How Do I Know if I Need a Tummy Tuck or Lipo?

A tummy tuck tightens fascia and removes extra skin. There are several types of tummy tucks, basically falling into three categories:
Mini tucks just below the belly button - OK for scar revision but does not tighten skin or fascia above the belly button. Short incision.
Hybrid tummy tuck(R) - tightens fascia all the way up, removes minimal skin. OK for patients with very little loose skin. Small incision.
Full tummy tuck - removes lots of skin and tightens the deep layer. Long incision.
Liposuction by any method removes skin only. I am totally unconvinced that laser / VASER do any significant tightening of the skin, and usually it is more of a marketing ploy to patients who hope to avoid the incisions of a tummy tuck.
Don't be conned into getting liposuction alone if you have lots of extra skin, or if you have a loose deep fascia. You will only be lumpy and disappointed.

One common myth I hear during consultations is that a Tummy Tuck and liposuction are the same thing and are interchangeable. This is untrue. The two procedures address different things. While liposuction of the abdomen removes excess fat deposits it does not address the skin or 'pooch' that is left behind. Liposuction also does not address the muscle separation that often results from pregnancy. A Tummy Tuck contours the physique. It tightens the skin and muscles of the abdomen. It is designed to remove excess sagging skin and correct abdominal muscle separation.

Without seeing you or examining a patient it is impossible to say what they would be best served having, either liposuction or an abdominoplasty. For those patients whose skin has fallen loose, a skin and subcutaneous tissue tummy tuck may be all they need. For those whose connective tissue envelope, fascia, has weakened by large weight gain or pregnancy, the fascia may not be able to prevent the muscle wall of the belly from bowing forward which creaetes a big bulge. When the doctor examines a patient, they feel the fat compartment under the skin and above the muscle. They might have you tense your belly muscle, when you are lying down by lifting your heels off the table and seeing how much fat is above the muscle. While standing and bending forward as if you were diving into the water, the profile of the abdomen is examined for a weakening of the muscle wall. If there is little fat but a big bowing forward, then a tummy tuck with muscle tightening is in order. See a board-certified plastic surgeon or dermatologic surgeon who performs a lot of liposuction. There are some patients who benefit from both procedures, liposuction and a tummy tuck, but they may be done at different times for safety issues (there could be a fat embolus traveling to the lungs, which could be fatal, when both procedures are done together. I have performed liposuction on the abdomen and after healing referred my patient to a plastic surgeon for a tummy tuck with very good results.

Hi there-
This is actually pretty straightforward...
Liposuction involves the removal of fat from between the muscle layer and the skin, and to achieve a good outcome requires skin with good elasticity or tone, so that it will contract after surgery and look smooth. Liposuction will not improve the appearance of skin that has lost its elasticity, or muscles that have become loosened by pregnancy.
For women that have experienced a loss of muscle tone and or have true skin excess, a tummy tuck is a much better option.
But the only way to know the option that is best for you is to visit with a Board Certified Plastic Surgeon for a consultation.
Need help finding one? Please read this:

The true way is to see a board certified plastic surgeon to exam you. 
Some things that point you more towards a tummy tuck is multiple pregnancies, loose skin, skin with stretch marks and bulging of the abdomen when you are completely relaxed.
Hope that helps.

Its amazing how many patients misdiagnose what they need or incorrectly assess their appearance. The fastest way to find out what you need is to make an appointment with a board certified plastic surgeon. This will allow you not only to see what you need but also to ask questions about recovery, pain, followup, etc...It will also give you an idea of the cost of the procedure.

This decision to have a tummy tuck or liposuction is in most cases straightforward: if your skin quality is good, your abdominal muscles intact and not stretched from pregnancy and you just have some excess fat, liposuction will usually work very well. If on the other hand the skin is stretched or thin, the abdominal muscles stretched or the belly bulges a bit, then a tummy tuck is really the only way to get a significant improvement.
I would look at the before and after photos of the surgeons you consult with to get an idea of what can be achieved with each option. This and your consultation should give you a good idea of what you can expect from each procedure.
Good Luck!

Dr. S

The important thing to recognize in your case is that liposuction has limitations: it will not 'tighten' your skin- no matter if your skin is heated with ultrasound or a laser- liposuction, in of itself, does not tighten skin.
Youthful, elastic skin has the ability to 'shrink' around the reduced volume that was liposuctioned. This ability is inherent to your skin, not to the liposuction technique that was used.
If you are starting with skin laxity and stretch marks on your abdomen, liposuction alone will likely exacerbate these issues.

I just saw a patient yesterday who had been to a liposuction clinic for another consult. She was seen only by a salesperson, who examined her and recommended liposuction (of course, since that's all they do). The problem is that she had extensive stretch marks, loose skin, and a separation of the muscles, all of the things that a tummy tuck corrects in addition to removal of localized fat. She was clearly not a good candidate for liposuction alone. A plastic surgeon who does both procedures is in the best position to recommend the right treatment.

Tummy Tuck = Treatment for loose skin, separated rectus muscles.
Liposuction = Treatment of localized fatty deposits in patients with excellent skin tone.
If you have had children or massive weight gain/loss, I would venture to say that there is a 95% chance you will need a tummy tuck
If you are young, fit, or have not had children and exhibit good skin tone with no hernias then you may be a better candidate for liposuction alone.
There are many other possibilities as well as permuations and combinations of these procedures and the decision making process is not always black and white.
This is the value in seeking a consultation with a board certified plastic surgeon to discuss your options.