I have a 3-year-old and 4-year-old. I know I need some sort of tummy tuck, but I heard there are two different kinds. Please tell me what I could do and if the stretch marks would still be visible after a tummy tuck.
How to Determine Which Kind of Tummy Tuck is Appropriate?
Doctor Answers (19)
Tummy tuck types - full vs mini vs hybrid
As several of my esteemed colleagues have pointed out, you would be best suited to a full abdominoplasty. There is a great deal of extra skin, fat, and undoubtedly fascia to be addressed.
Typically we consider tummy tucks to fall into categories, full tummy tucks and mini tucks. There is now a third category of tummy tucks, the Hybrid tummy tuck (R) and endoscopic tummy tuck category.
Here are the three categories:
Full tummy tuck. When a large amount of skin and fat are best removed, a full tummy tuck is the only option. It involves full tightening of the deep layer (fascia), temporary disconnection of the belly button on the skin (neoumbilicus), and fantastic results. The incision is long, from hip to hip. In ladies with long distances from their pubic areas to their belly buttons, the incision is also high.
Mini tummy tuck. This technique involves tightening of the skin below the belly button only. No tightening is done above the belly button. If the lower fascia is tightened but not the upper, a bulge results in the upper abdomen, the so called "mini tuck look". It is not attractive. Mini tucks involve short incisions, usually a bit longer than a C-section incision. Many doctors, as Dr. Rand so astutely notes, use predatory practices to lure women who actually need a full tummy tuck, to have a mini tuck "to avoid the long incision". Often, this is packaged with some type of laser liposuction, which is touted to tighten skin. Indeed, they do avoid the big incision, but in the process avoid the big result, too, Mini tucks are fantastic, however, for revising C-section scars only, and patients are very happy. They are not happy, however, if they are expecting the results of a full tummy tuck through a small incision.
The third category of tummy tuck is new. It involves tightening of the deep layer (fascia all the way up the abdomen, and little or no removal of skin from the lower abdomen. This type of tummy tuck is called the endoscopic tummy tuck of the Hybrid tummy tuck (R). The endoscopic tummy tuck involves very small endoscopic tightening incisions, and tightening is done completely through scopes. The Hybrid tummy tuck (R) involves a C-section type of incision, removal of some extra skin (and often a revision of the C-section incision) and full tightening of the deep fascia. This procedure involves short incisions, and is most suitable for fit moms who have not had a great deal of weight gain during their pregnancies and exercise regularly. It provides a very nice option for model-type ladies who have long waists, very little extra skin, yet the deep fascia has been ripped and bulges out from pregnancy. It requires experience with the endoscope and special instruments.
So there are the 3 basic categories. There are many, many, in between procedures that experienced tummy tuck practitioners develop as well to customize to each women's (or man's) anatomy.
Tummy tuck, mini vs full
You appear to be a great candidate for the traditional tummy tuck. That involves a lower abdominal incision from hip to hip, tightening the underlying muscle layer, removing the excess skin and possibly some liposuctioning. There are varieties of the basic procedure but generally this is the traditional full tummy tuck.
The mini makes a smaller incision and therefore does not remove as much skin. The muscles are tightened in a different fashion and the liposuctioing can be more aggressive. It has been my observation that when patients need a full tummy tuck they should not have the mini because they will not be happy with the mini results. For good results with the mini you need to be a good candidate.
Which tummy tuck?
There are different ways to do a tummy tuck and you have been given a lot explanations of how they are performed. I would like to give my opinion that you are the perfect candidate for the full classic tummy tuck; any thing else would be less than a complete correction. You will need all of the tissue layer addressed to get a nice result.
All of the stretch marks will not go away because some of them go above your belly button and you can not remove all of this skin. Chances are, most of the stretch marks will be below the belly button after the procedure.
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Appropriate Tummy Tuck
Different procedures to deal with excess tummy skin and fat have different benefits and risks. It certainly appears from your photo that you would get a nice result from a full TT which would include a muscle repair (this would improve the laxity in your central abdomen). You should obtain a consultation with a Board-certified Plastic Surgeon, with whom you can discuss these various procedures.
Choosing between tummy tuck types
As Dr. Aldea elegantly described, there are 2 fundamental types of tummy tucks - mini and full. The mini's are rare and are usually done by non-plastic surgeons whose lack of proper training and experience make them uncomfortable doing a full tummy tuck. They try to tempt the patient into this by telling them that they don't "need" a full tummy tuck even if they actually do.
