How Do Surgeons Address The Upper Pubic Area With A Tummy Tuck

Thank you for your question.  During the course of a well-carried-out tummy tuck, excess fat can be directly excised from the upper pubic area and the remaining tissue fixed in place with sutures.  In experienced hands, this results in an attractive, low-profile contour of this area.

You are absolutely correct with your observation that the pubic area is sometimes ignored in abdominoplasty.

I nearly always do liposuction of this area during the course of tummy tuck surgery.

If the pubic area is enlarged or sagging as is usually the case following massive weight loss, then I dip down with my abdominoplasty skin excision to remove the upper pubic skin and lift the remainder of the pubis.

Good luck!

 

It’s not
unusual for women who are considering abdominoplasty to have a prominent mons
pubis.This can occur for a variety of
reasons.In some cases, a prominent
pubic bone may be present.In other
cases, loose skin or excess fat may contribute to the problem.The treatment of this condition is entirely
dependent upon the cause of the problem.In the vast majority of patients
undergoing abdominoplasty.The mons
pubis can be addressed during the same procedure.In most cases, this involves removal of
excess fat and skin.The procedure is
associated with excellent clinical results and high levels of patient
satisfaction.If you’re considering abdominoplasty
and are concerned with your mons pubis, it’s important to consult a board
certified plastic surgeon.This surgeon
should be able to formulate a treatment plan that addresses your anatomic
findings and achieves your aesthetic goals.

Although a tummy tuck will often improve the pubic region, often a pubis lift done at the same time is required for the best result. The recovery period will not change in most cases

a typical tummy tuck doesnt include treatment of the pubic area as this varies from patient to patient.

treatment can include   suctioning, excision, both..   talk with your surgeon about your concerns

The pubic area should certainly be evaluated at the time of a tummy tuck. Some are easier to improve than others. Liposuction at the very minimum can be done in the majority of cases though the pubic skin does not shrink as much as in other areas. Pubic skin reduction can be done but it will add scars which many women do not really want. Even when not any surgery is done directly to it, it swells and remains swollen for months. It should definitely be discussed at the time of the consult.

Our current technique of tummy tucks will include the mons reduction routinely.  The enhancement of contours here involves a low incision with upward traction that raises the ptotic (drooping) mons pubis and anterior labia majora.  Be sure to ask about before and after pictures from your surgeon.  More than just a visual change, I have had patients comment favorably on improved intimate satisfaction with the anterior position of the clitoral structures with this technique.

This is a great question.  Over my 20 years as a plastic surgeon, treatment of this area has radically changed in practice.  The reason is twofold: 

Firstly, the complete eradication of pubic hair (which is disappearing faster from the planet than the Amazonian rain forest) exposes the mons area to view - it used to be invisible - and secondly, learning more about the form and appearance of the area from the development of surgery after massive weight loss, which provides many surgical challenges and learnings given the often massive skin and tissue redundancy we now see in the pubic area.

20 years ago, TT incisions were made across the top of the pubic hair.  These days, that's half way between the vulva and the belly button and looks far too high.  I still see way too many TT incisions that are too high.  Getting the incision low is the first key to an aesthetic result.  This also enables removal of a large amount of the redundant or extra skin seen after weight loss.  Secondly, if the mons is bulky it should be debulked by liposuction at the time of the initial surgery.

Beyond careful planning of the skin removal and planning the desired volume and shape of the area (which is normally all that is required for an aesthetic outcome and is all I would do at a primary TT) - if there's been a massive weight loss and a very large excess of mons pubis, then a secondary reshaping procedure of the mons area might be required.  This is specifically for those patients with massive skin redundancy, is done 6 months after the TT or body lift and comprises an aesthetic reshaping of the mons area.  This utilises skin reduction, volume reduction, and possibly labial reduction to achieve the best appearance we can achieve.

I hope this is helpful,

Good luck.

Patients who have lost a great deal of weight and present with sagging skin are difficult to surgically sculpt.  Our very crude approach is to remove extra sagging skin here and there, pull the edges together, and close.   The skin itself is abnormal after massive weight loss.  What remains often fails to shrink back and reflect the underlying beautiful and sexy musculoskeletal contours beneath.  Each patient is unique.  You do not like some results you see online, and neither do we plastic surgeons like all of our results.  Procedures available to us have intrinsic limitations.  The artistic ability of your plastic surgeon is important, and will affect your result.  There are always trade offs and imperfections however, regardless of who performs your procedure.  Listen carefully, and present each of your concerns to the surgeon, engaging in discussion until you both understand expectations, possibilities, alternatives, etc.  Lifting mons pubis excess and redistributing it naturally is an important part of a good result, both functionally and aesthetically.

When performing a tummy tuck, in our clinic the pubic area is always addressed in some way.  Liposuction to reduce the bulk, removal and tightening of the extra skin if necessary.  Just like all surgical procedures, the treatment of this area has to be based on the individual's needs.  The goal is to keep the scar as low as possible and to create a smooth contour to the tummy after a tummy tuck

Sincerely,

Martin Jugenburg, MD