Does subcutaneous fat under the skin get thinned out or removed before pulling the skin back down and removed? (Photos)

I am getting an abdominoplasty with Lipo to my flanks and lateral chest, but may need a little lips to lateral belly if it is not removed with the abdominoplasty. When the skin is dissected to where the ribs meet the breast plate, How long lateral is the dissection usually? nipple to nipple?

Doctor Answers 7

Comprehensive Abdominoplasty

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Unfortunately, most surgeons don't feel comfortable removing fat that exists, either directly or by liposuction,  under the skin of the abdomen. There is a long standing believe that it will potentially harm the circulation and cause poor wound healing or even cause tissue death.  This misconception has been firmly disproved, and liposuction of the abdominal wall and direct removal of deep fat (sub-scarpal fat) not only doesn't cause an increase risk of injury, but helps with diverting blood supply to the skin. In addition, progressive tension sutures also help minimize tension down low near the groin to further maximize blood flow while simultaneously eliminating the need for drains. Go visit a few surgeons that perform this kind of tummy tuck. Best of luck!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Questions about abdominoplasty

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Most of abdominoplasties are carried out with liposuction of the abdominal wall. This allows for removal of much of the extra fat. No dissection is usually done above the ribs. For your chest wall, the distribution of liposuction will be determined by where the most of the fat is distributed. As always, you should have a good idea of the intraoperative plan prior to going into surgery.

Ira H. Rex lll, MD
Fall River Plastic Surgeon
4.7 out of 5 stars 52 reviews

Tummy tuck dissection

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Thanks for your inquiry. During a full tummy tuck, the dissection is usually performed to the tip of the sternum in the middle and to the edge of the lowest ribs laterally.  No dissection is generally performed over the ribs as this is one of the most important blood supplies to the abdominal skin being raised.  Fat can be removed in the subcutaneous plane in some safe locations, ask you your surgeon and best of luck.  

Abdominoplasty technique

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The fat will be thinned using liposuction and resection. The dissection to your rib margin is used to help to mobilize skin and aid in closure.  The amount of undermining is determined by the amount of mobilization required and may only be in the midline or as lateral as the nipples.  More undermining can have the downside of more damage to the blood supply and can possibly compromise healing.

John Dean, MD
Baton Rouge Plastic Surgeon
4.3 out of 5 stars 23 reviews

Drainless Tummy Tuck May Be Possible

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If deemed a candidate, you may benefit from a #drainless tummy tuck. Silicone #drainage tubes are used by trained Plastic Surgeons for many different operations.  The purpose is to drain extra fluid that may otherwise accumulate under the skin, fat or muscle following an operation.  Patients generally find this annoying and uncomfortable and they can impede mobility and therefore slow aspects of #healing. Over the years, surgeons have improved procedures and found ways to eliminate the need for these #drains in a variety of operations; including #tummy #tuck or #abdominoplasty.

I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty.  I may use drains on a case by case basis for these patients. 
A newer option now can include the use of tissue #glue to adhere the abdominal #skin to the #muscle; eliminating any space that previously required a drain.

If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Eliminating Fat During Abdominoplasty

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Thank you very much for your question and photographs. It is common for a surgeon to include liposuction along with an abdominoplasty, to create a smooth, flat stomach. However, every surgeon will have his/her own protocol for this procedure. Additionally, the exact technique depends on the specific patient’s medical history, extent of correction, and desired results. I recommend that you put your trust in an experienced, board certified plastic surgeon. He/she will suggest the safest, most effective method for your needs and can answer any remaining questions that you may have.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 118 reviews

Does subcutaneous fat under the skin get thinned out or removed before pulling the skin back down and removed?

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You will find that exactly how they tummy tuck operation is performed may vary from one plastic surgeon to another,  and from one patient to another as well. Best, for accurate information, to address your concerns/questions directly to your chosen plastic surgeon. Communicate your goals carefully as well. Best wishes for an outcome that you will be very pleased with.

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.