It is True That Most Belly Fat on Most People is Behind the Muscle and Cannot Be Removed?

It is true that belly fat is located both in front of the abdominal muscles (subcutaneous fat) and behind the muscles, inside the abdominal cavity (intra-abdominal fat). It is also true that only the subcutaneous fat in front of the muscles is accessible for removal with liposuction or direct surgical excision or noninvasive techniques. It is not true, however that most belly fat is located behind the muscle in most people. In fact there is much variation depending on sex, age and individual characteristics, but a significant percentage of belly fat is usually present in the subcutaneous layer in front of the muscle. It is also not true that the amount or percentage of subcutaneous fat, in front of the muscle, cannot be easily determined. Whatever belly fat can be pinched is located in front of the abdominal muscles. If there is any doubt, an ultrasound or CT scan can measure the exact thickness of the subcutaneous fat layer.

Both men and women have intraabdominal fat in the mesentery and omentum, both of which enlarge with weight gain. Likewise, there is a layer of fat outside the abdominal wall musculature, but beneath the skin, which IS able to be sculpted via liposuction, Vaser liposuction, power-assisted liposuction, water-assisted liposuction, SlimLipo (laser-assisted liposuction), etc. The issue is further complicated by the fact that some women have had children, stretching the abdominal wall and the fascia between the rectus abdominis muscles (the 6-pack muscles), causing the belly to bulge even if there is little fat inside or outside! These patients may come in for a liposuction consultation, and may actually have little fat, but rather a stretched abdominal wall from pregnancy that requires abdominoplasty and rectus sheath plication (tummy tuck with muscle tightening). Men with round bellies may have inside fat, outside fat, and sometimes both--but only the outside fat is removable by liposuction (of any kind). That is why few men require abdominoplasty, and even fewer muscle plication when tummy tuck IS done. There are some men, and women who have not been pregnant, who have had massive weight loss after gastric bypass or lap banding, and  may still have loose abdominal walls that can be improved at the time of tummy tuck surgery or belt lift with muscle repair.

Some patients may have a firm, round belly where it truly is difficult to determine the exact proportions of inside and outside fat, but usually it is fairly easy on examination to determine which patient is appropriate for liposuction and which requires weight loss!

Abdominal fat is composed of both visceral fat, or omental fat,  the fat around the intestines and located safely behind the muscle wall and the supramuscular fat above the rectus abdominus (six pack muscle) wall. As a generalization, men and women tend to put fat on in the visceral fat , but the extra fat gets deposited in women as lower abdominal supramuscular fat and outer thigh fat, and men tend to place it in the love handles.  Certainly both men and women who have excess fat can have a significant mass in the supramuscular upper and lower abdominal areas.  During consultation with me, patients are examined in different positions to help identify where most of the fat is positioned.  I am then able, as was your doctor, to inform my patients if they are a candidate for liposuction.