Cutting out Fat for Mini Tummy Tuck Instead of Liposuction?

With abdominoplasty, whether a mini or full, my preference is to remove the fat from the central portion by directly cutting it out. Using liposuction on the part that is raised up as a flap may pose some additional risk, but it is commonly used on adjacent areas such as the waist or hips. By thinning the flap with direct removal of the fat, it gives a lot of control to the thickness and creates a surface for sutures called "progressive tension" which means less drainage (your drain can come out in a couple of days at the most) as well as good shaping and less tension along the skin closure, which contributes to good healing with minimal scar.

Dear poca,

Thank you for your inquiry. It's not uncommon for plastic surgeons to remove excess fat during a mini tummy tuck procedure, especially if the amount of fat to be addressed is limited and localized to the lower abdomen.

During a tummy tuck, the surgeon typically resects (removes) excess skin and fat to create a smoother, flatter abdominal contour. In some cases, particularly with a mini tummy tuck, where the focus is primarily on the lower abdominal area below the belly button, directly excising the fat may be a suitable approach.

While liposuction is often used to remove excess fat in other body contouring procedures, such as traditional tummy tucks or body lifts, its use in a mini tummy tuck may be less common due to the smaller treatment area and specific goals of the surgery.

The decision to remove fat directly rather than using liposuction may also depend on factors such as the patient's anatomy, skin laxity, and the surgeon's preferred technique. Additionally, considerations regarding blood supply and tissue viability may influence the surgical approach chosen by the surgeon.

If you have any concerns or questions about your mini tummy tuck procedure, I recommend discussing them with your plastic surgeon, who can provide you with personalized insights based on your specific case and surgical plan.

Best regards,

Dr. Katzen
Plastic Surgeon

I think that resecting the fat, dermolipectomy, if performed in a very limited area, is very reasonable alternative to liposuction when performing tummy tuck.

Both procedures will remove abdominal fat- in the case of the tummy tuck, the skin and fat is removed en-bloc, while a liposuction procedure removes fat discontinuously. Both procedures are effective at improving abdominal contour, but must be applied to the right patient.

I seldom see a good candidate for a "mini tummy tuck".  The surgeon who performed your operation removed fat directly as is always done with a full or partial abdominoplasty.  He might also have employed liposuction to enhance your results.  Ask him.

The way the fat is removed when sculpting the abdomen depends on where it is located.  In a mini tummy tuck, there is usually excess skin located in the lower abdomen.  A smaller incision than a traditional tummy tuck will allow removal of this excess skin as well as any fat in that area.  However, there is usually some excess fat located laterally in the love handle region as well as superiorly in the upper abdomen.  Liposuction is a good option in removing this fat since no further incisions would have to be made.  Most plastic surgeons will combine liposuction with a mini tummy tuck to give the best result.  However, the choice of fat removal is dependent on each patient's individual needs and anatomy.

Poca,
With most cases of abdominoplasty and mini-abdominoplasty, I perform both liposuction and the fat excision. However, it all depends on your fat distribution and amount of redundant or loose skin. So, there really is not a one-answer-fits-all solution as to whether cutting the fat out or if liposuction is the best answer - usually they go hand-in-hand. Hopefully, you are happy with the results you received.
David Shafer, MD
Shafer Plastic Surgery

When performing a mini tummy tuck, it's important for the surgeon to not only address any excess fat that may be present, but also to evaluate the abdominal wall muscles as well as the quality and the amount of skin. In most cases I will directly excise the fat so as to precisely control the thickness of the skin and fat that remains, and then plicate or tighten the muscles of the abdomen before removing any excess skin that's present. You can achieve good results with liposuction of this area first, but the surgeon must be cautious so as to avoid damaging the blood supply to the skin, which could cause a delay in healing. In the end, a lot of this comes down to your particular anatomy as well as the preference of the surgeon, and either technique can create very nice results.

In my practice near San Francisco we encourage patients to think of their abdomen as two parts. The first is abdominal volume, the second is the skin envelope around the abdomen. Each may have a need for cosmetic improvement and the approach for managing a particular patient must be carefully tailored for that patient.
Lipo is great for targeted permanent fat removal but not as good for skin envelope reshaping. Even with new gadgets like "laser lipo" most of the time if there is significant excess skin it needs to be removed by excision. Lipo is also not always appropriate in situations where there is a great deal of fat and in these situations excision of the fat or additional weight loss prior to surgical treatment gets patients better results.
A mini tummy tuck traditionally deals with both the skin and the abdominal volume. Some argue a greater ability to "shape" the underlying fat with lipo but few would argue the ability to remove redundant skin.
Hope this helps!
Steve Williams, MD

The main difference between an excisional lipectomy (cutting out the fat) and liposuction is the technique. Direct excisional lipectomy allows for quick sculpting of the fat without distortion from tumescent solution. However, many feel that liposuction allows for preservation of sensory nerves, blood supply, and lymphatic vessels which improve postoperative sensation, wound healing, and lower rates of seroma or fluid collections. Many surgeons will perform both procedures to complement each other. The technique used is really dependent upon your anatomy and desired goals. In summary, both are acceptable methods of fat removal.