What does "undermining" mean when referring to a tummy tuck?

Doctor Answers 17

Undermining during a tummy tuck

Thank you for your question. Undermining refers to lifting the skin and fat layer off of the muscle layer so that the skin can be pulled down and tightened. Once the skin is lifted up and advanced down the excess lower skin can be removed. Undermining also allows the surgeon to see the muscle layer from the ribs down to the pubic bone so that the muscle layer can be tightened. Good luck.


What this means is the the skin and fatty tissue layer are elevated off of the abdominal wall so they can be pulled down to tighten the abdomen.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 56 reviews

Definition of undermining

Undermining means to erode the base or foundation. It also means to damage or weaken. This is true in surgery as well as in other things. When plastic surgeons undermine an area , we weaken or divide the connection between the skin and the body wall. It allows us to lift the skin and stretch it down. But the other part of the definition is also true. The more you divide and lift the skin, the more you divide the nerve and blood supply. If the nerve supply is out, you are numb. If the blood supply is out, the skin dies. So, where's the balance?
Any thoughtful plastic surgeon will divide only that which has to be divided to get a good result. That's also why operating on smokers or those with other causes of poor circulation can be a really bad idea. 
That, by the way, was one of the big reasons that liposuction was often limited with abdominoplasty. The technique of lipo-abdominoplasty has shown us that it can all be done safely but with intentionally limited undermining.

Peter D. Geldner, MD
Chicago Plastic Surgeon
4.7 out of 5 stars 24 reviews

What does "undermining" mean?

"Undermining" is a surgical term used to describe dissection below the skin that takes place beyond the location of the incision.  The technique is used to facilitate advancement of the tissue from where the undermining took place.  In reference to a tummy tuck, the dissection takes place from the lower abdominal incision up towards the rib cage to lift the skin and fat off the abdominal muscles.  This allows the abdominal skin to be pulled down tight to optimize your results.  Without the undermining, it would be very difficult to pull the abdominal skin down due to the attachments to your muscles.

Erik Miles, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 25 reviews

What does "undermining" mean with a tummy tuck?

When we do a tummy tuck, we make an incision through the skin and cut straight down through the skin and fat to the muscle layer.  We then lift the skin and fat off the muscle heading upwards towards the chest.  This is what is known as undermining the skin.  When we have freed up the skin and fat from the muscle, we can then pull the extra skin/fat down like a window shade and trim off the excess skin/fat before we put it back down and sew it into place.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Undermining simple means opening a pocket

Undermining simple means opening a pocket between the skin and fat layer and the underlying muscle layer.  This is how we get access to the muscle fascia for repair in an abdominoplasty

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

What does "undermining" mean when referring to a tummy tuck?

Thank you for the question. Undermining in a tummy tuck is the process in which the surgeon cuts in the layer between the fat and the muscular fascia of the abdomen. In this the surgeon is not just elevating your skin and fat from the belly wall but also releasing the fibrous septae which keep your skin adherent to the underlying muscle wall.  In this way the skin and fat are "mobilized" so as to allow maximal advancement of the skin and fat and therefore maximal removal of same. I hope this helps.

What is "undermining" in regards to a #tummytuck

Hi Spev, Thank you for sharing your tummy tuck question.  The term undermining refers to when the incision is placed low on the abdomen, but all of the skin on the front of the abdomen (belly) instead of just going stright down it goes up all the way to the rib cage. Then the skin on top is like a blanket and slides down as if you're making your bed, and the wrinkles get smoothed out. I hope this explaination is helpful and wish you all the best.

Brian S. Coan, MD, FACS

Brian Coan, MD, FACS
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 52 reviews


It describes lifting the skin up from near the pubis upto the rib cage areas.  That then allows extra skin to be pulled down and removed.

Undermining is the region where the surgeon "lifts up" the skin

There are different techniques of performing an abdominoplasty. A traditional technique is where the surgeon removes an ellipse of skin (think of a flattened football shape) from the belly button down to the hair-bearing region. The skin from the belly button up to the ribcage is "lifted" off of the abdominal wall (all blood vessels and nerves are cut during this process. This is what is called "undermining".) Now that the skin is free from attachments, it can be stretched down to cover the area where the ellipse was removed.)

I hope that makes sense. Please look at the video on my link, as it has an animation that will help explain the term. (Don't worry, it doesn’t' show any real surgery or blood.)

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.