Is this internal or external fat on my abdomen and back? (photos)

Question

Im 22, 5'7 and weigh 173lbs with 1 previous pregnancy 5 years ago. My waist used to measure 28 inches, I had significantly less fat and had a slimmer appearance. I am having lipo 360, arm lipo, chin lipo, and Buffalo hump lipo + BBL with Dr Karl William Schwarz in Miami this coming June and I'm still trying to figure out if I have a lot of INTERNAL or EXTERNAL fat on/in my abdomen and back...?

Finny George, MD · Answer

Hi, thank you for sharing your question. You are a great candidate for 360 Lipo + BBL. Despite having moderate internal fat, the removal of the external fat will provide you with a significantly improved shape. Good luck!

Emmanuel Mallol Cotes, MD · Answer

Thanks for the question.

In this regard, I recommend you a Tummy Tuck to get a flat abdomen and waist and back Liposculpture, getting better curves especially in the waist, improving your body contour.

Finally, I suggested take the fat we get and transfer to the buttocks and hips, to mold them and get better volume, contour and butt projection, is that we know as "Brazilian Butt Lift" (BBL).

Kind regards,
Dr. Emmanuel Mallol Cotes.-

Daniel Barrett, MD · Answer

Dear Cheerful461312,
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

Karthik Ram, MRCS, DNB · Answer

Hello.Best way to differentiate between external and internal fat is using pinch test.Grasp the fat between the thumb and forefingers.The amount of fat you can grasp will be your external fat that can be removed by liposuction.Rest will be the internal fat that requires regular exercise to deal with it.Looking at your pics  you are good candidate for tummy tuck.It will remove the excess skin and tighten your abdominal muscles.Hope that I have cleared your doubt.Thanks for posting your query.Good luck

Michael Ablavsky, MD · Answer

-Good question. One way to determine if fullness of your abdomen is from intraabdominal (fat deep to your abdominal wall that cannot be liposuctioned) is by laying flat and seeing if your abdomen caves in (scaphoid) or if it is still full and protruding. Abdomens that are scaphoid do not have a lot of intrabdominal fat - or what you refer to as “internal” perhaps. A pinch test is another good option - pinch the skin and its underlying fat to see how thick the skin flap is over your abdominal wall. This is the fat that you maybe referring to as “external.”

Camille Cash, MD · Answer

From your photos it appears you have both internal (visceral) and external fat.  You will have improvement from your liposuction, but would likely get better results from a tummy tuck.  I've included a video I hope you find helpful.

Douglas Taranow, DO, FACOS · Answer

You are a very good candidate for Lipo 360 and a BBL.  A physical exam would answer what portion of the anterior abdomen (not sides or back) is visceral fat.  You also have a significant amount of excess abdominal skin some of which will retract, but not all.  You may require some sort of skin excision later.

Darryl J. Blinski, MD · Answer

You have easily over the external 4 liters (8.8 pounds) of fat for lipo, maybe even more than 4 liters. Make sure you are aware you are booked at a clinic setting Not a private practice Plastic Surgeon.

Mats Hagstrom, MD (license on probation) · Answer

I recommend all patients have formal in person consultations preferably with multiple providers before scheduling body contouring procedures.

It would seem that your question should have been discussed during the time of a consultation.

In regards to the front of the abdomen there are four variables that contribute to shape and contour.

In other words if someone doesn’t like the way their belly looks it is always because of one or more of these four variables.

Because each variable has a different treatment it’s important to understand what the ideology or diagnosis really is.

The variables are skin laxity, excess subcutaneous fat, muscle separation from previous pregnancies call diastasis recti and lastly access visceral or intra-abdominal fat.

Based on your pictures it looks like you have pregnancy related changes which are going to be skin laxity and muscle separation both which are treated with a full tummy tuck.

To assess skin laxity pull on your skin until it’s tight and see if that improves your contour. In your case I think it will.

To measure the thickness of subcutaneous fat put your skin under a gentle tension and with one finger very gently press until you feel the underlying musclewall. You don’t have to push hard. Around your midabdomen your subcutaneous fat thickness is probably 1.5-2 inches.

I street musclewall should create a bee line between the sternum and the pubic bone.  this is most likely what yours did prior to any pregnancies.

If the musclewall sits in front of an imaginary line between your sternum and your pubic bone then your muscle wall is bulging.  bulging muscle walls are either related to muscle separation from previous pregnancies or excess visceral fat sometimes a combination of both.

To differentiate visceral fat from muscle separation takes a little practice but generally if it takes a fair amount of pressure to push your abdomen completely flat then there may be visceral fat.  Another way to check is to lay on your back and see if your abdomen drops completely flat laying on your back.

This real fat can only be lost your weight loss. Access subcutaneous fat is treated with Liposuction, skin laxity and muscle separation both require a full tummy tuck.

This real fat can only be lost your weight loss. Access subcutaneous fat is treated with Liposuction, skin laxity and muscle separation both require a full tummy tuck. In reality you probably have all four of the variables so treating one out of four will give some improvement but a limited result.  For that reason A tummy tuck with liposuction will give a much better results.

Visceral fat only affects the front of the abdomen and waist to some degree.

Delivering consistent high-quality Liposuction results is more difficult than people believe.

The following is a list of recommendations for those seeking cosmetic surgery.

1. I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

2. Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

3. Whenever possible schedule in person consultations.  
4. During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

5. Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews.  Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles. 
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

6. Avoid scheduling for surgery or making a deposit on the day of the consultation.  Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

7. Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats Hagstrom, MD

Arian Mowlavi, MD, FACS (license on probation) · Answer

What you need is a modified abdominal skin resection combined with 360 liposuction to improve your overall body contour. 360 lipo will be done to your abdomen, upper/middle/lower back, flanks VASER liposcution and Renuvion skin tightening. Please consider a virtual consultation with a high definition body contouring expert for more insight.

Is this internal or external fat on my abdomen and back? (photos)

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