I am 35 and have had 2 C-sections. I do have a acummulated fat in the lower part of the abdomen and on the flanks. I had a recent consultation with a Plastic Surgeon who mentioned that I may be happy with Lipo alone, but could benefit from lipo+ mini tummy tuck (he says only a smalll % of people can actually qualify for it). I don't want the added risks involved with another procedure, and not the cost if would not make a drastic difference. He did say my skin is not in bad condition ...I do have some extra skin, but nothing sagging. You can notice it if I bend, for example, or move etc....It seems to be a lot of hype about samrtlipo and the benefits of skin Tightening. Would that be enough to have a flat tummy? Also, I don't like the idea of general anesthesia. Can a mini tummy tuck be performed under local+sedation, maybe?
Liposuction Vs Mini Tummy Tuck?
Doctor Answers 54
Depends on what the problem is
Which procedure you choose depends on what is wrong and how it can be fixed. Most women who have had at least two children and two C-sections have several problems: Loose skin, a C-section scar with irregularities, extra fat, loose fascia. If you choose not to fix any of these problems, the unfixed problems will still remain and most likely make you unhappy with your results.
1. Loose skin. If skin is loose, it needs to be removed to achieve a good result. This will involve either a mini-tuck (this removes just a little excess skin just on the lower abdomen) or a full tummy tuck (if lots of extra skin is present). A mini-tuck does nothing for loose skin above the belly button. Some doctors claim that lasers tighten the skin. I have yet to see a study where laser even approaches the results of a tummy tuck.
2. Loose fascia. Fascia is the deep layer covering the muscles. It often bulges in the lower and central abdomen after childbirth. The muscles separate. Loose fascia can be tightened with an "internal corset" with minimal skin excision when skin is not loose (hybrid tummy tuck) or with considerable skin and fat excision (full tummy tuck). Mini tucks do not tighten fascia above the belly button. If skin is removed from below the belly button and the lower abdominal fascia only is tightened, a "mini tuck look" can result, with a flat lower abdomen and an overhanging upper abdomen. If the upper abdominal fascia is bulging, patients may want to consider a hybrid tummy tuck or a full tummy tuck.
3. Fat. Fat can be removed with liposculpture. However, if the overlying skin is loose, liposculpture gives generally poor, uneven, cellulite-like results. Fat removal can be combined with a hybrid tummy tuck or a full abdominoplasty.
4. Scarring and irregularities from C-section. This can be fixed with a scar revision. This can be performed with a mini tuck, a hybrid tummy tuck or a full tummy tuck.
Your doctor should be able to talk about all these procedures with you and allow you to make the choice which suite you best. But please, don't take a shortcut route and be unhappy with your inadequate results.
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The best procedure depends on your body and how tight a result you want
When patients come in after having children, there are usually issues of excess skin and muscle laxity. Often there is extra fatty tissue as well and C-section scars with overhanging tissue rolls. There are several ways to approach these issues.
Liposuction alone is the most limited approach. No technology has yet been developed that will make our skin shrink better than nature will allow! So, if you have stretch marks, rolls of loose skin, or skin that shakes easily when you wiggle it with your hand, you will not get a tight result from ANY kind of liposuction alone.
A mini tummy tuck removes a small amount of skin in the lower abdomen and tightens the muscles up to the umbilicus. This is a limited procedure and there are not very many good candidates for it. If you have muscle laxity in the upper abdomen as well as in the lower abdomen (and most patients do!), you will have a buldgy upper abdomen if all you do is a mini abdominoplasty. Its like squeezing a tube of toothpaste at the wrong point.
A full tummy tuck gives the most dramatic result with the muscles tightened all the way up the abdomen and the skin removed from the umbilicus down to the pubic hairline in most cases.
Make sure your plastic surgeon does all of these procedures so they can help you sort out which is best for you and which will give you the results you desire. Also, make sure they work with a Physician Anesthesiologist (not a Nurse Anesthetist) so that the proper and safe anesthetic technique will be applied to your procedure.
Patients will determine what will benefit them
The basic question with any cosmetic surgery is asking what are the anatomical conditions that make you look the way you look and what do you want to achieve as an end result. It is a relatively simple puzzle of how to get from A to B. The procedure will be determined by answering these questions, not the other way around.
The abdomen is affected by a number of anatomical components: intra-abdominal contents including fat and organ, muscle mass and tone, extra-abdominal fat in many locations and layers, and amount and quality of skin. The C-section scar may help or hinder certain procedures. Liposuction will merely remove fat; skin tightening (i.e. scarring) is unpredictable. Skin excision may help with contour or shape, but is predominantly a determinant of skin tension or texture. Inany situation, when you sit or bend, the skin will become loose. Skin excision may help this situation but will not eliminate it. Muscle tightening might help if your muscles are separated or weak but cannot completely overcome posture and tone issues.
