Should I consider having flank liposuction done along with my tummy tuck? (photos)

Question

I am having a tummy tuck done in a couple of months and was told i do not need any liposuction of my flanks as i don't have enough fat to make a noticeable difference. My consult was done via video conference so my surgeon has not seen me in person. I am scared to lose my shape and end up looking like a box. Would flank lipo be recommended by others?

Emmanuel Mallol Cotes, MD · Answer

Thanks so much for your inquire,

Deciding whether to have flank liposuction performed along with a tummy tuck depends on several factors, including your specific body shape, aesthetic goals, and the recommendations of your plastic surgeon

Achieving balance and proportionality in your body contours is essential for overall aesthetic harmony. Combining flank liposuction with a tummy tuck can help ensure that your waistline is sculpted and defined, complementing the results of the tummy tuck procedure.
Sincerely, 
Dr. Emmanuel Mallol

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about whether to consider having flank liposuction done along with your tummy tuck. It's important to carefully consider all aspects of body contouring to achieve the best results.

By examining your photos, it seems that liposuction of the flanks is not strictly necessary, as your surgeon suggested, especially if there isn't a significant amount of fat in those areas. However, if your goal is to enhance your waistline and maintain a more hourglass figure, adding liposuction of the flanks could potentially enhance your contour and prevent a boxy appearance post-surgery.

More importantly, the tummy tuck—particularly an extended tummy tuck for your case—will likely provide you with amazing results. An extended tummy tuck is more comprehensive than a standard tummy tuck as it addresses excess skin and fat not just in the abdominal area but also around the flanks and lower back. This procedure combined with muscle plication, which tightens and realigns the abdominal muscles, can significantly bring in your waistline by 2-4 inches, instantly enhancing your natural contour and providing a dramatic improvement.

Given that your initial consultation was conducted via video conference, I recommend having an in-person evaluation with your surgeon or a second opinion if possible. This would allow for a more accurate assessment of your body's specific needs and ensure that all your concerns are addressed before proceeding with surgery.

Discussing these options in detail with a board-certified plastic surgeon will help you make an informed decision that aligns with your aesthetic goals and leads to satisfaction with your surgical outcomes.

Sincerely,
Dr. Katzen

Finny George, MD · Answer

Hi, thank you for sharing your question. I believe that you are a great candidate for liposuction along with your tummy tuck. Based on these photos, there seems to be adequate fat along the flanks and upper hips to remove with liposuction. This will elevate your results and I highly recommend it.

Ramin Behmand, MD, FACS · Answer

Thank you for including multiple views of photos.  In short, the flank liposuction helps create a better contour in the immediate term, and prevents contour issues in the future.

During a tummy tuck, a significant portion of the skin and fatty tissue is excised from the lower abdomen. The remaining tissue is then stretched downward to achieve a tighter abdominal appearance. As a result, the fat cell density in the treated area is notably reduced compared to the original state or that of the flanks. Failure to contour the flanks may lead to an abrupt transition from lower-density fat cells to the normal density in the flanks. This can result in disproportionate weight gain in the flanks if your weight fluctuates.

Dr. B

Arif Eroglu, MD · Answer

Hello; in the abdominal area, Liposuction only; not for reducing fat; in tummy tuck, it ensures for that; the tunnel opened between the skin and muscle in the upper abdomen; is narrower. During liposuction treatment, the upper abdominal skin; areas where it holds tightly to the ribs and resists pulling are loosened. Additionally, the skin becomes looser; due to the fat removal. In this way, Lipoabdominoplasty can be performed with less tension; it is possible for performing Abdominoplasty surgery.
You have fat in your abdomen and waist fields. Also, on your hip; there is a decrease in fat tissue and wrinkles on the skin. My advice for you; fat taken from the abdomen and waist; given to the hip and it balances the fat reduction; in this area.

Gary M. Horndeski, MD · Answer

From your photographs, it does not appear that liposuction is necessary. However, at the time of your examination, he can pinch your tissue laterally and determine how much fat you have there. You may get minimal improvement or you may get more improvement. That is a decision you and your surgeon will have to make once he examines you in person.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

An in person evaluation is needed for the best recommendation but typically patients do benefit from liposuction along with the tummy tuck.  This allows me to further contour and enhance the results of the tummy tuck.  Take a look at some of my before/after photos on my website and you'll see that the boxy shape is definitely not the result!

Connie Hiers, MD, FACS · Answer

An examination is needed to see if you have any residual flank fat that could benefit from liposuction.

