How can I make my stomach flat? (Photo)

Question

I went to a surgeon because I thought I needed a full tummy tuck as I thought my ab muscles were split from top to bottom. I hate how my stomach bulges and I want it to be flatter. The surgeon said he could only feel 15-20mm of separation and that repairing it wouldn’t make me flatter. He said my muscles might be stretched vertically and that was creating the bulge. I am thin and tall (59kg 175cm) and I don’t think I have any intradominal fat. Can my stomach be made flatter and how?

J. Timothy Katzen, MD, FACS · Answer

Hello Creative353812 in Poole, and thank you for your question regarding how to make your stomach flatter.

Thank you for providing your history and pictures. When it comes to the anatomy of the abdomen, the primary issues that can affect its appearance are excess skin, excess fat, and muscle weakness. In your case, you don't seem to have much excess skin or fat, which suggests that your main issue is muscle weakness.

The most effective way to address muscle weakness is through a tummy tuck with muscle repair. During this procedure, an incision would be made in the pubic region, and the tissue would be dissected up to the xiphoid (the lower part of the sternum). The muscle would then be repaired from the sternum to the pubic region, with special attention given to the area below the belly button. Afterward, the skin would be pulled tightly, which should help create a flatter abdomen.

For patients like you, who don't have much excess skin or fat but do have muscle weakness, a tummy tuck focusing on muscle repair often yields excellent results. I believe this approach would likely help you achieve the flatter stomach you desire.

Good luck, and I hope this information helps answer your question.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

An in person assessment is required, but you may benefit from a mini tummy tuck with tightening of the abdominal wall.

Richard Zienowicz, MD · Answer

Hello and thank you for your question. Based on your photos in different positions (flattened stomach when you lie down or flex your muscles) and your height and weight it does appear that you would benefit from muscle repair performed with an abdominoplasty to flatten your abdomen. Best of luck to you.

Daniel Barrett, MD · Answer

Dear Creative353812,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

If you are not planning future pregnancies, I recommend 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.

Best Wishes,

Gary Horndeski, M.D.

Scott C. Lindsay, DO · Answer

Thanks for your question! It's never a bad idea to get a second or third opinion. Make sure you are looking at before and after photos as well. Based on photos alone, I do think you would be a good candidate for a tummy tuck. Best of luck!

Geuris Cruz Quiroz, MD · Answer

Dear @Creative353812, Thanks for your question. 
Before giving you any recommendation is very important to know more about your health history, testing and physical evaluation are necessary, please start your consultation with your PCP and for sure you can get better recommendations in order to have a fat abdomen.
Good luck!

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast) · Answer

Thank you for your question.
It is not possible to give you a medical opinion on your problem based on limited information and photographs. You need an in person consultation with an examination. However, it possible to make some general comments about what is typical or may be possible, but you should not consider these a medical opinion on your concerns.
20 mm muscle separation of the recuts abdomens muscles. I would generally expect to repair a 20 mm rectus abdomens divarication (muscle separation) as part of an abdominoplasty. I would also expect it to at least improve abdominal bulging.
Your lower abdominal bulge could be due various different things and that is why an examination is necessary.1) muscle separation - divarication of the rectus muscles - often caused by pregnancy or obesity - usually treated with repair of the muscle layer during an abdominoplasty.2) excess fat under the skin - sometime people have a pocket of excess fat between the skin and the muscle layer - this is usually best treated with liposuction.3) something inside the abdomen - often fat, but enlargement of any organ from inside the abdomen or pelvis could do this. eg pregnant uterus, fibroids etc. - potential treatment would depend on diagnosis.4) natural body shape - some peoples natural body shape is one of a prominence of the lower abdomen. This is sometimes relative with a hollowing out of the upper abdomen.5) a combination of any of the above 4.
I advise you to have an in person consultation with a suitably qualified and experienced plastic surgeon to discuss your concerns and what may be possible. 
If the bulge is recent, enlarging or changing then I would have a consultation with your GP / family doctor to check there is nothing inside your abdomen, causing the bulge, that should be investigated.
I hope this offers you some useful information.Best wishes.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

I am assuming you've had children. You are very slim, but this is a classic sign of a muscle split mostly below the umbilicus. I believe that repairing the muscle would be the primary focus of your surgery. There is an operation called a floating umbilicus Repair, which allows repair of the muscle without extensive undermining. It makes the scar shorter, but there is still a significant scar, a little wider than a standard C-section.

I discuss this and other problems on my YouTube channel Adam goodwin surgery, if you'd like to watch some of the videos.

Hope that helps.

Best wishes, Adam, Goodwin.

I discuss this and other problems on my YouTube channel Adam goodwin surgery, if you'd like to watch some of the videos.

Hope that helps.

Best wishes, Adam, Goodwin.

Ulas Bali, MD · Answer

It can be indicable that your muscler are split. For your solution a tummytuck operation will be beneficial a succesful operation will provide your split muscles being repaired from top to button.

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