Liposuction and Abdominal Muscle Tightening??

Question

It seems people who have tummy tucks also have lipo and abdominal muscle tightening. After having my daughter, I have always planned to have a tummy tuck, but am unsure about stitching muscles together, bc i like to work out. Id like the possibility of controling those muscles and being able to work out w/o being in pain?! Also, I notice if people loose or gain weight after lipo, they have ripply skin bc it is burning away the fat cells.Seems harmful cant you just work out? Thoughts? Thnx!

Otto Joseph Placik, MD · Answer

Stitching muscles together does not mean you can't tone them and it is not a substitute for good exercise. To give a crude example, you need braces to put your teeth closer together but you may still need to brush or whiten your teeth and maintain good oral hygiene. Re-approximating the muscles and exercise are not mutually exclusive they are complimentary.

Ron Shelton, MD · Answer

Exercise can reduce fat in some individuals but some sites are depots of fat accumulation that are very difficult to reduce, especially the lower belly and outer thighs in women. If the abdomen has been stretched with pregnancy and you are not planning to have more children, then a tummy tuck may be necessary to tighten the fascial covering around the muscle that has become loosened. All the sit-ups in the world will not tighten this fascia and the loose fascia allows the muscle to bow forward. Abdominoplasty tightens the rectus abdominus muscle covering to help keep the muscle from bulging forward which diet, exercise and liposuction would never improve.

Richard Baxter, MD · Answer

Tummy tucks do three things, depending on individual needs: Remove localized fat that won't go away with diet and exercise, tighten skin that has been stretched out from pregancies, and re-align the rectus muscles to their original position when they have been pushed apart by pregnancy. Since the muscle separation is based on pushing out in a sideways direction but they contract in a vertical direction with exercise, you can't accomplish the correction with exercise, and they will function better not worse after the repair. With lipo alone, the skin will not tighten very much (even with laser lipo) so the result will be lumpy and uneven.

Brent Moelleken, MD · Answer

Liposuction removes fat.  It can't tighten the fascia.

	Tummy tucks tighten the muscles (actually tighten the fascia which holds the muscles), remove fat and remove extra skin.  There are many different types of tummy tucks, depending on what the patient needs.

	Patients who have their fascia tightened are usually quite happy that when they do a situp, they no longer have the bulge between the muscles. 

	While diet and exercise can reduce fat, there is no way to exercise away a weak fascia.  There is also no way to exercise away loose skin.  For patients with loose skin and loose fascia, a tummy tuck gives great relief.

Lavinia K. Chong, MD · Answer

The accumulation of fat, production of stretch marks and loosening of abdominal muscular tone, including umbilical hernias, are some of the changes, which women dislike after pregnancy. The best body contouring procedure is dependent on what's "objectionable" as well as the patient's health status and aesthetic sense, as well as the surgeon's recommendations. For example, some women will reject a tummy tuck because of their aversion of a long scar, preferring a more modest improvement by liposuction. Many women who consult me are "super Moms", who loose their "baby fat" rapidly after they deliver. This subset get frustrated because despite exercising diligently, they are unable to restore the integrity of their abdominal wall. This is where some variant of a limited incision tummy tuck may be beneficial, assuming that they do not have excessive skin. In order to choose the optimal combination of techniques for your individual needs, consult with some board certified PS. They will undoubtedly give you the rationale for a circumferential approach to the trunk (abdomen and hips), as well as caution you on whether you may be at risk for liposuction contour irregularities. Good luck.

Paul Gill, MD · Answer

Tummy tuck with liposuction is the most common body contouring procedure I perform.   It delivers superb results and restores what pregnancy and age have taken away.   The concerns you raise are quite valid and I will address each:

	1. Abdominal Muscle Tightening causing pain while working out:   Although you will experience abdominal soreness during the recovery from tummy tuck surgery, you should not experience prolonged pain or weakness from this tightening.    The sutures used to tighten the muscle are actually placed in the abdominal fascia overlying the muscle.   By tightening the fascia, the underlying muscle is drawn back together.   Therfore, the sutures never go through the muscle and should not result in any longterm weakness.

	2.  Rippling skin after lipo:   Regardless of weight gain or loss, skin rippling usually occurs when liposuction was performed when skin excision was indicated.   This is something that your plastic surgeon should evaluate in the initial consult and make the appropriate recommendation to prevent rippling skin postop.

	3.  Can't you just workout?  Diet and exercise are the key ingredients to a healthy lifestyle.   However, they cannot always reverse the changes brought about by pregnancy and aging.   A consultation by a board certified plastic surgeon will assist in determining the optimal solution to your areas of concern.

	I wish you a safe and happy result.

C. Bob Basu, MD, MPH, FACS · Answer

It is common for plastic surgeons to perform a tummy tuck and liposuctioning of the waist.  A tummy tuck (also called abdominoplasty) is a very popular cosmetic surgery procedure. A tummy tuck can be an effective tool for shaping and sculpting the body for better body appearance and improved self esteem.

	Sometimes no amount of diet and exercise can create a flat tummy. Tummy tuck plastic surgery actually tightens abdominal muscles and removes excess fat and skin from the stomach area to create a tighter, slimmer, smoother belly. A tummy tuck can be combined with other procedures such as liposuction of your waists or flanks (i.e. love handles) to fine tune your result

	Patients choose abdominoplasty cosmetic surgery for a number of reasons, including:

	Excess abdominal skin following weight loss Weight gain (beer belly or spare tire) from a sedentary lifestyle Abdominal fat that is resistant to diet and exercise Stretched stomach muscles from pregnancy Desire for a thinner profile Desire to look younger and fitter Desire to fit into clothes better

	I recommend you visit with an ASPS member plastic surgeon to further explore your options and to find out if you are a candidate for this procedure.

Peter E. Johnson, MD · Answer

It is possible to work out and strengthen the abdominal muscles, however with pregnancy there is a natural give and stretch in the covering over the muscle called the fascia. This is the layer that the muscles pull against and even in very athletic individuals a separation or diastasis may prevent them from ever achieving a flat stomach without muscle repair. You are right, the muscle is fine, and what we really are repairing is the fascia and for some strengthening alone just won't do.
	Best of luck,
	peterejohnsonmd

Steven Wallach, MD · Answer

I will often do some liposuction of the hips combined with tummy tucks. But I prefer not to liposuction the central abdomen at the same time of a tummy tuck for fear of injury to the skin and soft tissue healing.

Kenneth R. Francis, MD, FACS · Answer

Curly,

	Muscle tightening is usually needed after pregnancies to return the rectus abdominis muscles to their original position.  This really has no effect on the ability to exercise or work out after the healing process is completed.  The liposuction that is performed with a tummy tuck is usually limited to the hips and flanks, areas that don't generally develop skin rippling.  Of course, it is always better if you can tone your body and lose your fat by "just working out".  Easier said than done.  Good luck!

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