Is a tummy tuck not going to work long term for someone who is genetically prone to visceral fat accumulation?

Body fat is distributed by a fixed ratio. In men, 1/4th of total fat is distributed intra-abdominal and in women it is 1/5th. After 3 pregnancies and the diastasi recti, your abdominal cavity expanded and you are acquiring more fat intra-abdominal as well as extra-abdominal. If you do a tummy tuck at this time, you will be limited by how much fat can be compressed. I recommend you get on Ozempic or Mounjaro, lose weight until your desired weight is achieved and then undergo abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question regarding visceral fat and how it impacts tummy tuck results. Visceral fat, which accumulates around internal organs and is not easily accessible through surgery, can indeed pose challenges for achieving the best results from a tummy tuck. While a tummy tuck can address subcutaneous fat (the fat directly beneath the skin) and repair diastasis recti (muscle separation), it cannot directly target visceral fat.

If you are genetically prone to visceral fat accumulation, especially after having children, maintaining long-term results from a tummy tuck can be more difficult. As your previous surgeon mentioned, having a significant amount of visceral fat can affect the outcome of the procedure and potentially compromise the repair over time. The pressure from the fat inside the abdomen could prevent the muscles from holding their repaired position and may diminish the overall contouring effects of the tummy tuck.

While losing visceral fat can be challenging, there are options to help manage it:

Diet: Intermittent fasting combined with a ketogenic diet has been shown to reduce visceral fat effectively.
Exercise: Engaging in at least 30 minutes of aerobic exercise and 30 minutes of resistance training daily can help lower visceral fat levels.
Medications: GLP-1 medications, such as Ozempic and Zepbound, have been proven to assist with weight loss, including visceral fat, and may be a helpful adjunct in managing long-term weight maintenance.
If you're unable to reduce visceral fat to the level that would optimize tummy tuck results, these lifestyle changes and medications may help you manage it better and improve your surgical outcomes over time.

I hope this helps provide guidance, and I encourage you to continue working with your healthcare providers to find the best solution for you.

Sincerely,
Dr. Katzen

You do need a repair of your muscles, which will improve your symptoms. You are not doomed to visceral adiposity. This fat behaves not too much differently than all fat - you have to feed it excess calories in order for it to grow. Healthy habits and mindful choices in what you eat helps. Emphasis on nutrition dense foods such as meat and vegetables, and staying away from ultra processed foods will help. If you have a high food drive, this can be muted by GLP agonists (Semaglutides). The semaglutides are effective, but may have adverse side effects such as neuropathy, and long term dependence.