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

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

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.

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

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.

An experienced plastic surgeon can determine the difference between fat and loose skin in about 5 seconds via physical examination. It is done by feel, and how much can be pinched, when compared to areas of the body that don't normally have as much fat. It can take much longer to convince a patient that loose skin is loose skin, but the determination is the most important detail in deciding how to get a pleasing result.

We all want good results, and we all want to do the smallest procedure which will give good results. For the tummy, this boils down to liposuction vs. a tummy tuck. When skin is tight and fullness is from fat, liposuction works well. It is a quicker procedure with a faster recover. When skin is loose; however, liposuction can be a disaster. It can cause irregular folds in the skin that, while less full, looks less than attractive.

The advantage of the tummy tuck is the ability to tighten, as well as remove. The abdominal muscles and the skin can both be tightened with a tummy tuck. It is a longer, more expensive procedure that has a longer recovery, but it is also doing a lot more than liposuction can. The downside that most patients worry about is the scar. A well placed scar beats loose skin, especially liposuctioned loose skin, hands down.

If you have had liposuction of the abdomen and the skin is loose and irregular, you may stil be a candidate for improvement with a tummy tuck.