Denton Doctors

Liposuction Vs. Tummy Tuck - What's the Difference?

I've had 3 kids and definitely need some help in my stomach area, but I'm not sure if I would need liposuction, a tummy tuck, or both to get the pre-baby look I want. 

The decision on whether to do an abdominoplasty (tummy tuck) vs. LIposuction is actually quite simple if you can just break it down to answer 3 questions

1. How thick is your "fat layer" ? is it too thick for your liking ? Can you grab it in your hand and feel excess fat ? If this is true, then you need to either lose weight by dieting or you may be a candidate  for liposuction to reduce the thickness of this layer
2. Do you have excess skin that is a significant issue for you ? Women are individuals and tolerate certain amount of lax skin differently, but if it is intolerable to you then skin tightening is mandatory. The gold standard for tightening skin is through an abdominoplasty in which the entire abdominal skin is elevated along with the fatty layer and the excess skin is removed. 
3. Is there abdominal wall / muscle laxity. This assessment often requires your surgeon's evaluation to be sure. However if you feel below the fat layer and can tell that not only is your abdomen bulging due to fat, but also due to a protuberant abdominal wall, then the muscle layer must be tightened. 

Tying these concepts together you would benefit from 

• Liposuction : if you only have fat excess only with minimal to no skin laxity accompanied by abdominal wall firmness. 
• Skin only abdominoplasty : if you have skin excess only with great abdominal tone and flat muscle layer. the recovery for this type of tummy tuck is much less painful with much less downside.
• Full abdominoplasty with muscle tightening : if you are a typical mom who has had her muscles and abdominal wall stretched out of position resulting in a lax abdomen and excess lax skin

A final question is what do I do if I have all 3 problems. Personally I will carefully in some patients perform both  liposuction and tummy tuck at the same time. With experience I feel it is possible to carefully perform such a combination with excellent and dramatic improvement. However if you have a significant amount of fat to be suctioned, I strongly recommend that you do the liposuction AFTER the tummy tuck. There is a common misconception that you should have the liposuction first. At first glance this makes sense, thinking that there would be greater skin laxity you could then tighten with a secondary follow up tummy tuck. However, 25 years of experience and teaching has proven to me that after liposuction you create stiff scar tissue in the fat. Fat is usually very very mobile which allows the skin to be stretched maximally. However I can never get all the excess skin out after liposuction due to the scar tissue contraction in the fat layer after liposuction. there is no question in my mind that the order should be tummy tuck first followed by liposuction. This combination yields dramatic results. 

I hope this helps. It is a very important and common question. 

Jay Burns, MD

Dallas Plastic Surgeon

Choosing a Dr. for Breast Augmentation, If a Doctor has had a Bad Review Should I Keep Looking?

Hello,I was recently informed that the Dr. I had in mind for awhile is responsible for symmastia(a fellow JBI member informed me that she had this complication after having her breast augmentation done by him a few years ago) Now I was comfortable because a lot of my friends (5) have all had beautiful results with him and to find out that someone was not pleased with his work makes me uneasy.. is this acceptable or should I just look for another Dr. Any advice?

Great question-thank you.

You want to know as much as possible about your surgeon’s skills, experience, and credentials. Although complaints on the internet could represent a problem, it is important to note that not all complaints are valid. Any patient can say anything on the internet and such complaints can not be defended by the surgeon.
Your surgeon cannot violate the privacy of his or her patients, but he or she should be able to tell you how many complications he/she has had with your surgery. You can also check Medical Practice Act, which is available to the public and is a record of lawsuits which are complaints that have been judged with evidence.

The best way to pick a surgeon is to make sure he or she is a plastic surgeon, certified by the American Board of Plastic Surgery primarily. Then ask to review photos. You should see many photos that represent quality, not just one or two. This approach does not give guarantees but simply optimizes your chances of getting a quality surgeon and quality result.

Jay Burns, MD

Dallas Plastic Surgeon

Swelling 2 Weeks and 2 Days After Facelift, When Can I Expect this to go Down?

It has been 2 weeks and 2 days after my facelift. Only my neck has a little bruising. The swelling in face has gone down a lot but there still some. My neck is more swollen and a bit lumpy. When can I expect my neck to be more normal? I hate turtleneck sweaters and I have to go back to work in a few days and I don't want to tell anyone. I want the "refreshed" and not the "surgical" look. Thanks.

Hello, thank you for your question.

Bruising and swelling are normal and should be expected. Most bruising lasts for 2 weeks but the swelling will last longer. The majority of the swelling will gradually disappear over the first 4 to 6 weeks. The times vary with each patient, but are reasonable averages. The time also varies according the procedure performed. There are shorter recovery times for more minimal procedures. The time estimates given are for full facelifts in which the deeper layer called the SMAS is lifted completely.

You should discuss this thoroughly with your surgeon to determine what patients usually experience in his or her practice. In my experience, shorter recovery times are associated with more minimal procedures with shorter longevity of result. As a patient you must have realistic expectations about your recovery. If you prioritize the quality of the result, then several weeks of swelling is usually an expectation. If you optimize quick recovery then the longevity of result is usually compromised.

Jay Burns, MD

Dallas Plastic Surgeon