What Are Possible Causes for a Stomach Not Being Flat After the Removal of 2000cc's? (photo)

I had liposuction of my stomach and flanks 16 months ago, but despite the removal of 2000 cc's my stomach is not flat. I'm not overweight (5'2", 135-140lbs), and definitely expected a flatter stomach after the removal of approximately 2 liters of fat. What are some possible causes on my ongoing belly bulge after lipo?

Doctor Answers 14

What's the true diagnosis

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It can be one or more of several diagnoses, several previously mentioned.

If you have had one or more pregnancies, you probably have some separation of the abdominal muscle layers (diastasis rectii).

Secondly, you may carry fat around your intestines. This goes by several names like gut fat, visceral fat, intestinal fat, etc. Even with a relatively normal BMI, some people carry more of that type of fat, giving a fuller abdomen. Many men fall into this category.

Thirdly, loose skin can be deceptive and look and feel like fat.

Your BMI is right at the normal/overweight border.  

My guess is that you have had at least one pregnancy and carry a little extra weight, and a significant amount of that is gut fat.  

Based on your numbers, your BMI is 25. Removing 2,000 CC's of fat from just the abdomen on someone 5'2" with a BMI of 25 would be a little unusual unless other areas were treated as well.

You have two options if you want a flatter abdomen.
  1. Lose some weight (get rid of the gut fat) and do lots of abdominal exercises (strengthen abdominal muscles).
  2. Get an evaluation to see if you would benefit from a tummy tuck.
My personal recommendation is to go with number one.

Here are some thoughts on weight loss:
  1. Eat small meals throughout the day. Many times when I talk to patients with weight issues about their eating habits, they tell me that they eat once or twice a day. That's very bad if you want to keep your weight down. 
  2. Don't go hungry. It's tempting to think that we can lose weight by not eating. In reality, we tend to overeat after not eating for long periods of time, causing more weight gain.
  3. Be careful of foods with high glycemic loads and especially fatty foods with high glycemic loads. The perfect example is mashed potatoes (potatoes and butter/cream). Don't eat those foods. If you do, then only eat tiny amounts.
  4. Exercise is great, but it's generally not a good strategy for weight loss. Most people do not burn many calories when they exercise. There are exceptions, but most people with weight issues do not fit in that category. Exercise makes us hungry and can give a sense of entitlement to overeat. By all means, work out! Just realize weight is 90% diet. Exercise is 90% fitness (not weight management).

Best of luck,

Mats Hagstrom, M.D.

San Francisco Plastic Surgeon
4.8 out of 5 stars 20 reviews

Abdominal bulging following liposuction

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Thank you for your post. It looks like you achieved a reasonable result following that much liposuction, but that you are experiencing the limitations of what it can do. If you have a weakening of your abdominal musculature and fascia tissues from pregnancy, then truly only a tummy tuck/abdominoplasty will help correct that. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 8 reviews

You have a good result from Smartlipo

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 your problem is that some of your fat is behind the muscle layer. you need to lose some weight if you want a truly flat abdomen. Smartlipo, no doubt, helped you, but like all liposuction procedures etc can only work on the subcutaneous fat. 

i always explain to all of my patients that it is a partnership. i can help them out but if they want to get their best results, they need to work on decreasing their total body fat by being stricter with their diet and increasing their exercising

david berman md

Weight Gain.

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Unfortunately smartlipo is not a weight loss procedure nor a guarantee against future weight gain.  Weight gain after lipo can completely erase the results.  A good weight loss diet can get your results back!

Lawrence Broder, MD
Cedar Park Family Physician
4.5 out of 5 stars 27 reviews


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Thank you for your question, Yonkers Smartlipo. I am sorry to hear that you have had a negative experience with SmartLipo. Please consider SculpSure, an FDA-approved treatment that is much less invasive and has the power to melt up to 25% of your unwanted subcutaneous belly fat in 25-minutes. Please consult with a board certified facial plastic surgeon.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

What Are Possible Causes for a Stomach Not Being Flat After the Removal of 2000cc's

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Thank you for submitting your question.  You have visceral fullness, which is fat that is located behind the muscle and cannot be liposuctioned. Only recommendation is exercise and diet.  Discuss ypur concerns with your Plastic Surgeon.  Best Wishes

Stomach not flat after lipo

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your result is predictable given your preop photos
a rounded abdomen can be caused by
1.excessive intra abdominal fat around your intestines
2.weak abdominal muscles
3.separated abdominal muscle after pregnancy
4.increased fat between muscle and skin
liposuction only treats the fat between muscle and skin, you probably have a little of all the rest

David J. Goodkind, MD
New Haven Plastic Surgeon

Liposuction vs Abdomnioplasty

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Liposuction can remove the fat of the abdominal wall but it does not tighten your abdominal muscles or address fat that is inside your abdomen, around your internal organs.  Weigh loss is the only way to get rid of fat inside the abdomen.  There is a great book called "Wheat Belly" that reviews dietary changes needed to reduce intraabdominal fat.  If your abdominal muscles are weak or separated, that will effect the shape of the abdomen as well.  In that case, muscle tighteing and repositioning would give you the tight abdomen you desire.

Marisa Lawrence, MD
Atlanta Plastic Surgeon

Stomach not flat after liposuction

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Liposuction removes fat but it does not give a flat stomach.  A flat stomach may never happen again after pregnancy or weight gain, and a flat stomach also requires on-going abdominal exercises.  Consult with a board-certified plastic surgeon or return to your surgeon to discuss any options going forward. Best of luck. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Abdominoplasty Versus Liposuction

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There are 3 major questions when improvement in the abdominal appearance is desired

1. is there loose skin?

2. is there extra fat?

3. are the muscles tight?

1 & 2 can mostly be corrected with liposuction. Smartlipo in particular may be able to tighten skin to some degree.

If there is significantly loose skin and muscles that are spread apart, liposuction may actually make the appearance worse. Rectus Muscle Diastasis occurs from pregnancy. It creates a bulging abdomen, even if there isn't much fat to pinch. The only way to treat this is with a tummy tuck. A bulging abdomen is more common in male patients because men usually store fat intra-abdominally, but this can also be seen in female patients as well.

A tummy tuck will likely be helpful in addressing your concerns.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.