How to Remove Vertical Belly Crease?

The creasing around your belly button is clearly due to skin laxity which will increase after significant weight loss due to a "deflationary" effect. Unfortunately, liposuction will not provide any significant skin tightening and your best bet is a full tummy tuck. It would be best to do this when you have reached your final weight. 

Abdominoplasty would be the most complete solution to the laxity in your tissues, but only if it would meet your overall goals. It is not a minor procedure, and it comes with a transverse scar. Although the scar is usually easy to "hide" under a barthing suit or underwear, you need to be sure that it would be a good tradeoff for you. If the "crease" is your only concern, you may want to consider less aggressive alternatives (e.g. fat grafting, non-invasive skin tightening) . There is no substitute to a thoughtful discussion with a qualified plastic surgeon to establish goals and discuss alternatives.

You have done well to lose weight and improve your lifestyle. It is common for the skin not to have the same smoothness and tone after a significant weight loss. You should think about your specific goals and share these with your Plastic Surgeon. An extensive tummy tuck with liposuction of the torso will likely give the best results. This procedure would remove much of the damaged and poor quality skin from your lower abdomen and produce the flattest and firmest results. However, if you goal is to become slimmer and look better in fitted clothes then further weight loss or laser assisted liposuction would help you. Liposuction does not remove skin so a flatter and not tighter  tummy would be possible with this less invasive approach. If you are truly focused on the creases then skin removal as part of a tummy tuck is the only way.

Dr. Mosher

From the picture, you look like an excellent candidate for a tummy tuck / abdominoplasty.  While liposuction will remove the fat, you have loose skin and likely loose underlying muscles which can be fixed during tummy tuck / abdominoplasty.  

 

Good Luck.

Thank you for posting the photo.  If you are planning on loosing more weight, I would recommend that you wait until you are at your goal weight before making any decisions.  You may end up having more laxity, and may choose to have a tummy tuck. But if you stay the same or similiar, and the only thing that bothers you about your abdomen is the crease, then you can have a minimal liposuction for fat harvesting, and have a fat transfer to the area at the crease.  This often times can give excellent results with a small procedure.  Good luck!

Congratulations on your weight loss! You have partially "emptied out" your skin, giving you a slightly deflated, wrinkled appearance. Losing more weight will only further reduce the fatty layers beneath your skin, reducing the skin tone even more. Liposuction removes even more fat, leaving loose, wrinkled, poorly-toned skin that looks more deflated than it does now. The only effective treatment for this is abdominoplasty to remove excess skin, sculpt the remaining fat under direct vision, tighten the abdominal wall fascia (the gristle layer surrounding the abdominal muscles which every pregnancy stretches to a certain degree), and smooth and tighten the skin. This requires an operation to remove the loose "extra" skin, which will leave a long scar in the bikini line, but re-tightened skin and a flatter abdominal profile!

Many patients like the idea of short incisions and lesser cost of liposuction as compared to abdominoplasty, so there will always be physicians who will give the patient what they ask for, rather than what is obviously best. These may be "cosmetic surgeons" who have not completed full training in plastic surgery and earned board-certification by the American Board of Plastic Surgery, and "do not do abdominoplasties," or someone who is trying to meet a certain price point. If you are tempted to consider lipo, SmartLipo, or ultrasonic liposuction (because they "help to tighten the skin from inside," or mesotherapy or Lipodissolve, consider that you will ultimately require what you really need--skin removal, muscle tightening, and the result you are hoping for via abdominoplasty!

Based on the appearance of your abdomen in the photograph, an abdominoplasty would be my choice for overall improvement of the abdominal contour- the vertical scar that you have would likely come out with the rest of the excess skin.

I see a lot of patients like you that have changes of the belly area after pregnancy and weight loss. For loose or damaged skin in the abdominal area, a Tummy Tuck is by far the most powerful procedure.