Sit down, or stand, witht your surgeon and carefully discuss what is going to make you happy. If muscle tightening is not a signifacant part of the final procedure, it is possible to do liposuction and a mini-abdominoplasty under sedation and local anesthesia, but you need to discuss this with your surgeon to see if he is comfortable with that. Surgery such as what you are looking at must be a collaboration between patient and surgeon.
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Smart Lipo is not so Smart!
Tumescent liposuction tightens the skin significantly if the Plastic Surgeon is aggressive with Liposuction. Smart Lipo is just a Hype and there is nothing smart about it.
Considering that you have had two c-sections, there is a high likelihood that you have poor skin elasticity, especially in the lower abdomen. Therefore, doing a mini-tummy tuck along with lipo is a very good idea. Otherwise, you will most likely have some redundant and wrinkled skin in the lower abdomen.
Although all these procedures can be done under local anesthesia, the extent of surgery would be very limited. Meaning that what a doctor can accomplish under general anesthesia is usually more dramatic than under local anesthesia.
The risks of either method are not different as long as you have an anesthesiologist. Often times, patients who are have liposuciton under local aneshtesia don't have an anesthesiologist monitoring them, and this can be a risky thing, especially that during local liposuction patient do also recieve intravenous sedative and other medications.
Lipo with a mini-tummy tuck.
It's difficult to know exactly what the best option is...
It's difficult to know exactly what the best option is for you without an examination, but in general if you have some skin laxity now, chances are liposuction alone (regardless of it is conventional lipo or smart lipo) may not be enough, especially if you have had C-sections and the scar is stuck down to your abdominal muscles, creating an indentation or "shelf".
Options include tummy tuck, tummy tuck plus liposuction done at the same time (this needs to be done very carefully to make sure everything heals properly) or lipo and tummy tuck done as 2 separate procedures.
While having a general anesthetic may be concerning, for most healthy women the risks are very low. In general I think it is very difficult to get good abdominal wall contour, tightening of the abdominal muscles, and removal of excess skin and fat with only a local anesthetic. This is why second opinions can often be very helpful, if for nothing else than to confirm your first surgeon's assessment.
Sounds like you should do the mini-abdominoplasty.
If there is loose skin, this may improve or may get worse after liposuction of your abdomen depending on your skin elasticity. If your plastic surgeon recomends the mini-abdominoplasty, you would probably benefit from it. You already have a portion of the scar from your C-section. I frequently do a miniabdominoplasty at the time of abdominal liposuction in patients who need the benefit of skin tightening. This can very easily be done with just light sedation and local anesthesia, even with muscle tightening.
Your Best Outcome
Your desire to avoid a larger operation is very understandable, and I agree that you should- but only if the more minor operation will achieve your goals. I do believe that you should always have the smallest operation necessary to make you happy, but just as important is understanding that the only thing worse than being unhappy with your abdomen is having an operation and still being unhappy... so if the more minor operation is unlikely to achieve your goals, you would be better off finding a surgeon you're really comfortable, planning well for the recovery, and saving a bit more to have the operation that will result in your satisfaction.
It has been my experience that patients who have lost skin elasticity and need some form of a tummy tuck are never happy with liposuction alone (no matter what type of liposuction). Only a qualified surgeon can give you (after a careful exam and review of your goals) a good idea of how likely you are to get what you want through the various options.
Think carefully about what you want, how unhappy you'll be if you don't get there, how much you'd like to avoid the larger procedure, and the costs involved, and discuss it openly with the surgeon you choose. You'll know what's best for you in the end.
A mini tummy tuck certainly can be performed safely...
A mini tummy tuck certainly can be performed safely under sedation. In fact some surgeons would tell you that it would be safer than general anesthesia for a procedure such as this. Liposuction works very well for some people but given the extra skin and c-section scar you would likely have a "better" result with the mini-TT. I offer Smartlipo and some ladies in exactly your situation have been delighted with the result but you need to understand that skin tightening from Laser or Smartlipo is not nearly as strong as skin removal with a tummy tuck. In the end it comes down to how much of a result you are looking for...
Lipo vs mini tummy tuck
Without being able to examine you, it is impossible to be sure what the best option for you would be. I think it is most likely, with your history of a C-section scar and extra skin, that you would benefit most reliably by a mini-TT. I also feel that this is best done under general anesthesia, which should have very low risk given your good health.
Of course, you may get enough improvement from either liposuction alone or esp by the Smartlipo (this may be more beneficial for extra skin tightening). However, having the skin directly excised is going to be the most reliable.