Tummy Tuck vs Liposuction

The most common question in the mind of patients that are considering a tummy tuck is: Do i need a tummy tuck or could I have liposuction, instead?

while tummy tuck is designed to remove loose abdominal skin and to tighten abdominal muscles, a liposuciton only removes excess abdominal fat. therefore, If you perdominately have excess abdominal fat, then liposuction is a better choice for you. many women who have had children find that despite loosing weight after their pregnancy they still have a "pooch". This is not due to excess fat but as a result of abdominal wall laxity, Its correction requires a tummy tuck or a "mommy make over" which is a combination of a tummy tuck and breast lift!

To decide whether you are a candidate for a tummy tuck, you will want to examine:

1.  Skin.  Is the loose skin below the belly button, above the belly button or both?  Despite what you hear,  loose skin cannot be tightened with lasers or creams.  It needs to be removed.  If the loose skin is primarily below the belly button, a mini tuck may suffice.  If it is above and below the belly button, either a fully tummy tuck or a minituck with a reverse abdominoplasty (done through breast lift scars) may be an option.   Another new option is the 'medium tummy tuck" in patients where it is not possible to remove everything through a low incision.  Here, a longer incision is made, a new belly button is fashioned

2.  Fascia.  This is the deep layer lining the muscles.  Is the stomach flat or does it bulge out, especially around and below the belly button?  If the fascia is loose priarily below the belly button, a mini tuck may suffice.  However, it is often better to perform a hybrid tummy tuck, or full tightening of the fascia through a short incision, in fit patients who don't have a lot of skin excess.  This is a new option that was not available previously.  Also available is endoscopic tummy tuck, where through portholes the fascia is tightened.

3.  Fat.  Is there excess fat?  Liposuction can be combined with any of the procedures above.  Don't expect liposuction to tighten skin or fascia.  It won't.  Also don't be misled by claims that anybody has designs on their special surgery that can be performed under local anesthesia.  Any surgery can be performed under local anesthesia, just with varying degrees of discomfort on the part of the patient.  Lasers are useful for many purposes, but they have no proven advantage in the performance of surgery other than to increase the cost and possibly kill skin.

4.  Hernias.  Is there a hernia?  Sometimes around the belly button there is a sensitive bump that can be pushed back in.  Hernias can often be repaired at the time of tummy tuck.

Now, what to do about it?  A few years ago, there were three options:  lipo alone, a mini tuck or a full tummy tuck.  Now there are many in-between options.  You may not necessarily be stuck with a long incision.

Now things are more complex.  The available techniques have expanded to:

1.  Lipo alone - remove fat.  Doesn';t tighten skin or fascia

2.  Mini tuck (or variation) - small incision, lower fascial tightening only

3.  Hybrid tummy tuck - short incision, small to moderate skin and fat removal, full fascial tightening (requires endoscopic experience on the part of the surgeon)

4.  Endoscopic tummy tuck - several small incisions, full fascial tightening, no skin removal

5.  "In-between" tummy tucks- medium or long incision, vertical incision on top of the lower horizontal scar; or possibly mini tuck combined with reverse abdominoplasty

6.  Full tummy tucks - long incision, considerable skin and fat removal, full fascial tightening

7.  Body lift / bariatric surgeries- flank extensions / body lift procedures to augment full tummy tucks, usually performed in patients who have had large weight losses.

That being said, the only one in the world who can answer the question of whether you are ready for surgery or not is you, not your doctor.  He can only tell you what your options are, what in his opinion the best choice is, and whether you are a candidate for a procedure. 

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The most ideal / typical candidates for a tummy tuck are:

1. Those who have had children (often multiple pregnancies).

2. Those that have had massive weight loss (usually post bariatric or lap-band patients).

These patients both typically have:

1. Loose hanging skin with some stretch marks that extend from the belly button (sometime even above it) to the pubic area.

2. Bulging of the upper abdomen due to muscles that have been stretched out due to the cycles of weight gain / weight loss and have lost their ability to "snap back". In simple terms, this is sort of like a pair of sweat pants that have lost their elasticity. No amount of exercise (weight loss, sit ups) will help this.

So a tummy tuck is not a just a procedure to remove loose hanging skin, but to also re-establish the muscles of the abdomen and give one further improvement in their body contour.

Whether or not it's an option for you depends on:

1. The presence of the above factors (loose skin, stretch marks,etc)

2. The amount of excess skin you have (you might be a candidate for mini tummy tuck with some liposuction)

3. Whether you are willing to trade-off a moderate to fairly lengthy scar for an improvement in your abdominal contour.

4. If you have primarily fat deposits that might be amenable to liposuction

5. Whether or not you are at or at least close to your ideal body weight.

Having said all this, my personal experience has been that most patients (greater than 90%) are extremely satisfied with the results and say they would do it again. So if it's something you are seriously considering, definitely set up a consultation with a plastic surgeon in your area.

Generally speaking, most patients who come in for a tummy tuck (abdominoplasty) have had children before.  They may have excess fatty tissue, excess or loose skin, and possibly loose abdominal muscles or separation (diastasis recti) with or without stretch marks.  Adominoplasty will address all of these issues.

Some women are fortunate enough to retain a tight abominal core following childbirth and may retain good elasticity and thus only require liposuction.

Have your plastic surgeon evaluate your abdomen to let you know your options.

The Center For Aesthetic Plastic Surgery

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