Liposuction alone vs. Lipo with a Mini Tummy Tuck after 2 C-sections?

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.

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.

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...

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.

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 a GA, 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.
sincerely,
david berman md
deberman08@comcast.net
bermancosmeticsurgery.com

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.