I Have Decided to Get Tummy Tuck; but I Was Told That I Have Visceral Fat? (photo)

Visceral (or inside) fat refers to the normal fat that surrounds the intestines and abdominal content. This can not be reduced with an abdominoplasty- only with weight reduction. Outside fat refers to fat within the skin layer- this can be be reduced with surgery.

Looking at your pictures, you have components of both and I agree with the other experts who feel that you should see an improvement with a tummy tuck. That being said, to get the best possible result, we would like to plicate (or tightenting) the abdominal muscles when possible. The issue of visceral fat has to do with the fact that if a patient has too much inside fat, the surgeon can not effectively plicate the muscles. A good rule of thumb is that when you lay down on your back, if your abdomen flattens, you will do well with a plication. If however your abdomen remains protuberant when flat, there is probably too much visceral fat to do an effective plication.

I encourage you to see a board-certified plastic surgeon who can fully evalaute you and make the best recommendation.

Yes, you have visceral fat.  Everyone does.  And the only way to reduce this fat is through weight loss.  However, you also have excess subcutaneous fat and skin laxity.  You are a candidate for a tummy tuck.  I would highly recommend liposuction of your abdomen and flanks at the same time.  If you don't, you'll look squared of in the hips and will have a persistent bulge in your upper tummy area.  But this has to be done carefully by an experienced plastic surgeon so as not to raise the risk of complications.  Looks like an old scar of your upper abdomen, which can sometimes lead to skin loss just below the scar after a tummy tuck.  The best option is the surgery and also some weight loss afterward to ge the best possible result.  The muscle tightening done at the time of the tummy tuck is helpful too.  I've attached a linke to my website in case you wish to read more.

Visceral fat is fat within the abdominal cavity as opposed to the fat that you can feel in your abdominal wall, which is subcutaneous fat.  You would benefit from a new technique called Abdominoplasty with Mesh Reinforcement.  This technique has recently been in Plastic and Reconstructive Journal literature.  The advantage of this technique is the mesh will provide additional support, which will help you lose weight and maintain the reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Visceral fat refers to the fat within the abdominal cavity all around your abdominal organs.  This type of fat can NOT be reduce with liposuction or a tummy tuck.  A plastic surgeon can pinch your subcutaeous fat (that fat just behind the skin but outside of the abdominal muscles) to get an idea of its thickness.  This will give some indication of the amount of reduction in overall girth that can be obtained by surgery.  If needed, a CT scan can measure the thickness of the subcutaeous fat and also document the amount of visceral fat.  Then you and your surgeon can discuss how much improvement this surgery may offer you.  However, only diet and exercise can reduce visceral fat, and you should remember that an abundance of visceral fat would still bulge forward after a tummy tuck, detracting from the surgical result.

You should expect significant improvement after your tummy tuck, especially if liposuction is performed at same time to give you better contour. The amount of visceral fat and integrity of your abdominal muscles will also affect your final result. To reduce visceral fat, you have to continue diet and exercise. I recommend patients start diet and exercises even before their tummy tuck surgery and continue once they recovered from surgery. This allows them to maintain the surgical result over time.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Thank you for the photos which are most helpful.  The TT will address the amount of loose and lax skin above the muscle, however, the visceral fat will not really be affected by this procedure since it sits behind the muscle and really responds to diet and exercise. You will see a difference but a completely flat abdomen may not be realistic outcome.  I would revisit with your PS and get a realistic picture of what the outcome would be and if that meets your own expectations. 

In looking at your photos I agree, I think you will have a nice result.  There is some loose skin (mild pannus) from the side view that will be corrected with a tummy tuck.  There still may be some fullness left on top of the abdomen and this often requires a second minor procedure - liposuction only - to get fully flat.  Some plastic surgeons will do lipo in this area at the time of the tummy tuck; however, the blood supply is a bit more tenuous in the upper abdomen.  For this reason, I prefer to do it in two "steps" because of enhanced safety.  Visceral fat shrinks with weight loss so as you start to see the improvements, improved diet and fitness will lead to further weight loss and naturally "shrink" the residual visceral fat.

Your photos appear that you do have more than the usual amount of visceral fat. However, I also see "love handles" which makes me think that you have excess fat outside of the muscular wall as well, and your abdominal muscles appear very lax. I expect that an abdominoplasty would offer substantial improvement for you. It would remove the excess skin, the excess fat outside of the abdominal wall and tighten the muscles. Some liposuction would be necessary, but most tummy tucks require liposuction.

Through the years I have noticed that many patients had no incentive to lose weight because they continued to have a protuberant abdomen or an apron of skin hanging down. Often a TT has given them a new lease on life and they lost more weight after the surgery. Most patients have felt it was a very positive experience for them. It's important to have realistic goals.

Good luck, and thank you for your interesting question. I hope my answer has helped you.

In your case I would be close to 130 before the operation. This allows you the best chance of obtains the "flat" look. 

Everyone has "visceral fat", that is, fat inside the abdominal cavity, vs. fat beneath the skin.  The doctor is really saying that you have more visceral fat than say a skinny person.

Visceral fat, even when thick, doesn't mean you won't get a great result.  It means you won't get the same results as a skinny person.  It is a good idea to look at tummy tuck pictures of patients with a similar body type, and see if the results would be worth it to you.

 

The bigger question I think, is your weight.  Usually, we like to operate when the weight is within about 10# of your target weight.  You want to loose 25#, which is 16% of your total body weight. 

My recommendation is that you either wait until you reach your goal weight and have it stable, or reassess your goal, and see if it is reasonable or not.  I would also keep in mind that you have not been able to get the weight down.  If you really want to lose the weight, you will need to try something different.

 

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