Tummy tuck? Other options? (Photo)

Question

I'm a 45 year old mom of two and can’t stand my stomach. I’m 5’3 and 110 lbs so not overweight however I have never gotten my stomach back after having my second child. Is my only option a tummy tuck?, what kind? Are there any non-surgical treatments to consider or do I just need to take the plunge? I’d rather not have deep scars but I’m not sure what else to do and am super self-conscious

J. Timothy Katzen, MD, FACS · Answer

Hello Eclectic9704 in Mount Pleasant. Thank you for your question regarding potential treatments for your post-pregnancy abdominal changes.

Based on your description and the photos you've provided, it appears that the primary issue you are facing is excess abdominal skin, a common concern among mothers post-pregnancy. Given that you are not overweight but still dissatisfied with the appearance of your stomach, a tummy tuck (abdominoplasty) would indeed be the most effective option to achieve a firmer, flatter abdomen.

Here's what you should know about the procedure:

Procedure Details: An abdominoplasty typically involves removing excess skin and fat from the lower abdomen and tightening the abdominal muscles. This surgery is performed under general anesthesia and usually takes about 3 to 4 hours.
Incision Placement: The scar from a tummy tuck is strategically placed so that it can be hidden beneath underwear or a bikini. It's important to discuss the placement of the scar with your surgeon during the consultation and to bring examples of your typical underwear and swimsuits to ensure the scar aligns with your clothing.
Recovery: Recovery time generally ranges from 2 to 3 weeks, during which you'll need to wear a compression garment to support healing and reduce swelling. Drains may be placed to remove excess fluid and are usually removed 7 to 10 days post-surgery.
Additional Care: Post-operative care includes antibiotics, pain management, anti-nausea medication, and often a stool softener. Some surgeons also recommend blood thinners to prevent clotting issues post-surgery.
Non-Surgical Alternatives:
While non-surgical treatments such as radiofrequency or ultrasound therapy can offer mild tightening effects, they are generally insufficient for significant skin laxity. Liposuction, which you also mentioned, is indeed not suitable as it targets fat reduction rather than skin tightening and could exacerbate the issue of loose skin.

Given your specific concerns and goals, a tummy tuck is likely the most suitable choice to address the loose skin effectively and provide you with the aesthetic results you desire. It’s a commitment to a surgical solution, but it’s the most reliable method to significantly improve the contour of your abdomen.

Thank you for sharing your concerns, and I hope this explanation helps you prepare for your upcoming consultations. Should you have any more questions or need further assistance, feel free to reach out.

Good luck on your journey to regain confidence in your appearance.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Daniel Barrett, MD · Answer

Dear Eclectic9704,
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. 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Emmanuel Mallol Cotes, MD · Answer

Thanks so much for your question,

Whether a tummy tuck is your only option depends on your specific concerns, goals, and physical examination by a qualified plastic surgeon. There are different types of tummy tuck procedures, and the most suitable one based on your pictures seems to be Full Tummy Tuck (Traditional Tummy Tuck).

This procedure addresses excess skin and fat from the entire abdominal area, from the lower ribcage to the pubic bone. It also involves tightening the abdominal muscles to create a flatter and more toned appearance. The incision typically extends from hip to hip, but the scar can often be concealed beneath underwear or swimwear.

During your consultation with a plastic surgeon, they will evaluate your concerns and goals, examine your abdominal anatomy, and discuss the most appropriate tummy tuck option for you.

Sincerely, 
Dr. Emmanuel Mallol

Joel Patrick Maier, MD · Answer

Given the loose skin above the umbilicus, you will need to have skin excision and umbilical transposition. It looks like you have tight muscles, so a skin only type of tummy tuck will suffice. This can be done with oral sedation and local without drains so your recovery will be limited. The only significant cosmetic factor is that you will likely have a vertical scar extending from the low transverse scar as the umbilical opening may need to be closed in an up-and-down fashion. Possibly not, but also need to expect a vertical incision. Thank you.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Eclectic9704, Thank you for your photos and great questions as well!
Tummy tuck is not your only route to get back to the old you. If you want immediate and long lastly results, surgery would be the best way to go. Other non-surgical treatments are going to fall short of your expectations. Scarring is inevitable with any surgery, but there are  techniques to minimize and conceal scars as much as possible. Post-op patients can use various treatments to further minimize permanent scarring such as Scar Guard (a liquid containing steroid, Vitamin E, and silicone), silicone gel strips (such as Neosporin scar strips), and silicone ointment (such as Scar Fade).

Robert M. Wald, Jr., MD · Answer

Unfortunately, your only option is a tummy tuck. You would need a full abdominoplasty to excise all this loose skin. There is no non invasive device that can correct this loose skin. You have to accept a scar of the lower abdomen in your underwear line. Your down time is 1 to 2 weeks with no heavy exercise for 8 weeks.

David Hill, MD · Answer

It is hard to tell in the photo if you have any diastasis recti (separation of the muscles) but if not, you have what looks like a skin excess-only issue, and there are some less invasive options. While only surgery will reduce extreme skin laxity, a combination of laser therapies, collagen-building biostimulators, and heat devices will give you some degree of skin-envelope tightening. That being said, it is impossible to know to what degree you will have improvement prior to utilizing all of these, and you may have all these treatments and still require an abdominoplasty (tummy tuck) to get your preferred final result. Consulting with a surgeon will give you a greater degree of confidence if their recommendations can get your desired results!

Jonathan Heistein, MD · Answer

The only way to take care of the extra skin would be to have a tummy tuck.  You would be trading the excess skin for a long scar in your lower abdomen and around your belly button, but it would make your skin tight again.  There aren't any noninvasive options that would tighten your skin enough. Talk to a surgeon in your area to discuss the specifics of the surgery and to make sure all of your goals will be met.  Best of luck!

Tyler Frew, MD · Answer

Hi there,
You certainly have some options assuming only your upper abdomen is bothering you. I would still recommend surgical options but one that is not as invasive.
Skin tightening device- Renuvion, Bodytite are two that show good results in this area. They do require small incisions but recovery is rapid.
Reverse Tummy Tuck- this is a surgery that places the scars under your breasts and removes the excess skin from above upper abdomen. This can be a good option if your lower abdomen doesn't bother you.
You would need to be seen in person so the surgeon can assess the quality of your skin.
All the best

Ramin Behmand, MD, FACS · Answer

Indeed, it appears from the photos that you have done everything possible to regain your prepregnancy shape. And, you are in shape.  However, skin that has been stretched beyond its limits, loses its ability to tighten back up, and does not respond to diet or exercise.

You're an ideal candidate for a tummy tuck with the scar placed low, discreetly inside the bikini line. To stabilize the incision, it is supported with quilting sutures from inside, which dissolve on their own as you heal. This prevents the scar from migrating up by the newly tightened upper abdomen skin as you heal, Also, by using these quilting sutures, you will not require drains after surgery, which will make your recovery much nicer. You likely have some degree of abdominal muscle separation, and that will be fixed at the same time. It's the same recovery, and there is no point in not fixing the muscle separation while everything is exposed.  The scar will be red for up to a year, but in most people, it then turns into a thin white line, and is hardly of any visible concern.

Dr. B.

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