Is it better to get lipo first before my tummy tuck?

Question

Hi I am a bigger lady but I am pretty happy with my size at 5”7, 200 lbs. I am getting a tummy tuck to get rid of some stretch marks and extra skin on my belly. Wondering if in general it’s better to get lipo first?

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  I find that most patients will want some additional liposuction after a tummy tuck.  The reason for this is because during a tummy tuck we don't want to be too aggressive in the flank area because of the blood supply.  I would suggest doing the tummy tuck first and if you want some more definition then consider doing aggressive laser assisted liposuction after the tummy tuck, minimally 3 months after having the tummy tuck.  Best of luck to you.

Jeff Angobaldo, MD · Answer

This is very dependent on your surgeon. Some prefer to liposuction in addition to the abdominoplasty surgery, some surgeons make patients wait 6 months after the tummy tuck to do more aggressive liposuction since the blood supply could be compromised when doing lipo along with the abdominoplasty. We recommend our patients get within 10-15 lbs of their end goal weight and then proceed ahead with surgery. It lessens complications and if you get the abdominoplasty too soon and plan to lose more weight, you could end up with loose skin again. Best of luck for your procedure in the future!

Jason Emer, MD · Answer

Thank you for your question. For best results, I recommend a hi-definition procedure like VASER liposuction, which can be performed at the same time as a tummy tuck, depending on skin laxity. I use VASER HI DEF with ThermiRF and fat grafting to get the most fat removal, skin tightening, contour and definition. This combination will give you the most toned result. I recommend getting a formal evaluation with a hi definition physique expert. Best, Dr. Emer

Rodger Shortt, FRCSC · Answer

I typically would do an abdominoplasty first followed by liposuction as a touch up if needed. It often is not. I think that if you do liposuction first you will more than likely still need a tummy tuck. Although it is not a good idea to combine excessive lipo suction a small amount can be done at the same time as a tummy tuck

Alex Campbell, MD · Answer

Thanks for your question. It is hard to advice you without seeing photos or doing an in person evaluation. Tummy tuck, also know as abdominoplasty, is a procedure to remove excess skin and fat from the lower abdomen and to restore the weakened abdominal wall, giving a firmer and smoother appearance.  We nearly always add liposuction to our tummy tucks to sculpt the body 360 degrees to achieve an ideal feminine figure.  Tummy tuck is a very powerful technique in the right hands, and can have dramatic results if done correctly.  You definitely have to choose your surgeon correctly and make sure that he/she has the training and experience to meet your goals with absolute safety.  Don’t settle for less than a Board Certified Plastic Surgeon with specialized expertise in this procedure.

Kenneth Hughes, MD · Answer

An exam would be necessary to make that determination.  Best to be somewhat near your goal weight prior to having the liposuction.  Liposuction will be appropriate with fat excess. Liposuction will allow you to have stubborn fat resistant to exercise and diet removed from unwanted areas (hips, stomach, thighs, back) and will result in a waist as small as possible. Liposuction results are highly surgeon dependent as the skill of liposuction rests in removing as much fat as possible while leaving the skin smooth. If there is loose skin or the skin has poor quality, a tummy tuck may be the better option. A standard tummy tuck does not involve liposuction, but most of my patients have the combination surgery.

Andrew Turk, MD, FACS · Answer

The decision to perform liposuction and abdominoplasty depends on your consultation with a board certified plastic surgeon.  It sounds like with your  stretch marks and extra skin, the abdominoplasty should be performed as the priority surgery. Liposuction can be performed on adjacent areas, such as flanks and back area during the abdominoplasty procedure.If abdominal liposuction is performed first, then  only fat would be reduced, not addressing the skin.    With the  subsequent tummy tuck performed at a later date, the plastic surgeon may encounter greater  scar tissue during the surgery.The best way to determine if liposuction or abdominoplasty should be performed is with visiting a plastic surgeon for evaluation with a history and physical exam.

Francis Johns, MD · Answer

Thank you for your question.A tummy tuck will take care of the abdomen, removing the excess skin and tightening the abdominal muscles. Typically I perform it in conjunction with liposuction to the hips to help contour everything. Liposuction can also be done on the upper abdomen and flanks to further improve the result. This decision is up to you and your surgeon, based on what results you are trying to attain.

Donovan Rosas, MD · Answer

Concerns about the appearance of the abdomen are very common among patients consulting with a plastic surgeon. Just like every patient is different…so too is every abdomen. Different problems require different solutions. Your board certified plastic surgeon is uniquely trained to identify the problems as well as the appropriate solution.
The abdomen is commonly addressed via liposuction or abdominoplasty (“tummy – tuck”). Which procedure is best is dependent upon the source of the problem. 
Excess fat deposits underneath the skin can be addressed via liposuction. Liposuction will not address any other issues and may worsen the situation if there are other factors at play (such as skin excess and muscle laxity, see below)
Commonly patients concerns are centered around issues of excess skin as well as fat. A third factor, which is often overlooked by most patients is abdominal wall muscle laxity (typically seen in post partum mommies).  The tummy tuck, also known as abdominoplasty is a surgical procedure designed to eliminate excess skin and fat and tighten the muscles in the abdominal wall to create a smoother and slimmer contour. The tummy tuck is designed to target areas of the abdomen that have not responded to diet and exercise, making it particularly popular among people that have a lot of loose or sagging skin around the abdominal area due to significant weight loss, as well as women with excess skin and stretched abdominal muscles following pregnancy and childbirth. 
Candidates for tummy tuck should be already at or near their ideal weight for optimal results. It is recommended to women that are planning on becoming pregnant to postpone the procedure until they are finished having children. 
Liposuction alone, while an option, would not address all of the issues common in a "mommy tummy" i.e. skin excess, muscle laxity and excess fat. There are alternatives including lipo with BodyTite which uses RF heating to address skin laxity as well as subcutaneous fat excess. There are also non-invasive means of addressing muscle laxity such as EMSculpt which uses HiFEM (high frequency electromagnetic waves) to induce muscle contractions and strengthen and tighten your core in a non-invasive fashion. These are all options, however, the abdominoplasty is the gold standard in your particular case for rehabilitation of the abdominal area.With regards to the order in which they are undertaken, liposuction first would temporarily worsen the appearance of lax skin (until excision via abdominoplasty). Abdominoplasty first, avoids this temporary worsening but will leave you with residual fullness of the abdominal flap which can only be addressed once healing is complete.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Jonathan Berman, MD · Answer

Liposuction and tummy tuck are two techniques that go together well for optimal re-contouring of the midsection. In some cases, the two are actually performed at the same time. There are some benefits to having liposuction performed separate, either before or after your procedure, but this decision will ultimately depend on your specific concerns, your trouble areas, and your surgeon's preference. Make sure you meet with a board certified plastic surgeon to ensure the safest, most effective results from your procedure.

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