Differences between Tummy Tuck and Liposuction of the Abdomen

For me, a Tummy Tuck refers to Five things:


Removal of excess or damaged skin (all patients)

Removal of fat from the abdominal area (as needed -- most patients)

Tightening and re-supporting the muscle wall of the abdomen (all patients)

Re-supporting of the deep tissue "body suit" that supports the skin (all patients)

Liposuction contouring of the hips and lower back (as needed -- majority of patients)


Liposuction, by contrast, provides only two of these five benefits:


Removal of fat from the abdominal area via liposuction

Liposuction contouring of the hips and lower back


What about Skin Tightening with Liposuction?

"If it sounds too good to be true, it probably is." Liposuction certainly has the potential to provide small amounts of skin tightening, but this is limited.

I don't care about all the flashy marketing and whiz-bang sounding technologies, there is no liposuction or skin treatment technique that holds a candle to the skin rejuvenation seen with a well-performed Tummy Tuck procedure.

Smart Lipo and Vaser Lipo both use energy sources to disrupt fat cells. Plain-old "Dumb Lipo" achieves fat removal without using potentially dangerous energy sources that can burn the skin.

A study in the February 2011 Aesthetic Surgery Journal (from the American Society of Aesthetic Plastic Surgery) reports that while a large majority of ASAPS member surgeons have experience with Smart Lipo, Vaser Liposelection or other energy-based liposuction techniques, fewer than half prefer these methods today.

Interestingly, this same ASAPS study lists "Marketing Advantage" as the number one reason for selecting Smart Lipo or other laser-assisted-liposuction technique over other methods! While I've personally been told this by a number of surgeons, it is enlightening to see this reported.

To me, all of this reinforces the thought that "it's the surgeon, not the device" that is important in liposuction.

Hope this helps,

Nick Slenkovich MD, FACS

Thank you for the question and picture.

 

I think you'll be best served with the standard tummy tuck procedure. Liposuction and/or  mini tummy tuck surgery will leave you disappointed with the end results  of surgery.

In my opinion, for example,the mini tummy talk is an  operation that  produces very limited results and is very rarely indicated. It involves a shorter incision but does not address the majority of the abdominal wall issues present for most patients who present consultation. For example, the area of skin excised is quite small. The abdominal wall musculature is addressed below the umbilicus leaving the upper number wall potentially lax. The appearance of the umbilicus is not necessarily addressed sufficiently.

 
For most patients who have had pregnancies and/or weight loss a full abdominoplasty is necessary to achieve the desired results. Of course, there are downsides (including a longer scar and probably a longer recovery time) but for most patients the benefits outweigh the downsides. It is not unusual to see patients who've had mini tummy tuck  surgery present for  revisionary surgery.
 
For some patients an area of concern may be the “muffin top” (flank or lower back skin and adipose tissue).Treatment of the stubborn muffin top involves excision (lipectomy) of excess skin and adipose tissue. Liposuction  surgery alone  will potentially leave you with loose skin and an  unsatisfactory result.
 
Treatment of this stubborn area involves excision (lipectomy) of excess skin and adipose tissue. Liposuction  surgery alone  will potentially leave the patient with loose skin and an  unsatisfactory result.
 
Although not relevant in many cases, patients who are undergoing a standard tummy tuck procedure  should be aware however that often an “extended” tummy tuck is necessary to treat the muffin top area. This extended tummy tuck procedure involves flank and back skin and adipose tissue excision as well as liposuction surgery. If liposuction alone is done the patient may still end up with the muffin top and require further surgery to improve the waistline in the future.
 
It is important to work with a well experienced board-certified plastic surgeon to obtain advice (based on good ethics and judgment) to  improve your chances of a successful outcome and minimize the need for further surgery.
I hope this helps.

 

The vertical belly crease you see after weight loss is a result of laxity in the skin, a kind of draping effect as the fat disappears beneath. Liposuction will result in more skin laxity and a tummy tuck is the best solution. Keep up with your weight loss goal.
Best of luck,
peterejohnsonmd