2 c-sections? Am I a good candidate for Smart Lipo on the abdomen? (Photos)

Question

I am 5’9 and weigh 211 pounds. I am considering having plastic surgery. I would love to have Smart Lipo because it requires less down time for recovery. I even thought about BBL with fat transfer from my stomach to get a flatter look. I’m fine with the stretch marks I just want to appear slimmer on in the front and sides. What do you suggest?

Thomas Wright, MD · Answer

Ti,  Thank you for your inquiry and sending pictures. It appears from your pictures that much of the fat in your stomach is internal or below the muscles.  Smart Lipo and or a Tummy Tuck can't address the internal fat.  Either of these surgeries probably won't give you a flat stomach without some additional weight loss. Smart Lipo could give you a flatter look and a slimmer waist, but I won't give you a flat stomach or skinny waist.  My recommendation would be to try to lose 20 pounds and you could get a better result.

Jason Tomsic, DO · Answer

It is ideal for patients who have specific areas of localized fat deposits and have tried unsuccessfully to eliminate them through diet, exercise and weight loss.

Kenneth Hughes, MD · Answer

Many varieties of liposuction are available including ultrasonic, smart lipo, and conventional lipo. Healthy people at their ideal weight should have the best overall recovery from a TT and liposuction, but some of this will depend upon the surgical technique and adherence to postoperative protocols. Liposuction, combined with the standard TT, will allow you to have stubborn fat resistant to exercise and diet removed from unwanted areas. A TT with muscle tightening will create a flat abdomen and would also provide the benefit of placing your incision along the lower pubic region. The TT also creates a more youthful belly button.

Daniel Barrett, MD · Answer

Dear Ti2020,
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. Flanks liposuction would give you a better shape. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Harry T. Haramis, MD, FACS · Answer

Unfortunately, you appear to have deep fat, inside your belly which is not removable with Smart Lipo or tummy tuck.

Best results would be a tummy tuck with 360 liposuction plus BBL after weight loss of the deep fat.

An exam and consultation with a plastic surgeon is recommended to better discuss your options and expectations.

Marco A. Pelosi III, MD, FACOG, FACS · Answer

Good news first: lipo can improve your back and sides to give you a tighter waist and a smoother back. The front has 3 problems that lipo can't fix. First, you've fat deep inside your abdomen called visceral fat which is creating the beer belly shape. This can only be reduced with dieting and weight loss. Second, you've got a large diastasis in the middle from top to bottom. In other words, your six pack is widely separated. This requires a tummy tuck with muscle tightening after you lose weight. Third, you've got loose saggy skin. This also requires a tummy tuck. So do your back and sides with lipo whenever you want, then do a tummy tuck when you've lost weight and you will achieve your goals.

Victoria Falcone, DO · Answer

Selecting the right procedure requires careful decision making. Your expectations play a big role in selecting the right procedure. From the photos, it appears you may have some visceral (organ) fat and a rectus diastasis (loose abdominal muscle). Liposuction can only remove the fat you can pinch that is above your abdominal muscle. There is no form of liposuction that can remove fat under the muscle. 
If you want a flat abdomen, you would require a tummy tuck.
You mentioned that you do not mind your stretch marks but with the level of stretch marks you have, your lower abdominal skin will not fully retract even with Smartlipo. Smartlipo can achieve some very impressive skin retraction but it won't eliminate the loose nature of the skin. The skin will still jiggle after use of the Smartlipo laser but in clothing, the fit and appearance will improve. 
You would benefit tremendously from body contouring on your sides and back. Liposuction of your low back, flanks, upper hip and bra line will give you a more hourglass figure. The skin quality of your back appears to be good so the result will be noticeable. You may be happy enough with your buttock shape once your sides and back are improved. 
Fat transfer procedures require much more downtime, 1 week that you should not sit at all and 8 weeks total that you should not place any pressure on your buttocks. If you are looking for less downtime, you may want to skip the fat transfer.
Because of your size, I recommend that you consider Vaser and Smarltipo in combination. Vaser is very effective in emulsifying larger volumes of fat. Then the Smarltipo Triplex can be used during the same procedure to enhance skin tightening. This will allow for a larger volume fat reduction with enhanced skin tightening. 
Best of Luck in your decision making.
Dr. Falcone

Scott C. Lindsay, DO · Answer

Thanks for your question! I don't think that SmartLipo is the right answer for you. Although it has a longer downtime, a tummy tuck is definitely the way to go. Lipo or SmartLipo would leave you with a lot of loose hanging skin. More importantly, before you do anything surgically, I would advise losing a little bit of weight. These photos make you appear as though you carry a fair amount of fat intrabdominally (under the muscle wall). We can't address that with lipo or tummy tuck. I would suggest losing at least 20 lbs before moving forward with surgery. Good luck!

Michelle Copeland, MD, DMD · Answer

Thank you for sharing your photos! Although it is difficult to say without an in person examination, if you have good skin elasticity, you should be a good candidate for liposuction. Liposculpture as an outpatient procedure under I.V. sedation can reduce the bulge that some people have in their calves and ankles and restore a more shapely leg. Unlike other areas of the body the ankles, calves, and knees require a certain delicacy which is why I use several innovative forms of liposuction, including SmartLipo, to contour and resculpture the area while providing the most beautiful results with minimal scarring. 
Liposuction works best on patients who are of relatively average weight, but who need help with a problem area, and it can reduce and improve the contour of the thighs, calves and ankles . SmartLipo, used in combination with other forms of liposuction, is a procedure that uses laser light to liquefy fat and tighten the surrounding skin. It’s thought to involve less downtime and side-effects than traditional liposuction and is particularly good for small areas of fat deposits like the ankles. New technology that's gentler and faster than ever before not only allows the removal of fat, but also resculpts the abdomen. I suggest making an appointment with a board-certified plastic surgeon for consultation to discuss your options.
For people who don’t want surgery CoolSculpting is also an option to help reduce fat in selective areas, such as the abdomen and arms. The CoolSculpting fat-freezing procedure is the only FDA-cleared, non-surgical fat-reduction treatment that uses controlled cooling to eliminate stubborn fat that resists all efforts through diet and exercise. After CoolSculpting, treated fat cells that die are naturally eliminated from the body. This process is not as rapid as invasive procedures, such as liposuction. Typically, the most dramatic results are seen in 1-3 months after treatment.
Another non-surgical option for your buttock is EMSCULPT –  the only non-invasive procedure to help both women and men build muscle and sculpt their body. In addition to reducing fat of the abdomen and buttocks, EMSCULPT helps builds muscle to create a tighter, more defined look. It can also help improve diastasis recti, or the separation of the abdominal muscles from pregnancy. And with no downtime! I suggest making an appointment with a board certified plastic surgeon for consultation to discuss your options.

Leonard Grossman, MD · Answer

As seen in your photographs, you have quite a bit of extra loose skin. Laser liposuction or any form of liposuction is not going to improve on that extra skin. you absolutely have to lose some weight and follow up with a full tummy tuck. Tummy tuck surgery can be combined with a BBL. I hope this helps and good luck from New York City plastic surgery

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