Paul M. Parker, MD, FACS

Given the brief history and pictures you provided, I believe a tummy tuck along with liposuction would give you a more significant improvement. Liposuction will only remove fatty tissue whereas a tummy tuck along with liposuction will remove fatty tissue, tighten loose rectus abdominus muscles and remove loose skin.

If you have not been pregnant and had children, your rectus abdominus muscles will probably be in good shape and not separated (a condition called "diastasis recti"). This would allow the surgeon to perform a tummy tuck without muscle tightening. Discuss this option with the plastic surgeon you visit. We have had several patients in our practice successfully do this because they had lost quite a bit of weight and were extremely self-conscious about their loose skin.

Based on the history and pictures you provided, I would lean toward a tummy tuck with liposuction, often referred to as a lipoabdominoplasty. This will allow the surgeon to remove excess fatty tissue, excess skin and tighten loose rectus abdominus muscles, giving you a significant improvement. Liposuction with Bodytite will allow for removal of excess fatty tissue and some skin tightening but not nearly to the extent that will occur with a tummy tuck. There will be no muscle tightening with this procedure, either. Hope this helps.

Both can be accomplished at the same surgery. You can have a tummy tuck performed along with liposuction of the abdomen and hips. At the same time, the fat from the abdomen and/ or hips can be purified and injected into your hip dip. The recovery from this procedure should be slightly greater than that of a tummy tuck alone but not excessively so. This allows for one surgery, one anesthesia and one recovery.

These approaches really should be individualized based on the patient's history of weight loss, anatomy as well as their concerns regarding ultimate outcome and scars. A FDL will reduce this abdomen in both a horizontal and vertical direction leaving both a horizontal and vertical scar--it will have little effect on the hips, outer thighs and buttocks posteriorly. A circumferential abdominoplasty will reduce the abdomen in a vertical direction as well as reducing the hips, outer thighs and buttocks in a vertical direction. It will improve the abdomen somewhat in a horizontal direction from the rectus abdominus muscle tightening but not as aggressively as a FDL.

Yes, this can be done. It is called a neoumbilicoplasty whereby the new belly button is made to look like a real one in the appropriate location. This is done by shaping the abdominal skin in the area of the new belly button using sutures to create a realistic belly button size and shape.

An elective tummy tuck should be safe but there should be careful preparation and attention paid to detail by your treating team to make your course as seamless as possible. Medical clearance should be obtained including an evaluation by a nephrologist to assess baseline renal function. The anesthesiologist should maintain adequate renal perfusion throughout the procedure with appropriate intravenous solutions. The surgeon should discuss the appropriate amount of rectus muscle plication with the nephrologist depending on your renal function. Postoperatively, avoid an overly tight abdominal binder, minimize NSAIDS and certain other drugs which might be harmful to your kidneys.

Yes, it is possible to perform a tummy tuck that only removes loose skin and tightens the remaining skin without repair of the rectus abdominus muscles. That would be most appropriate in a patient who has not had children and/ or does not have separation of the rectus abdominus muscles, often referred to as "diastasis recti". Liposuction can be performed at the same time as the tummy tuck if the patient has sufficient fat in the abdomen to be removed. I have found that patients who maintain a healthy lifestyle without significant changes in weight maintain their tummy tuck results for many years.

Given the picture you supplied, a reverse tummy tuck can be considered since it places the incision along the breast creases called the inframammary folds and can lift the loose skin you photograph shows. The scar will be present along the inframammary folds and may extend along the skin in between them. A more traditional tummy tuck can place the scar low down in the mons area and just above the groin creases. This can usually be well concealed by revealing clothing. My advice would be to find a board certified plastic surgeon near you who performs a lot of tummy tucks and obtain a consultation. They can examine you and after doing so, discuss these options in detail.

Based on your brief history and the photographs you supplied, you appear to be a good candidate for a combination of liposuction of your abdomen and a tummy tuck, often referred to as a lipoabdominoplasty. You are correct, that most often, patients who have not had children do not need muscle tightening though there are exceptions. Find a board certified plastic surgeon near you who performs a lot of tummy tucks to obtain a consultation and discuss in more detail.