Do I Need Lipo on the Hips with a Tummy Tuck & is It Safe? (photo)

Thank you for your question. Congratulations on your marathon and fitness following your pregnancy.

You are in good shape but do have some lax skin which you notice. More importantly to your question is that you do have excess subcutaneous fat beneath the skin.

liposuction to remove the excess fat especially in the flank area but also in the upper abdomen will improve your tummy tuck results.

During a tummy tuck it is difficult to get optimal tightening of the skin when there is excess fat beneath the skin of the abdomen, because the fat prevents downward pulling and tightening of the skin following your surgery.

It is very important however that the liposuction be limited and judicious and not be aggressive. You need to discuss this specifically with your surgeon. I almost always do liposuction in conjunction with my tummy tuck procedures but I am very careful not to be too aggressive because aggressive liposuction during the course of a tummy tuck can interfere with blood supply and injure the skin.

Please consult a plastic surgeon who is certified by the American Board of Plastic Surgery, very experienced in tummy tuck and liposuction surgery, and who has an excellent reputation in your community.

I usually perform liposuction at the ends of the incision of a tummy tuck to reduce the tendency to have a "dog ear" or bulge at this point, and to improve the contours of the flank areas. The pubic area is also frequently suctioned so that it doesn't stand out under the tight lower abdomen. The amounts of fat removed are usually small, and the risks are much smaller than compared to treating larger areas (hips, thighs).

    Liposuction of the flanks and tummy tuck can be safely performed, and it will create a better result by narrowing your waist (and hips) if you want.  Kenneth Hughes, MD Los Angeles, CA

After three children, it is likely that the connection between your stomach muscles has weakened.  This may account for a lot of the bulge that you see in your picture.  One of the advantages of a tummy tuck is that this weakness can be corrected during the procedure.  As for liposuction, I try not to get too aggressive with suctioning the abdominal area during a tummy tuck because I don't want to jeopardize the blood flow to the undermined skin.  Besides, when you remove the excess skin from the lower part of the abdomen, much of the fat will come out with it.  Liposuctioning to other areas such as the hips in conjunction with a tummy tuck is fine.  I often do liposuctioning to other areas in conjunction with a tummy tuck.

Almost all of my tummy tuck patients also receive some liposuction to the front side of the love handles.  I think it helps to blend the transition between the tummy tuck site and the non-operated back side.  This combination is very safe.  There are endless combinations of liposuction in other areas and tummy tucks.  Some of these are safe and some are not.  You will need to discuss what other areas you are considering with your surgeon and get their opinion.

There may be some issues about simultaneous TT and liposuction on the lifted areas if not done carefully. It does not appear from the photos that you will need any lipo in the lifted areas. 

You  should expect a nice improvement with a TT in terms of tightening the abdominal muscles and removing excess skin. I can't quite tell from the photos alone if you would benefit from liposuction in the flanks (side of the abdomen), but if you do that is a safe addition to a TT, as would be any area outside the field of the abdominal surgery field. 

When you are ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.