Did my surgeon leave too much fat around my waist? (photos)

Question

I had a tummy tuck and went back for liposuction. The surgeon however left what I think is too much fat around my waist (about .5 to an inch of pinchable fat). When I asked the doctor about it, she said I was too skinny to be a candidate for a second round of lipo and it looked fine. I know she's being conservative to prevent contour irregularities but I've never been able to lose naturally even when very underweight.

Fernando Ovalle Jr., MD · Answer

Hello and thank you for your question! Unfortunately it is almost impossible to say with certainty without examining you in person if "too much fat" remains. In general, I try to have the patient contract or put the underlying muscle on stretch (in this case, a slight twist to do that to the obliques) to "exclude" being able to pinch/pull up the muscle during exam. If this is done, then I try to "pick up and pinch" everything above the muscle (fat and skin). If there is at least 2+ fingerbreadths of tissue that I can pinch, then there is at least some fat there that I can safely remove.

My best recommendation for you would be to get a second opinion during an in person consult and exam with a board certified plastic surgeon!

My best recommendation for you would be to get a second opinion during an in person consult and exam with a board certified plastic surgeon!

John Reilly, MD, FACS · Answer

Hello, it is important to differentiate between loose skin and skin with too much fat.

When pinching the skin, "pinching an inch", as the TV commercial used to say, you are pinching together TWO surfaces of skin along with its underlying fat.  In your mind's eye you now need to unfold that pinch and allow the skin to lie flat.

Half the thickness of what you pinched together is the actual thickness of your skin and fat. Subtract out the thickness of the skin which is different in different parts of the body and now you are left with the actual thickness of fat in that area.

It appears from the photo that you do not have a significant amount of treatable fact. Some patients have tighter attachments from their underlying muscles to the skin and it is more difficult to pinch their skin as opposed to someone else's who may be more loosely attached skin which can be mistaken  for too much fat. I hope that helps.

Joel Patrick Maier, MD · Answer

Judging on your photos, it looks as though your "pinch test" is maximized. Your surgeon has a point where some liposuction is good, but more is not necessarily better. There are limitations as to just how much liposuction can change your contour given one's underlying body structure.

Reza Rod, MD · Answer

Thank you for submitting your question in photos. Although it’s difficult to do a proper assessment without the physical examination, it appears that most of this is loose skin. There are multiple options for noninvasive skin tightening. I would recommend using a treatment that is based on radiofrequency. We have had excellent success with our BTL Exion system.

Albert Ko, MD · Answer

Thank you for your question and photos! Liposuction removes unnecessary fat; however, you must leave some fat for avoid contour irregularities. You are always welcomed to get a second opinion if you are unhappy. This would include an in-person exam so that the provider can feel the area and make a surgical plan according to your goals.

Babak Moeinolmolki, MD, FACS · Answer

Whether or not you have more fat left and whether your waistline can be narrowed even further requires a formal evaluation by a high definition body contouring provider. The waistline should be narrowed from the front and backsides to maximally remove the fat around the sides. In addition, Renuvion J plasma can be used to help eliminate any skin laxity to provide you maximum waistline snatching and exagrerate your curves.

Daniel Barrett, MD · Answer

Dear Forceful845647,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ajaya Kashyap, MD · Answer

Thank you for your query! The pictures are difficult to assess but I would trust your surgeon in being conservative and not over-doing the liposuction. She may consider a non surgical option like ThermiTight or Bodytite which can tighten the skin a bit and remove a small amount of fat. Please discuss all your concerns and options with your Plastic surgeon who should be able to help . All the best!

Bruce B. Kadz, MD, FACS · Answer

In general, it's best to be conservative with liposuction. If it bothers you a lot, you can consider a secondary liposuction keeping in mind that contour irregularities may occur.

Sean Satey, MD, FACS · Answer

Thank you for your question and submitting your photos. In my practice, I would recommend VASER assisted liposculpting. VASER assisted liposculpting will help increase the fat extraction yield, minimize the risk of contour irregularities, decrease your recovery time, and allow for enhanced abdominal definition and contouring. It also allows me to go more superficial than I would be able to go with conventional, traditional liposculpting. We could also perform Renuvion j plasma which will allow for skin tightening through the same small poke holes as the VASER lipo and will act like an internal shrinkwrap. Hope this helps. Best of luck, -Dr. Sean Satey, Beverly Hills, CA.