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.

The tummy tuck will not change visceral fat gain or loss. That weight gain must be controlled by diet. You might consider being checked for food allergies because those can expand your abdomen.

Those with excess visceral fat may have suboptimal results from a tummy tuck as the intrabdominal fat will impact the amount of tightening the surgeon can perform. Weight loss can reduce visceral fat. In our office we offer a Semaglutide program to help qualified candidates lose weight.

The answer to your question is yes.
There is no surgical treatment for excess visceral fat.
The only way to reduce visceral fat is with weight loss.
It’s important to get quality assessment before having a tummy tuck.
There are four tissue variables that determine what the abdomen looks like.
These are.
1) Laxity due to previous pregnancies or weight loss.
2) Excess subcutaneous fat.
3) Muscle separation from previous pregnancies.
4) excess visceral or intra-abdominal fat.
Tummy tuck primarily treats, skin laxity, and muscle separation.
This means that the ideal candidate for a tummy tuck is someone who has significant muscle separation and skin laxity with no issues regarding subcutaneous fat or visceral fat.
And the other hand, the ideal candidate for Liposuction is someone who only has access subcutaneous fat with tight, abdominal muscles, tight skin, and no excess visceral fat.
individuals who have excess visceral fat Esther primary variable are not good candidates for surgical intervention until they lose enough weight to get the access visual fat under control.
Access visceral fat can have a similar appearance to muscle separation on exam.
It’s really important for providers to differentiate which one of these components is contributing more.
Including pictures would allow us to make a baseline assessment.
Best,
Mats Hagstrom MD