What can I do about upper abdominal laxity after 2 children? (photos)

I work out, eat healthy do most everything I'm supposed to but after my 2nd child I can't seems to get the skin on my upper abdomen to tighten up. My breasts got so engorged with my last pregnancy and since they shrunk I am left with loose skin and what seems like excess fat on my rib cage. I've been told I'm not a candidate for coolsculpting or laser lipo, what else can I do? Thanks in advance!

Doctor Answers 8

Upper abdominal laxity after Children with loose skin / fatty deposit on ribs

The procedure depends on your expectations and the extent of the procedures you are willing to undertake. The best results are with a tummy tuck as it will tighten your muscles for the laxity, remove the fat and the extra skin to give a tight abdomen.  
There are patients not willing to go through an extensive procedure and thus can be offered other procedures depending on their exam and expectations.  Liposuction may help with fat and shrink the skin if it elastic but will not help with there is a lot of extra skin as well as muscle laxity.  Also, you will realize that costs of different skin tighening procedures can add up and if your expectation are still not met, you will not be happy.  It is best to meet with a board certified plastic surgeon and review your options. 

Baltimore Plastic Surgeon
4.5 out of 5 stars 3 reviews

Loose Upper Abdominal Tissue

Great question! I agree you are not a candidate for CoolSculpting or Laser Lipo. From your pictures you are a perfect candidate for a full tummy tuck. A tummy tuck will help tighten the upper abdominal skin. You look like you are in great shape so the tummy tuck will help you get the tummy you are working so hard to achieve. Make sure you see a board certified plastic surgeon. Best of luck!

Cynthia L. Mizgala, MD
Metairie Plastic Surgeon
5.0 out of 5 stars 60 reviews

Lipo vs TT

Thanks for the question, I would say that a classic tummy tuck would tighten that skin but that since you are in such good shape you may be left with a  small vertical incision where your old belly button was, I would suggest trying some skin tightening devices first before having a big operation

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 73 reviews

Loose upper abdominal skin

Thank you for your question. Full abdominoplasty will address upper abdominal loose skin. If you want only upper part of abdominal skin rivers abdominoplasty can be done to address the issue. Pl see a board certified PS for evaluation.

Ven Erella, MD
Austin Plastic Surgeon
4.9 out of 5 stars 32 reviews

What can I do about upper abdominal laxity after 2 children?

From your photos and description, I don't think coolsculpting or laser lipo will improve your upper abdomen.  A full abdominoplasty or possibly a reverse upper abdominoplasty would be your better options.  Best wishes, Dr. Lepore.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

The correct treatment

It appears that your primary issue is skin laxity. The treatment of choice for skin laxity is an abdominoplasty.

My guess is that your subcutaneous fat layer, or the layer of fat between your skin and muscles, is quite thin. Regardless of the equipment used (laser lipo, VASER or traditional liposuction) or brand name, liposuction will give limited results. CoolSculpting will give significantly limited results. 

Your best option is most likely to either accept your body and know that your children were worth the sacrifice or undergo an abdominoplasty. 

The fullness of the upper part of your rib cage below your breasts is because of a skin attachment. Our bodies have areas where our skin is attached to our muscle layers with connective fibers. One of those is at the lower part of the rib cage. When people have skin laxity, the skin will drop with gravity and pile up or bunch up at the skin attachment.

If you take your finger and move the skin up and down on that area on your rib cage, you will notice that the skin moves down to a certain point but not below that point. That is where the skin attachments are. The only way to eliminate that crease is to cut those skin attachments, which is typically done during an abdominoplasty if the procedure is done correctly. 

We have the same type of skin attachments on the back. That is what creates the crease or fold on the back for many women. As the arm is lowered, the skin drops, and the skin folds over the skin attachments, and the crease forms. 

Please see the attached link to my website and look at the patient in the right lower corner. The fullness on her lower rib cage would never be addressed unless the skin attachments were cut during her abdominoplasty.

If, by chance, you choose to have an abdominoplasty in the future and are concerned about the fullness of the lower rib cage, make sure you bring this to your plastic surgeon's attention and insist that they go up high enough to release the skin attachments. Otherwise, the fullness in that area will still be there after the procedure. 

Best of luck,

Mats Hagstrom, M.D.

Mats Hagstrom, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 19 reviews

Upper Abdominal Laxity -- Consider VASER Hi Def and/or Thermage/Velashape/Venus Legacy

Based on your photos you may be a better candidate for a tummy tuck but I had found that just upper laxity does well with hi definition energy based liposculpture with skin tightening treatments after.  I suggest seeing a well trained body contouring specialist who can evaluate you if you are caondidate for liposuction alone or with skin surgery.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

What can I do about upper abdominal laxity after 2 children? (photos)

It is hard to see much detail in these photos.  However, in some cases, you can perform a Reverse Tummy Tuck were the incision is made under the breasts and the abdominal tissue is pulled upward.  It sounds as though your breasts may also need some corrective procedure and it may be possible to incorporate some (or all) of the scars for the breast surgery into the tummy tuck scar.  You need to seek out an experienced board certified plastic surgeon to see if this (or other options) might be appropriate in your case.

David A. Caplin, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 37 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.