Diastasis recti with little excess skin and stretch marks below the navel. What should I do: full TT, mini, or nothing? (Photo)

39 yo, 3 kids (the youngest is 2) and happy with overall body Kmart. I just have some skin laxity below the navel and A LOT of stretch marks. I've been thinking about skin tightening treatments but this week a PS examined me and said I have some muscle separation and that I would need a full TT to fix it. However, because I don't have enough skin to pull, he would have to bring my incision up, much higher than my c-section incision (which is VERY low). Is a surgery this big really necessary?

Doctor Answers 14

What to do?

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This situation is more common than you might think. Because there is no way to remove the majority of your stretch marks, I would recommend focusing on your skin and diastasis. It is very straightforward to simply perform some liposuction, raise the abdominal skin flap, plicate the entire length of the rectus muscles, reinsert the bellybutton stalk in the same place or slightly lower (without having made any incision around the bb - a free-float tummy-tuck), and excise whatever extra skin there is between the bb and the pubis. Nothing special about this and much underutilized by surgeons. This addresses fat, addresses the diastasis and addresses the skin - All quite adequately and with any bb scar nor vertical scar.

Get another opinion from a Board Certified Plastic Surgeon

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Thank you for referring your case which includes stretch and possible muscle separation. Congratulations on your three children the youngest of which is two.

Your photos do not fully define your problems and so firstly I would suggest a visit to a Board Certified Plastic Surgeon is probably necessary.

Following this depending on the severity of the stretch marks it may be possible to do a reduction of the stretch marks and plication of the abdominal wall musculature through a lower or mini abdominoplasty.  It may be necessary to release the umbilicus in order to achieve a satisfactory muscle plication.

I hope these suggestions help.

Best wishes.

Geoff Barnett, MBBS, FRACS
Melbourne Plastic Surgeon

Full tummy tuck with muscle reconstruction will give you an excellent outcome

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Based on these photographs you appear to be an excellent candidate for a full tummy tuck with muscle reconstruction. This will flatten the muscles, reconstruct your core muscular corset, revise the belly button, eliminate the stretch marks from the belly button to the pubic hairline, and remove the loose skin and fat of the anterior abdomen.

Those damn stretchmarks!

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If only one of the late night ads claiming stretch mark removal was truthful, you could have the perfect tummy. Since we have not figured out how to eliminate stratch marks without cutting away the involved skin, your best bet is to tighten the skin with a mini tummy tuck. This will make the stretch marks less noticeable. 
Beware of the surgeon that wants to remove excess fat that you do not have. He/she could leave you with a cottage cheese tummy!

I hope that this helps you.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 28 reviews

Tummy Tuck Pros/Cons and Sciton Joule Laser

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You look fantastic! Congratulations on having 3 kids and being in such amazing shape.

The question I would pose, is how much are you bothered by your stretch marks? You truly don't have much excess skin, and the muscle separation is not obvious in your side-profile photo. I trust that your plastic surgeon palpated the muscle separation, and of course, if you want this corrected, a tummy tuck is your best option. The downfall to surgery, other than cost and physical recovery, is a scar. Does the idea of a high transverse scar bother you more so than your stretch marks? Only you can decide.

One other option you might consider is laser treatment.

Laser treatment for stretch marks is a possibility to help reduce but not completely get rid of your stretch marks. We use the Sciton Joule laser which can be used to reduce the pigmentation of scars so that they are less noticeable. We recommend a minimum of 4 treatments. In our practice, a package of 4 treatments for scar treatment is approximately $900. Profractional therapy is also another option; this is more intense and treats scars like yours more aggressively. These treatments begin at $1000 per treatment.

A tummy tuck would remove some of the skin thus getting rid of some of the scars, but all the scars probably could not be removed. I hope this help, and good luck with your treatments.

Which treatment would work best for the abdomen

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Most of my patients would love to have a stomach as flat as yours.  In fact, I would love to have a stomach as flat as yours!!  A full tummy tuck would remove skin and stretch marks from the navel to the pubic area, however, I don't see enough excess skin here to warrant a full tummy tuck.  A mini- tummy tuck is somewhat limited in that it will only allow removal of a very small amount of skin.  The longer the incision, the more skin can be removed.  You don't have any fat so liposuction is out.  Other than the stretch marks, I don't think there is much that needs work.  I don't know a cure for stretch marks other than to cut them out and, as I mentioned earlier, you don't have enough loose skin to effectively remove this skin.  I would suggest that you schedule a consultation with a board-certified plastic surgeon who can examine you in person and review your options with you.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews


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3 kids, really? You look great, try liposuction, don't see muscle separation. See a board certified plastic surgeon for a second opinion. Good luck!

Robert M. Tornambe, MD
New York Plastic Surgeon
5.0 out of 5 stars 33 reviews

Diastasis recti with little excess skin and stretch marks below the navel. What should I do: full TT, mini, or nothing?

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Only you can decide whether or not this area of improvement is desired by you. Abdominopalsty - is an elective procedure- so if the excess skin and fat bothers you, and if you want to tighten the muscles- then yes. The final decision will be between your chosen Surgeon and yourself.  Based on your photos- you appear to be a good candidate for an Abdominoplasty. I am constantly amazed by how much skin can be removed during this operation. Good luck!

What's is the BEST Tummy Flattening for me?

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You happen to fall into a rather small group of women who have tummy muscle stretch and separation with some stretch marks and small amount of skin excess. 
What can be done would depend on the extent of pooching/muscle separation and your willingness to accept a transverse scar. Personally I would NOT recommend doing a Tummy Tuck with s high transverse scar on you. You have s very nice figure and I would not mar it by putting a high transverse scar which is not hidden by conventional panties or bathing suit bottoms. 

Your options as I see them are:
1. Do nothing. It's cheap and safe and besides you look pretty damn good already. 
2. Have HiDef Liposculpture. It will tighten the skin somewhat and create a nice shape without a transverse scar. If you do not like it you can later have any of the options below. 
2. Have a version of a MINI Tummy Tuck
a. With liposuction ( without relocating the belly button)
b. Floating the belly button and doing muscle tightening above the belly button which is not usually done in a mini tummy tuck. 
3. Have a FULL Tummy Tuck with a transverse scar hidden in your panty territory but it most likely would require a short vertical scar where the hole where your belly button exits needs to be stitched together vertically because the skin excess is too small to allow its removal. 

As you see, you are blessed to have a lot of options but need a surgeon who is versatile enough to offer you these choices and allow you to choose rather than imposing one on you. 

Peter Aldea MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon

It is optional

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Tummy tuck is always optional and never necessary.  If you can be comfortable with the way you are you do not need surgery. If you want better looking tummy you need full tummy tuck. Nothing short of full tummy tuck will do it. 

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

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