Tummy tuck with no muscle separation? (Photo)

Question

I’m late 40's, 170 cm, 76 kg and ranged from size 6 to 16. I’ve always looked like I do in the photos even with weight loss. Ultrasounds confirmed there is no muscle separation. I have no children. 2 PS consults have given different advice. 1 advised a TT w/ muscle repair & lipo can be done. The other said there is nothing that can be done, no TT and/or lipo. He indicated that a TT would stretch the skin causing laxity & lipo won’t help. What to do? TT, mega lipo, nothing?

Carmina Cardenas, MD · Answer

The reason of protruding abdomen is mainly 3 and most commonly the combination of the 3. 1)Loose muscle as the result of pregnancies, gaining and losing significant weight (expansion—deflation), or genetics and some develop real dyastasis. 2)Visceral fat which is genetical and also because of high BMI. 3)subcutaneous fat. 
Recommendation number 1: have a BMI below 25. 2.-you will be candidate for Tummy Tuck to remove the excess of skin and 3)a wide and tight muscle repair to create a flatter abdomen and smaller waistline. Muscle is literally a steak and it will not remain tight forever, and your enemy number one to remain flat is to put on weight and gain visceral fat and also you must work out to get tonification of yor muscle. 
Be encouraged. 
Dr. Cárdenas

Sepehr Lajevardi, MBBS, PhD, FRACS · Answer

Hi. It is hard to give the best advice without physical examination. In some instances there is visceral fat deep to the fascia that cannot be addressed with liposuction. In some instances the fascia is lax and stretched which would still benefit form fascia plication even if distance between the Rectus muscles is not too wide. Hope this helps.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your images. It's not always easy to provide a definitive answer without a physical examination. From your photos, it appears you have minimal body fat, but your abdomen is visibly distended. The ultrasound suggests that there's no muscle separation, which leads me to believe that your condition might be due to increased visceral fat or volume in your peritoneal cavity.
This means that the area behind your rectus muscles has expanded, causing your muscles and abdomen to bulge outwards, giving your abdomen its enlarged appearance. This distention can occur even without muscle separation, like an inflating balloon stretching its material without tearing it.
In your situation, liposuction would not be beneficial as there's no significant excess fat to remove. A tummy tuck, on the other hand, would address three key areas: skin, fat, and muscle. Given that your primary issue seems to be distension of the muscle, the focus of your tummy tuck would be on muscle repair.
In your procedure, an incision would be made low on the abdomen, and tissue dissection carried up tothe sternum. After this, the rectus muscles would be plicated or sutured flat. You might need both vertical and horizontal suturing due to the degree of your abdominal distention.
Given the extent of your muscle distension, you might also benefit from the insertion of mesh to help flatten your abdomen. The final steps of the procedure would involve removing any residual loose skin, although this does not seem to be substantial in your case.
The umbilicus or belly button would also need to be repositioned due to the overall alteration of your abdominal structure. Thus, I would strongly recommend a full tummy tuck procedure, focusing on rectus muscle plication due to your distended muscles.
This recommendation, however, is based on your provided photos and description. A physical examination is needed to confirm this plan and ensure it meets your unique needs and desires.
I hope this gives you a better understanding of what could be done to address your distended abdomen. I encourage you to consult with a board-certified plastic surgeon for further advice.
Sincerely,
Dr. Katzen

Randal Haworth, MD, FACS · Answer

You’ve been given an incorrect information about the "tummy tuck" or Abdominoplasty.

The TT is a significant surgical operation that aims to eliminate surplus skin and fat from the lower and middle abdominal areas, while tightening the muscles of the abdominal wall. This procedure can significantly minimize the appearance of a protruding belly.

From what I can see based on your pictures, it looks like you would greatly benefit from the procedure.

Daniel Barrett, MD · Answer

Dear slg7890,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ahmad H. Ahmadi, MD · Answer

The cause of the bulge needs to be determined before undergoing surgery.  Is it visceral fat (fatty gut), weak abdominal msucle tone, or fatty tissye of the skin (less likely)? An experienced plastic surgeon will be able to figure this out.

Connie Hiers, MD, FACS · Answer

An examination is needed to see how much internal fat is present compared to external fat. If most is internal fat, a tummy tuck or liposuction will be limited. EMSculpt, a nonsurgical procedure, can help with internal fat and tightening the abdominal wall muscles.

Lourdes Rodriguez, MD · Answer

Hello, thank you for your question and pictures.

After evaluating your case you seem to be a great candidate for a tummy tuck to remove the skin excess on the abdomen combined with 360 liposuctions to reshape your body, The BMI need to be under 33 for surgery. By combining these procedures, we can achieve good results.

Make sure to approach to a certified surgeon to help you clear all your doubts.

Best wishes!

Leland Webb, MD · Answer

You have some good options before you. Sometimes people carry more fat on the inside of their abdomen versus the outside of their abdomen. Only the fat on the outside of their abdomen can be addressed with Liposuction. Tightening the abdominal muscles can help improve shape and contour as well. You may be an excellent candidate for an abdominoplasty with some Liposuction. The most important thing is that you are appropriately evaluated by board-certified plastic surgeon.

Camille Cash, MD · Answer

An in person evaluation is best, but if selecting between the two procedures the tummy tuck will likely be recommended.  If the contour of your abdomen is from visceral/internal fat neither procedure can improve it.  The only way is through weight loss.  If the contour is from muscle wall laxity then the tummy tuck will address it.  An examination is needed to confirm.

Tummy tuck with no muscle separation? (Photo)

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