excess skin and fat from the abdomen,” agrees Jonathan Freed, MD, Auburn, California. “I like to contour everything from the breast down to the pubic bone, and on the back to the back of the hips. It’s important to include as much liposuction as possible. However, I perform 75 percent of my abdominoplasties as two-stage procedures. The second stage comes about four months later when I do a small, 30-minute touch-up liposuction on the lower abdomen.”
“I use a combination of liposuction and skin excision to tailor the surgery to the patient’s physique,” adds Kaveh Alizadeh, MD, of Garden City, New York. “I combine all my abdominoplasties with a little bit of liposuction in the waist area so the abdomen and waist ﬂow together and form a natural contour,” says David V. Poole, MD, of Altamonte Springs, Florida. “That way you don’t end up with a ﬂat tummy and a wide-looking hip or waist area. I won’t do liposuction above the incision, on the abdominal flap, as I think you risk having some healing problems.”