How Can a Physician Tell the Difference Between Fat and Loose Skin for a Tummy Tuck?

Doctor Answers 12

Physical Exam Is CRITICAL!

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Patients considering abdominoplasty should be carefully evaluated prior to surgery.It’s important to realize that no two patients are ever exactly alike and that pregnancy impacts each patient differently.Depending upon the circumstances patients can have loose skin, fat accumulation, weakness of the underlying muscles and stretch marks.The success of this procedure is dependent upon an accurate assessment of these anatomic factors.
This assessment is accomplished almost entirely by physical examination.The amount of loose skin and excess fat can be determined easily by manual palpation of the abdomen.The presence of muscle weakened and a diastasis can be determined by flexing the abdominal muscles.Stretch marks are easily noted by inspection of the abdomen.
Based on the specific anatomic findings the treatment plan is modified appropriately.If you’re considering abdominoplasty surgery it’s appropriate to consult a board certified plastic surgeon with experience in this area.This surgeon should be able to formulate a treatment plan that addresses your anatomic factors and achieves your aesthetic goals.

Skin and fat

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The difference between skin and fat should not be difficult to determine if you surgeon is a board certified Plastic Surgeon. 

Body Contouring Evaluation

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Most patients seeking tummy tuck have a combination of loose skin and fat. However, patients who are candidates for body contouring tend to fall on a continuum between liposuction and tummy tuck based on the skin quality, the amount of subcutaneous fat, the elasticity of the skin, and amount of intra-abdominal fat. Each surgeon will utilize his or her own preferences, experience, and expertise to determine what the optimal surgical plan should be. Therefore, you should consult with 3 board certified plastic surgeons to understand your options, and choose the surgeon/surgical plan that best meets your needs/objectives.

Evaluation of the abdomen for body contouring

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When evaluating an abdomen several factors must be examined
  1. Skin
  2. Subcutaneous fat
  3. Anterior abdominal wall laxity
  4. Intra-abdominal fat or visceral fat
If your skin has multiple stretch marks then liposuction may not be the best option. There are modifications of an abdominoplasty but in your particular case a standard abdominoplasty would be the best choice. This will flatten the abdominal bulge, contour the abdomen with liposuction of the trunk, flanks and posterior hips, and tighten the skin. The trade off is the scar. This is an individual decision for your to make after you weigh the risks and benefits. If you want to have a flat abdomen the trade off is the scar that can be hidden by your bathing suit or underwear. With proper planning the scar can be managed. Proactive scar care is vital to obtain an aesthetic result.

Tummy Tuck

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There's always a combination of fat and loose skin in any patient thinking about a tummy tuck.  The better question is,"is my skin so loose enough that it needs to be tightened, or is it elastic enough to bounce back after liposuction alone?"  An experienced plastic surgeon should be able to examine you and tell you which procedure would be best for you.

Robert K. Sigal, MD
Reston Plastic Surgeon

Extra skin or extra fat?

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To determine if the patient has extra skin or extra fat is done by simply pinching loose skin.  Skin itself is relatively thin (1-5mm) so anything over that is fat volume.

During a tummy tuck the skin and fat are removed together in the area between the belly button and the pubic area.  If you have extra skin then you can grab it and pinch it with your hands.  Only in very thin patient is this skin only, everybody else has excess fat as well

Skin v fat

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It is not difficult to tell the difference between skin and fat.  I think the more important point is that there is a layer of superficial fat which should  not be removed with liposuction or you will develop contour abnormalities.  On the other hand, the skin and this superficial layer of fat are removed together in a tummy tuck.  Hope this helps.

Tummy tuck

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It is not difficult to tell the difference between the two.  Even a photo can distinguish between the two.  Skin laxity is a good sign that a tummy tuck is necessary.

How to determine if a tummy tuck or liposuction is the appropriate choice to treat your abdomen

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A well trained board certified plastic surgeon would examine you and then should easily be able to determine whether the issue regarding your abdomen is related to too much fat, lax and excess skin or a combination of both. Relevant recommendations can then be made. With excess fat alone (but not massive), liposuction could be considered whereas with solely excess loose skin a tummy tuck would be the appropriate choice. 

Tummy tuck v. Liposuction

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Many patients come to my office wondering if they have too much fat or too much skin and are often confused by which procedure is right for them.  In general a quick examination is all it takes for an experirence PS to know if you have too much fat or skin or both.  Take the time to sit down with a PS in your area and discuss your questions.

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.0 out of 5 stars 30 reviews

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.