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What Are Possible Causes for a Stomach Not Being Flat After the Removal of 2000cc's? (photo)

I had liposuction of my stomach and flanks 16 months ago, but despite the removal of 2000 cc's my stomach is not flat. I'm not overweight (5'2", 135-140lbs), and definitely expected a flatter stomach after the removal of approximately 2 liters of fat. What are some possible causes on my ongoing belly bulge after lipo?

Doctor Answers 9

What's the true diagnosis

It can be one or more of several diagnosis, several previously mentioned.

If you have had one or more pregnancies, you probably have some separation of the abdominal muscle layers (diastasis rectii).

Secondly, you may carry fat around your intestines. This goes by several names like gut fat, visceral fat, intestinal fat, etc. Even with a relatively normal BMI, some people carry more of that type of fat, giving a fuller abdomen. Many men fall into this category.

Thirdly, loose skin can be deceptive and look and feel like fat.

Your BMI is right at the normal/overweight border.  

My guess is that you have had at least one pregnancy and carry a little extra weight, and a significant amount of that is gut fat.  

Based on your numbers, your BMI is 25. Removing 2,000 CC's of fat from just the abdomen on someone 5'2" with a BMI of 25 would be a little unusual unless other areas were treated as well.

You have two options if you want to flatter abdomen.

  1. Lose some weight (get rid of the gut fat) and do lots of abdominal exercises (strengthen abdominal muscles).
  2. Get an evaluation to see if you would benefit from a tummy tuck.
My personal recommendation is to go with number one.

Here are some thoughts on weight loss.

  1. Eat small meals throughout the day. Many times when I talk to patients with weight issues, they tell me they eat once or twice a day. That's very bad if you want to keep you weight down. 
  2. Don't go hungry. It's tempting to think we can lose weight by not eating. In reality, we tend to over-eat after not eating for long periods of time, causing more weight gain.
  3. Be careful of foods with high glycemic loads and especially fatty foods with high glycemic loads. The perfect example is mashed potatoes (potatoes and butter/cream). Don't eat those foods. If you do, then only eat tiny amounts.
  4. Exercise is great, but it's generally not a good strategy for weight loss. Most people do not burn many calories when they exercise. There are exceptions, but most people with weight issues do not fit in that category. Exercise makes us hungry and can give a sense of entitlement to over-eat. By all means, work out! Just realize weight is 90% diet. Exercise is 90% fitness (not weight management).

Best of luck,

Mats Hagstrom, M.D.


San Francisco Plastic Surgeon
5.0 out of 5 stars 7 reviews

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Stomach not flat after lipo

your result is predictable given your preop photos
a rounded abdomen can be caused by
1.excessive intra abdominal fat around your intestines
2.weak abdominal muscles
3.separated abdominal muscle after pregnancy
4.increased fat between muscle and skin
liposuction only treats the fat between muscle and skin, you probably have a little of all the rest

David J. Goodkind, MD
New Haven Plastic Surgeon
4.0 out of 5 stars 8 reviews

Liposuction vs Abdomnioplasty

Liposuction can remove the fat of the abdominal wall but it does not tighten your abdominal muscles or address fat that is inside your abdomen, around your internal organs.  Weigh loss is the only way to get rid of fat inside the abdomen.  There is a great book called "Wheat Belly" that reviews dietary changes needed to reduce intraabdominal fat.  If your abdominal muscles are weak or separated, that will effect the shape of the abdomen as well.  In that case, muscle tighteing and repositioning would give you the tight abdomen you desire.

Marisa Lawrence, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 27 reviews

Stomach not flat after liposuction

Liposuction removes fat but it does not give a flat stomach.  A flat stomach may never happen again after pregnancy or weight gain, and a flat stomach also requires on-going abdominal exercises.  Consult with a board-certified plastic surgeon or return to your surgeon to discuss any options going forward. Best of luck. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 21 reviews

Abdominoplasty Versus Liposuction

There are 3 major questions when improvement in the abdominal appearance is desired

1. is there loose skin?

2. is there extra fat?

3. are the muscles tight?

1 & 2 can mostly be corrected with liposuction. Smartlipo in particular may be able to tighten skin to some degree.

If there is significantly loose skin and muscles that are spread apart, liposuction may actually make the appearance worse. Rectus Muscle Diastasis occurs from pregnancy. It creates a bulging abdomen, even if there isn't much fat to pinch. The only way to treat this is with a tummy tuck. A bulging abdomen is more common in male patients because men usually store fat intra-abdominally, but this can also be seen in female patients as well.

A tummy tuck will likely be helpful in addressing your concerns.

Adam J. Oppenheimer, MD
Melbourne Plastic Surgeon
5.0 out of 5 stars 86 reviews

Intraabdominal fat and muscle laxity hinder smartlipo results in some cases

ideally, you would be learning this prior to the procedure.  There is visceral fat and muscle laxity that can hinder your results.  visceral fat can be rid of by diet and excercise.  Muscle laxity would require a tummy tuck.

Marwan R. Khalifeh, MD
Chevy Chase Plastic Surgeon
4.5 out of 5 stars 68 reviews

What Are Possible Causes for a Stomach Not Being Flat After the Removal of 2000cc's?

Unfortunately your surgeon did not explain the two types of fat. The subcutaneous fat that is corrected by liposuction and the intestinal or visceral fat around your abdominal organs, that can not be operated upon. 

Stomach

At five feet two, I would like to see you at less than 140 pounds. However you may have retained fat excess skin or weakened stomach muscles requiring a tummy tuck

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Smart lipo

It appears that you have either one or both of the following issues:

1- visceral fat

2- diastasis recti

You should certainly discuss this with your surgeon

Roger Bassin, MD
Orlando Oculoplastic Surgeon
4.5 out of 5 stars 68 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.