Darryl J. Blinski, MD · Answer

Based on the post of photos you were candidate for added flank Lipo with the full tummy tuck best to discuss with your chosen surgeon or seek virtual consult with expect fees to range from $6000-$10,000

Mats Hagstrom, MD (license on probation) · Answer

As a general statement, I do not recommend people have virtual consultations, and instead recommend people have in person consultations.
I also recommend patient consult with multiple procedures before selecting a provider.
There are major differences in skill and experience among different plastic surgeons, and to find the best provider requires interviewing multiple surgeons.
Provider selection is by far the most important variable.
A tummy tuck is a permanent and irreversible operation.
If done poorly, it’s very difficult to improve on the outcome with revision surgery.
Most plastic surgical outcomes are based on patient, candidacy, and skill of the provider.
 to find the right provider I generally recommend patients start the process by having multiple in person consultations with providers in their community.
Before even considering providers, patient should probably learn to differentiate what quality results look like.
For example, if you take a look at before, and after pictures from the website of Doctor Eleonore Zetrenne, M.D. you’ll see what I believe. Are some of the best tummy tuck results of anyone.
Her choice of incision design is in my opinion ideal and some of the best work I’ve ever seen.
I’m guessing she was most likely inspired by her teacher, Mark Kobayashi MD who does the best tummy tuck work of anyone I’ve ever known.
Once you have a clear understanding of what quality work looks like you can begin to assess the outcome by the providers by reviewing before, and after pictures.
Pay close attention to who gets the most natural looking bellybuttons and design and placement of the incision.
There’s no correct number of consultations needed to find the right provider.
The more consultations you have the more likely you are to find the better provider.
The biggest mistake patients make is having only one consultation which more or less eliminates the ability to choose a better provider.
I do not believe you can adequately select providers using the Internet.
 Some of the best surgeons I know spend virtually no effort on self promotion, don’t update their website and some plastic surgeons who are world class don’t show before and after pictures and one surgeon I know who does some of the best facelifts in the world doesn’t even have a website.
Providers who are really good at self promotion tend to be focused on the financial rewards of doing plastic surgery, and these may or may not be talented providers.
Self promotion, and patient advocacy do not always go hand-in-hand.
To find the best provider, I suggest patients start by having a complete set of proper pictures of their body, taking the same way plastic surgeons take before and after pictures.
Use these pictures for reference, whenever reviewing before and after pictures including during consultations.
During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own.
An experienced provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Highly experienced surgeon should have access to 100s or preferably thousands of before and after pictures to choose from.
 Being shown a handful of pre-selected images, representing only the very best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider.
Take careful notes during each consultation, especially regarding the quality and quantity of before and after pictures.
Ask providers what their most common reason for doing revision surgery is and what the revision policy is.
Well done, Liposuction should feminize body curves, and not leave you box shaped. I don’t see a strong indication for doing liposuction on the back half of your torso.
When Liposuction is done in conjunction with a tummy tuck, it is very important to vet providers for both liposuction and tummy tuck skills.
You have significant skin laxity, but very thin layers of subcutaneous fat, so I don’t think you need Liposuction.
It is, however, very important to make sure that any skin laxity on the lateral aspect of your torso is included with the procedure.
The extent or length of the incision that should be determined, based on how far the skin laxity continues.
For some individuals, a slightly extended, extended or full wrap around tummy tuck is indicated.
In yours and my Lee extended tummy tuck may be a good option.
These are the types of variables that need to be confirmed during an examination.
Extending a tummy tuck is a bit complicated but will diminish the chance of having revision surgery. 
Being bored, certified in plastic surgery, with years of experience, and overall good reputation does not mean somebody is mastered most plastic surgical procedures.
There are major differences in both skill and experience, depending who you choose, regardless of reviews and credentials.
Considering that you’ll be reminded of the results every day for the rest of your life and that tummy tuck results cannot really be altered. Once the procedure is done I think the time spent having multiple consultations and especially having exclusively in person consultations is an investment that pays great dividends.
Most plastic surgeons can do a competent tummy tuck, but average work in my opinion does not look all that great.
The difference between outstanding high-quality work, and average work is substantial. 
Often the best plastic surgeons don’t charge anymore than the rest of us.
Some providers are simply much more talented than others.
I don’t think you can properly vet, plastic surgeons and I don’t think plastic surgeons can properly assess patients without meeting them in person.
There is a lot of variables to review, and there’s no substitute for a proper examination.
I recognize that medical care has changed dramatically since Covid and many medical visits are now done without meeting the provider.
Cosmetic surgery is different.
It is highly visible and tactile.
Patients also have a unique way of judging the skill of the provider by insisting unseen, as sufficient collection of before, and after pictures to get a clear understanding of what average results look like.
This is unique to plastic surgery.
Most medical specialties, do not have this visual format used to assess a medical providers skill. 
I’m a strong believer in meeting my patients in person and find that this eliminates the potential for misunderstanding and disappointment.
Simply getting to know the person and having a rapport with them can be helpful, especially after the procedure.
I also generally do not recommend people travel long distances for elective surgical procedures whenever possible.
Best 
Mats hagstrom MD

Should I consider having flank liposuction done along with my tummy tuck? (photos)

Answers (11)

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