Hello, thank you for your question regarding whether you have sufficient skin for a tummy tuck and whether Lipo 360 and Jplasma would be appropriate. Thank you for your history and your photographs. First, we should analyze your images to determine the most appropriate procedures. You have abdominal cutis pleonasmus (excess skin), dermatocholosis (loose skin), and striae (stretch marks). Striae indicate that your skin has been stretched. You have abdominal stretch marks and vertical skin lines extending from your rib cage to the top of your pelvis. Your excess skin is due to weight gain and loss, as well as your previous liposuction. You also have excess abdominal fat, which is visible on the frontal view. Second, we should analyze whether you have vertical or horizontal excess abdominal skin. For orientation, vertical is defined as up and down (or north to south) when you are standing; horizontal is defined as side to side (or east to west) when you are standing. The type of abdomen you have can be best determined by pinching your excess tummy skin. If you can pinch excess tummy skin in a vertical dimension above your pubic region and below your umbilicus, you have horizontal excess tummy skin. Some people have both. However, based on your photographs, most of your excess abdominal skin appears to be vertical excess. Therefore, you have both excess vertical abdominal skin and excess fat above and below the umbilicus. Now, let’s discuss your treatment options. If you only do abdominal liposuction, you will be left with excess tummy skin. In fact, your tummy may look worse with isolated abdominal liposuction. Therefore, most plastic surgeons would recommend abdominoplasty (tummy tuck). There are EIGHT different types of abdominoplasties: horizontal (traditional), extended horizontal, high lateral tension, mini, vertical, lateral vertical, fleur de lis (FDL), and reverse. The most common is the horizontal abdominoplasty, in which an incision is placed low on the abdomen, and excess skin and fat from the top of the pubic region to the belly button are removed. Horizontal abdominoplasty is best suited for patients with excess abdominal skin and fat in the horizontal plane. Since you have mostly excess skin and fat in a vertical dimension, most experienced plastic surgeons would suggest a vertical tummy tuck. Some plastic surgeons also refer to the vertical tummy tuck as an hourglassing procedure. During a vertical tummy tuck, an incision is made from your sternum to your belly button and down to the pubic region. A large elliptical area of skin and fat is removed. The long axis of the removed skin is in the vertical dimension. The rectus abdominis muscle is plicated to achieve a firmer, flatter abdomen on the profile view. By performing rectus plication, the waist is brought in, giving the patient a more hourglass shape. The vertical abdominoplasty takes about 3 to 4 hours to complete under general anesthesia. Allow approximately 2 to 3 weeks for healing after a vertical tummy tuck. If you wish, and you are healthy and your plastic surgeon agrees, you can have liposuction and a BBL done at the same time as a vertical abdominoplasty. Most patients can return to activities of daily living after about two weeks. Most patients can return to their regular exercise routine after about six to eight weeks. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. Good luck. I hope that I have answered your question regarding whether you have enough skin for a tummy tuck and whether Lipo 360 and Jplasma would be what’s needed. If you have any further questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, consult an experienced plastic surgeon. Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks. Do your research. If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. (Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)
