Who should consider a tummy tuck?

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. 

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

Frequently, patients are trying to discern whether liposuction alone will meet their goals or do they need some variation of a tummy tuck (or mini tummy tuck).

A tummy tuck (abdominoplasty) accomplishes three things:

1. It removes extra loose skin
2. It tightens the stomach muscles (that nasty bulge below the belly button that won't go away with sit-ups) that have permanently spread apart after child bearing.
3. It creates a new attractive belly button

Liposuction alone will mainly remove some of the bulk or the thickness of the fatty layer of tissue.

I actually combine liposuction with every tummy tuck to enhance the results on the sides/love handles to avoid the bulge on the sides when your central abdominal skin is tightened by a tummy tuck alone.

Some patients confuse the benefits of liposuction and tummy tuck.

Many patients tend to benefit first from the liposuction procedure to shape the body, and then have a tummy tuck to remove excess skin and improve muscle laxity. With either procedure, the patient should be near their target weight and in good general health.

In general men and women who have excess skin and fat of the abdominal wall are good candidates for a tummy tuck. I prefer that my patients get to a stable body weight prior to any surgery. This allows for a stable long-term result.

For women in particular it is a good idea to be done having children. If a women has had children she often will also have splaying of her rectus ("6-pack") muscles, which will need repair during the tummy tuck.

As far as incision length is concerned, someone can have a mini-tummy tuck if they have a little extra skin and fat centrally below the belly button. If there is excess skin and fat above and below the belly button, the incision usually goes hip bone to hip bone. In some cases, the incision goes from front to back if there is a large excess of flank skin and fat. This allows for tapering of the silhouette.

Occasionally, tummy tuck surgery is combined with liposuction to further enhance the final shape.

There are 2 options to improve the abdomen. One is liposuction and the other is a tummy tuck. There are also combined procedures utilizing both techniques.

The ideal candidate for liposuction has good muscle tone, good skin elasticity and just some extra fat under the skin. They are typically young and often have not had children nor have they lost significant amounts of weight.

The typical patient who should consider a tummy tuck has some muscle laxity, loose skin with loss of elasticity and possibly some extra fat in the lower abdomen. Basically, these people need some skin removed because theirs will not shrink more than it has done after pregnancy or weight loss. These people can be very slender and just have extra skin or they can have some redundant fat in the lower abdomen that needs removal. They should not be obese however and are best treated when they are within 20 lbs of their ideal weight.

There are 3 main anatomic components to consider in determining whether a tummy tuck surgery is a good option for a patient:

• Skin
• Muscle
• Fat

If there is excess skin (often noted by patient) and laxity of the abdominal muscle (noted by the surgeon), then one can consider tummy tuck surgery, as this procedure will reduce the lower abdominal skin excess (by resecting the skin from suprapubic region to just past the umbilicus in an elliptical fashion) and will tighten the abdominal wall musculature. This condition is usually present after pregnancies or significant weight loss.

On the other hand, if fat is the main component present, with minimal skin excess, then tummy tuck surgery is not the right option to consider. In such condition, if the fat is resistant to proper exercise and dieting regimen, then liposuction can be considered.

At times, all 3 components may be present - that is - excess skin, lax muscle and fat. Although it is tempting and often requested by patients to address all 3 components via tummy tuck surgery and liposuction of the abdomen, for anatomic and physiologic considerations (blood supply preservation to promote proper healing), aggressive liposuction of the central abdomen is usually not performed in conjunction with a full tummy tuck surgery. However, liposuction of the flanks/hips can be performed concurrently with tummy tuck surgery to enhance the overall abdominal contour.

At times, a surgeon may recommend a mini-tummy tuck surgery (which would only remove part of the lower abdominal skin) with more aggressive liposuction. Because the tummy tuck surgery is more limited in a mini-tuck, it maintains more blood supply and thereby a more aggressive liposuction can be performed concurrently. However, less skin will be removed.

Other important points of consideration include scarring. Scarring is often extensive (hip to hip), and although scars may improve with time, they are permanent. It is a trade-off - for the reduction in skin, a scar is given.

Although every measure of proper principles of plastic surgery may be enforced, there is always an element of unpredictability when it comes to scar maturation, some of which is inherent to the individual patient. Truthfully speaking, some people just simply scar better than others. Previous scars may offer some clue as to the scarring nature - e.g. - if someone ALWAYS develops hypertrophic or keloid scars - then it is most likely that poor scarring will be expected post tummy tuck surgery as well.

There are measures to facilitate better scarring post surgery - whether it is in the form of laser, massage, steroid injections, silicone sheets, OTC ointments, etc - be sure to speak to your surgeon about the various options. Also, realize that scar maturation process may take up to a year (or even longer) before the final appearance of the scar is evident, but this is not to say that appropriate interventions may not be instituted at various times to improve the overall outcome.

Another question regarding scarring that often surfaces is the placement of the scar. Ideally, we would all like to give the shortest, lowest, and symmetrical scar as possible. However, scar placement is often dictated by the anatomic considerations - i.e. - the nature of skin redundancy. A person may have more fullness or excess on one side than the other, one side may be higher or lower than the other, one side may extend further around than the other, etc, etc, etc. And depending on what is seen (and hence what is needed), the surgeon will determine the scar placement (its width and location).

Personally, I illustrate on the patient where the scar is to be placed, how long it is expected to be, and if applicable telling the patient that one side may be higher or longer than the other side (showing the patient why this is needed). I think patients need to know what to expect in terms of their scar, as this is such an important element of tummy tuck surgery. And because of the disclosure and extensive discussion prior to surgery, scarring becomes less of an issue in my practice, as we minimize "surprises."

Tummy tuck procedures are rapidly growing in popularity as more and more young mothers seek out ways in which to reverse pregnancy related changes and effective restore their Before Baby Body.

• While these procedures are performed in the same way for clients who have had C-sections, I find that these patients probably notice even more dramatic results than their non-C Section counterparts.
• I see more patients with abdominal wall laxity who have had kids than who have not.
• If a young patient consults with me about body contouring and intends to have more kids (or have kids), I recommend that she hold off on this procedure since the muscle tightening effect will tend to be reversed if she becomes pregnant.
• While more and more men continue to seek Cosmetic Surgery, the bulk of my practice is still comprised of women.

The best tummy tuck candidate is the patient who has lost a lot of weight or had children and now has stretched out, saggy abdominal skin and fat with an associated stretching of the abdominal muscles.

During this procedure, the muscles of the 6-pack of the abdomen are tightened, and the excess skin and fat are trimmed away to produce a leaner, newer you!