Can I get away with lipo and no tummy tuck? (Photos)

Question

43 y/o with 3 kids (one was a c section). I’m 5’9” and weight 169. I’m scheduled for a breast aug/lift and TT but would like your opinion on whether my stomach can be flat with just lipo. I’m really physically active. Can not add more workouts to my schedule but I am copping away t those “Covid 15.” Doc said my stomach muscles are separated but I can stick my fingers in the middle so I’m not sure?

Alan Gonzalez, MD, FACS · Answer

Thank you very much for your question, in the photo, I cannot see that you have excess skin in the abdomen, however, for a flat abdomen result it is very important to be able to identify how your abdominal wall is, have you had pregnancies ?, evaluate your rectus abdominis muscles, and determine whether or not they are separated (diastasis) in the case that your abdominal muscles are separated, my recommendation is to do a mini tumytuck so that the result is what is expected, in the case that your muscles and andominal wall are in perfect condition, my suggestion is to make a liposculpture and combine it with technology such as jplasma that will allow the skin of the abdomen to stick and prevent saggingLiposuctionThe surgical procedure of liposculpture,may or may not be associated with technology. Many times the characteristics of these lumps under the skin or retractions are secondary to a conventional fat extraction technique. We handle fat from the use of laser technology, which is light, or vaser, which is internal ultrasound associated with microair (PAL- Power ssisted liposuction) the first two devices allow us to vase or Laser produce lipolysis (is to pass the fat of a solid state to a liquid state so that there are no irregularities under the skin) and the microaire or the PAL allows us to make the extraction of the melted liquid without so much trauma.The problem in your case, is that not only has the sequelae of the lipo, but besides, I think you can have a little diastasis of the abdominal muscles secondary to pregnancy.It is important to be able to evaluate the case a little more to determine if only with a new lipolysis from the combination of technology can be improved. If it is only a lipolysis of the body contour, we will be able to improve the appearance by 50% towards 70% of the result you currently has; because fibrosis behaves as a scar inside the tissue and it is very difficult to be able to remove it completely. Associated with that if the skin is flaccid in order to give a little more reaffirmation, we complement it with a technology called Jplasma, the equipment is known as Renuvion, this produces plasma energy and this produces collagen retraction working inside the tissue The liposculpture that we practice is always associated with technology. What we use is Vaser, that is, internal ultrasound, laser, which is something from the light that is produced from the breakdown of fat, these two equipment fundamentally to produce lipolysis that is to pass fat from a solid-state to a liquid state This allows us to maintain that patients are not left with fibrosis or irregularities under the skin. As a complement always use microaire for the extraction of fat that is liquid, and in the final part if it is the case that the patient requires because it presents sagging skin in determinate areas, arms, back, abdomen, etc we use Jplasma, which is a specific equipment to produce
Liposuction with technologies
For the back, the ideal would be definitely to do an lipolysis associated between vaser and microaire combined with j-plasma to produce skin retraction (it is a tension inside the skin), and finally also a back lift, leaving a scar for remove excess of the skin that is left over. The reduction of fat through high-tech equipment and skin reaffirmation, will give us the best result; a toned skin and a scar that must be left in order to remove the skin that is left over

Casey Anderson, MD, FACS · Answer

I generally do not try to "get away with" things in surgery as it does not work out for the patient. You appear to have minimal fat and excess skin. I think it would be reasonable to do liposuction with bodytite with the understanding that nothing happens to the muscles and there is a possible risk of the appearance of a bit of excess skin.

Leyla Arvas, MD · Answer

Hi, if we do only liposuction your skin would sag. I recommend you to make it with tummy tuck . After tummy tuck you would have flat stomach.

Gary M. Horndeski, MD · Answer

After 3 pregnancies and 1 c-section, it is most likely that your abdominal has been stretched and damaged. Liposuction only removes fat and does nothing for the abdominal wall. If you want the best results and hourglass figure then I recommend a tummy tuck. If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

John L. Burns Jr., MD · Answer

Liposuction would benefit you but would not address any of your skin issues:  loose skin or the underlying muscle which usually needs to be tightened after having kids.  A tummy tuck would give you a much flatter and tighter abdomen but would required a long hip to hip incision.

Daniel Barrett, MD · Answer

Dear slgirl,
based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kenneth Hughes, MD · Answer

Your shape will be determined by how the surgeries are performed, how much tissue is undermined, how much tissue is removed, how much fat is extracted, etc. The key here is not the procedures performed but how these procedures are performed. Most patients get an immense benefit with maximal liposuction of the abdomen, sides, and back to obtain the smallest waist possible. A TT with muscle tightening will create a flat abdomen and would also provide the benefit of placing your incision along the lower pubic region

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Although you may be a good liposuction candidate to improve contour, it will not provide you a flat stomach, nor will it result in muscle or skin tightening.  The best treatment advice can only be offered after an in-person examination of your tissues.

Jonathan Heistein, MD · Answer

Hi.  I think you could do you liposuction instead of a tummy tuck. It would certainly help the contour of your abdomen. But liposuction cannot tighten the part of your abdominal wall that has been stretched from pregnancy, so a tummy tuck would give you a flatter and more tight overall look. Of course, it is much more surgery and much more downtime to have a tummy tuck, but the results are usually worth it.  Ask your surgeon to discuss the expected results with each surgery so that it can help you make the right decision.  Best of luck!

Robert M. Tornambe, MD · Answer

I appreciate your concerns and desires and it appears from your photos that liposuction alone certainly is an option for you. However, after three full-term pregnancy’s with C-section, chances are that your abdominal wall and muscles are stretched out, and a tummy tuck would allow tightening of the structures and provide a much more dramatic result. Discuss the pros and cons of each option with your board-certified plastic surgeon. Good luck.