Does Liposuction to the Upper Abdomen Prior to a Full Tummy Tuck Give a Better Result?

Lipo or tummy tuck or both?

For ladies who have never had children, or for those fortunate women who have not developed an abdominal bulge after childbirth, lipo is just the ticket.  Often local anesthesia or IV sedation are possible.

Lipo removes fat.  It doesn't tighten the deep layer (fascia).  Lipo doesn't fix hernias.  Lipo doesn't remove extra skin.

There are many types of short incision tummy tucks for ladies who have had children, maybe have some fat but also have a loose deep layer.

The question you should ask yourself is not how can I get a pretty good result, but how can I get the best result.

Generally patients who have a lot of extra weight they just can't shake should have lipo first.  Aggressive lipo with a tummy tuck is not a good combination and has a higher complication rate for the patient.

Thank you for your question. It is hard to provided with a valid medical opinion without photos.  I would suggest to be treated by board certificated plastic surgeon with experience in this procedure, to get the best desired results.
Kind Regards,Dr. Emmanuel Mallol Cotes.-

Liposuction may be performed before or after an abdominoplasty. Some plastic surgeons do both together but it is important to asks about the surgical risks of doing these two procedures at the same time. You need an examination to determine if you are a candidate for either the abdominoplasty, liposuction or both.

In some cases the tummy tuck will "unfurl" the fat in the upper abdomen and treat this roll as well. However, liposuction is discouraged with the tummy tuck in the areas you mention. Therefore I tend to perform the liposuction at a later date if needed.

The problem with just doing a tummy tuck is that it doesn't address the fullness of the upper abdomen.  You will almost always need to liposuction the upper abdomen, either prior to, during or later.  Ideally you would want your surgeon to do it at the same time as the tummy tuck to get it all done at once.

Getting the best results with a tummy tuck is a team effort between you and your Plastic Surgeon. Many patients desiring this surgery have the combination of a too thick layer of fat across the abdomen in addition to the laxity of the skin and underlying muscular wall. The first step is to achieve a high level of fitness and to be near your ideal body weight. A starting point is to have a Body Mass Index (BMI) of less than 30 and preferably less than 25 before having surgery. Some patient who reach this goal still have disproportionate amounts of fat on their abdomen and in most cases liposuction will be recommended either before a tummy tuck or during the tummy tuck procedure.

Each Plastic Surgeon will have their own recommendations as to whether the liposuction is best done in separately or as a single procedure. Although it has been shown to be safe to combine Liposuction of the upper abdomen at the time of a tummy tuck, this may increase of risk of complications such as seroma and delayed wound healing. Newer laser liposuction techniques such as SmartLipo are not recommended to be done at the time of a tummy tuck because of the heat delivered into the tissues.

There is no "recipe" that works for all patients so get a couple of opinions from Board Certified Plastic Surgeons to determine what will work best for you. Remember, that getting fit before your surgery will improve your results and lower your risk of complications.

Dr. Mosher

Not infrequently I see patients in whom there is as much skin laxity in the upper abdomen as there is in the lower abdomen. In fact, some patients after pregnancy will have fairly 'toned' lower abdominal skin, but very lax and redundant upper abdominal skin. In these situations, the removal of skin in a vertically downward direction ( a conventional tummy tuck) is not adequate to correct the upper abdominal skin laxity. Such patients are often very good candidates for what I refer to as a 'reverse upper' abdominoplasty.

This surgical technique involves removing excess abdominal skin vertically upwards using incisions hidden in the inframammary folds underneath the breasts. In general, this operation is best reserved for patients with fairly full or at least slightly droopy breasts, which serve to nicely conceal the inframammary folds. An important part of this procedure is the placement of permanent lifting sutures that elevate the lower skin edge, following removal of excess skin, to the upper skin edge in the inframammary fold. These permanent sutures ensure that the resulting surgical scar remains hidden within the inframammary fold.

A great advantage of this procedure is that the patient's original belly button is preserved, and thus there are absolutely no surgical scars that are visible when wearing a two-piece swimsuit or typical underwear (bra and panties). Additionally, because this procedure generally requires less skin undermining and thus less interruption of the normal blood supply of abdominal skin, more thorough liposuction of the waist and back can be performed at the same time.

Many patients having this surgery, therefore, undergo a reverse upper abdominoplasty combined with a lower 'mini' abdominoplasty, tightening of the entire length of the rectus abdominis muscles, and liposuction of the circumferential trunk - and keep the belly button with which they were born. I usually refer to this operation as 'reverse upper / modified lower abdominoplasty'.

I perform liposuction during tummy tucks on virtually all my patients, including liposuction in the upper abdomen.  Once considered an unacceptable risk, combining these procedures has become mainstream and perfectly acceptable so long as the surgeon adjusts his  or her technique to maintain adequate blood flow to the abdominal wall tissues.  Staging the procedures is fine but this adds significant cost to the final result. 

Many people who think they need a "tummy tuck" benefit from liposuction alone. If after a consultion with a surgeon one decides to have an abdominoplasty, it is safer to liposuction the upper abdomen separately, before or after. This can be done with only local anesthesia. See link below.

It is difficult to predict the best procedure for you without a physical exam or pictures.   Many patients can have an upper abdominal bulge due to skin excess or muscle laxity.   This will be corrected by the tummy tuck.  

If the primary problem is a thick fat pad, I would not recommend central upper abdomen liposuction in conjunction with a tummy tuck.   This carries a higher risk of wound healing complcations.  

If necessary, I would perform the liposuction in a 2nd stage procedure if necessary.