The mini only addresses the abdomen BELOW the belly button and if you have any issues above the belly button (like you do), it will leave you very unhappy. A well performed full tummy tuck by a Board Certified plastic surgeon will be what you need. Most, but not all, of your stretch marks will be removed and the ones that remain will look tighter. Your muscles will be tightened and will respond to exercise better and the extra skin from below your belly button will be removed.
Remember that no 2 surgeons are alike and even Board Certified plastic surgeons all produce different results so be sure to visit a few and be sure you like what you see in their photos. I have many posted on my web site for reference. You have the potential for a very nice result!
Determining which Tummy Tuck is appropriate
There are MORE than 2 types of Abdominoplasties (Tummy Tucks) but the choice is simply split to either a "Mini" or a "Full" abdominoplasty. They are NOT the same!!
First let's go over what happens during a pregnancy. As your uterus enlarges rapidly it begins to occupy increasing parts of the abdominal cavity pushing up against the diaphragm and front wall of the tummy. The front wall of the tummy (shown on your photo) has a built in safety valve - the 2 six pack (Rectus Abdominis) muscles in the midline. These muscles split and get pushed aside (the split is called a DIASTASIS)allowing the uterus to rapidly expand and stretch the skin. As the skin stretches IT CRACKS in multiple places (as has your skin) giving rise to the stretch marks.
Once the child is born there will be some reduction in swelling and a variable amount of shrinkage BUT the rectus muscles will ALWAYS stay sideways (despite any exercise you may do), the stretch marks and the remaining skin looseness are permanent and cannot be erased by anything or tightened much by anything on the market.
With EACH pregnancy this is repeated and the results are made worse.
A tummy tuck will remove loose stretch mark damaged skin but it should DO much more than that if you go to a REAL Plastic Surgeon (see www.PlasticSurgery.org). From my review of your photo you will do poorly with a mini tummy tuck (where only the area below the belly button is treated).
In your case, a "full" Abdominoplasty would give you a GREAT FIGURE. It will tighten your tummy, marrow your waist, remove a very large amount of the loose, hanging stretch mark dotted and damaged skin completely elimination "the pooch", it could lift a sagging Mons pubis and IF a Lockwood procedure is done, it could lift your anterior thigh skin smoothing any cellulite dimpling.
Full Tummy Tuck may be asked option
Thank you for your question. Please see the link below which discusses the various types of Tummy Tuck surgery.
From your photographs it appears that a full tummy Tuck may be your best option. Stretch marks below the belly button will be removed but stretch marks above the belly button will persist but be at a lower level.
Tummy Tuck results are best if you are at or near your ideal body weight prior to the procedure.
Be sure to consult a plastic surgeon who is certified by the American Board of Plastic Surgery.
Standard abdominoplasty would be best option
You do have a prominent abdominal bulge from your pregnancies. I think you would get a satisfactory result wth a standard abdominoplasty and diastasis recti repair. I would recommend waiting 6 months after your final delivery to ensure the best repair and recovery. There is always a possibility of making a bad scar but attention to detail and using standard plastic surgical techniques can keep this to a minimum.
Tummy tuck for stretch marks
I would recommend a full tummy tuck. This will allow you to remove a good portion of your stretch marks. It appears that you also have a laxity of skin that you may be able to remove the belly button hole without leaving small vertical incision below the belly button (i.e. removing enough tissue to get rid of your old belly button hole). The full tummy tuck will also allow you to tighten abdominal muscles to give you a flatter abdomen. In addition, you should consider some liposuction of the sides and possibly upper abdomen. If you add laser liposuction to the mix, you may get some additional skin tightening as you heal to further enhance the results.
Mini or full tummy tuck?
Thank you for the question and picture.
The only operation that will give you the results you're probably looking for is a full tummy tuck procedure. In my opinion, the mini tummy talk is an operation that produces very limited results and is very rarely indicated. It involves a shorter incision but does not address the majority of the abdominal wall issues present for most patients who present consultation. For example, the area of skin excised is quite small. The abdominal wall musculature is addressed below the umbilicus leaving the upper number wall potentially lax. The appearance of the umbilicus is not necessarily addressed sufficiently.
For most patients who have had pregnancies and/or weight loss a full abdominoplasty is necessary to achieve the desired results. Of course, there are downsides (including a longer scar and probably a longer recovery time) but for most patients the benefits outweigh the downsides. It is not unusual to see patients who've had mini tummy tuck surgery present for revisionary surgery.
It is important to work with a well experienced board-certified plastic surgeon to obtain advice (based on good ethics and judgment) to improve your chances of a successful outcome and minimize the need for further surgery.
I hope this helps.
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