Endoscopic Tummy Tuck - Surgery Through the Belly Button?

The endoscopic tummy tuck indeed exists. You probably can't find much about it because there are few patients for whom this is an effective procedure, and most of the patients suitable for this procedure are actually men.
A standard tummy tuck removes and tightens skin, tightens muscle, and removes some fat.
Liposuction only removes fat, leaving the muscle and skin unchanged. In fact, if the skin is loose and a lot of fat is removed, the skin can look looser after lipo.
Endoscopic tummy tuck only tightens muscle. it does not remove any skin at all. If there is extra fat, liposuction can be done at the same time.
The problem is that most women that complain about their tummy usually have loose skin in addition to loose muscles. Women that seek a tummy tuck because of a large weight loss usually have very loose skin, and often muscles that are not very loose. Sometimes they need their muscles tightened, but usually they need the opposite of what an endo tummy tuck does: they need skin removed but the muscle left alone.
Women that have had their muscles stretched from babies almost always have had their skin stretched, too. Not always, but most of the time. The only ideal candidate for an endo tummy tuck is someone with fairly smooth and tight skin - even when sitting up in a chair undressed - and laxity of the muscles (what we call a rectus diastasis - meaning that the two muscles that are joined in the center have been spread apart, usually by the pressure of the uterus.)
This procedure was touted widely when it was first described in the nineties, but after the initial enthusiasm settled down, it became clear that it was true that it was a great procedure, but that there weren't a lot of women who were best suited for it.
And even when women are well-suited for it, there is often a C-section scar, so either reusing that scar or extending it a bit can result in tightening of skin, and there are few women who couldn't benefit from that. So at the end of the day, there just aren't that many women for whom this procedure is well suited.
However, there are a lot of men who for reasons that are not understood get separation of the rectus muscles of their abdomen, but otherwise have good and tight skin. Most of the endoscopic tummy tucks I have performed have been on men in this situation.

Hello, and thank you for your question about whether an endoscopic tummy tuck — performed through the belly button — is possible.

Technically, yes, an endoscopic tummy tuck does exist, but it is very rarely performed today. The procedure is designed for a very specific group of patients:

Those who have tight, good-quality abdominal skin

Minimal to no excess skin

Some muscle separation (diastasis recti) that needs repair

Very minimal fat deposits in the abdomen

During an endoscopic tummy tuck, a surgeon makes a small incision inside or near the belly button, inserts a tiny camera (endoscope), and uses specialized instruments to suture and tighten the abdominal muscles internally. However, no skin is removed, and only very minimal fat contouring can be done.

Because most patients seeking tummy tucks also have loose, sagging skin after weight loss, pregnancy, or aging, the endoscopic approach doesn’t address the primary concerns that most people want corrected. That’s why it’s not commonly offered — it simply doesn't meet the needs of most tummy tuck candidates.

In practice, most experienced plastic surgeons, including myself, do not perform endoscopic tummy tucks, because most patients are better served with traditional approaches — whether that's a full tummy tuck, a mini tummy tuck, or a lipoabdominoplasty. These techniques not only tighten muscles but also remove excess skin and fat, providing a much more complete and satisfying result.

If you're concerned about the idea of a hip-to-hip scar, it’s important to know that surgeons today work very hard to place tummy tuck scars low, typically below the underwear or bikini line, and the scar fades significantly over time for most patients with good healing. Most patients ultimately feel the scar is well worth the dramatic improvement in their contour and confidence.

Thank you again for your great question. It's always smart to explore your options thoroughly — and with the right surgeon, you can find the approach that fits your anatomy and your goals best.

Wishing you the best on your journey toward feeling your absolute best.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

If you’re considering any type of tummy tuck, make sure to consult a board-certified plastic surgeon, review their before-and-after photos carefully, and have a thorough discussion about the best technique to achieve your goals safely and beautifully.

 

1.       An endoscopic tummy tuck can be a great way to tighten up the abdominal wall for a select group of patients that do not want tummy tuck incisions.

 

2.       It is performed using an endoscope and camera like that which we use for a brow lift or your surgeon uses to take our a gall bladder

 

3.       The resulting incision can be as short as 4” in length and would be in the area of a standard         C- section.  This is the perfect option for a patient that already has a C-section scar.

 

4.       The surgery is performed by lifting the skin and tightening the abdominal wall with special threads made to be used with the endoscopic instruments.

 

5.       Speak to your board certified plastic surgeon and schedule a full evaluation to see if you are a good candidate for this approach.

 

I hope this helps and good luck!

Although possible, few patients are candidates as the only purpose would be to bring the separated muscles (rectus abdominus muscles) together. As no skin or fat is generally removed with this procedure it would result in minimal results and in most patients - unhappiness.

Endoscopic tummy tuck is a procedure to tighten the abdominal muscles after abdominal wall laxity. Through a small incision, the muscles are brought together via stitches. in my practice, I have never seen anyone who has not needed more than muscle tightening. Almost everyone also needs removal of some skin and fat in the form of a mini- tummy tuck or a full tummy tuck.

A classic tummy tuck removes excess skin and fat and tightens lax muscles. If your problem is strictly limited to the muscle layer, an endoscopic tummy tuck may be the right choice. It tightens the muscle layer while limiting the scar. Excess skin is not addressed. It can be combined with liposuction if there is excess fat.
This is not appropriate for the typical tummy tuck candidate, where there is lax abdominal wall skin. It is most commonly performed in men with significant rectus diastasis, or separation of the abdominal wall muscles.
I always look to limit scarring and the tell tale signs of having had surgery, but not at the expense of compromising the result. Talk to a board certified plastic surgeon who is familiar with all of the variations of the tummy tuck to find the best approach for you.
Good Luck!