Can the Muscle Walls of the Abdomen Be Tighten Without Having a Tummy Tuck? (photo)

Question

I am curious to know if a full tummy tuck needs to be performed to tighten both the upper and lower muscles of the abdominal wall? I have 2 stretch marks from birthing two children; I don't have a pouch like most moms I know... rather my stomach just protrudes out even though I work out (5'3", 125lbs).

James E. Chappell, MD · Answer

Some people carry much of their fat around the organs in the abdomen (so called "visceral fat") more so than outside the muscle wall of the abdomen. The visceral fat tends to bulge out the abdomen in people, and these people often do not have a lot of extra skin. The only real way to fix that situation is through diet and exercise.

Kenneth Hughes, MD · Answer

The walls can be tightened without a tummy tuck, but you may or may not want skin removal. To be honest with you, I cannot tell much from the pictures. Find a plastic surgeon with ELITE credentials who performs hundreds of tummy tucks each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Jourdan Gottlieb, MD · Answer

It is sometimes possible to do just a muscle tightening. These photos are dark, but on viewing them I am not sur you would get enough of an improvement without removal of excess skin and fat.

	Another issue can be that if there is a lot of tightening, the skin will be carried along and can buckle along the vertical midline if a skin release is not also done. 

	Discuss carefully all options with your surgeon. Best wishes.

David Finkle, MD · Answer

A tummy tuck involves 3 components:

	
		Skin removal
	
		Fat removal
	
		Muscle tightening


	One can choose to have all 3 components performed or just one or two.  Please have a discussion with your plastic surgeon to figure out what would work best for you.

Gavin Sandercoe, MBBS, FRACS · Answer

Hi Chinadoll11550

	The short answer is yes, abdominal muscles can be sutured together without doing a full tummy tuck incision. What is more important is whether you are a good candidate or if you will be happy with the final result.

	Your photos seem to show global bulging of your abdomen. This could be due to muscle looseness or intra-abdominal fat. A good method of checking this is to see how flat your tummy is when you lie down. If your tummy is flat between your ribs and pelvis, you are still carrying a bit of fat on the inside, which will only be removed through diet & exercise. If you are concave (sucked in) when lying quietly, it is more likely to just be abdominal muscle weakness.

	If you elect to proceed with muscle tightening only, your Plastic Surgeon needs to show you the 6 month or 1 year results of their last 10 consecutive patients (not just the good results). In my humble experience, patients are generally underwhelmed with the results of this procedure. They'd like to avoid the scar, but the contour change is less significant than can be achieved with a typical tummy tuck.

	Good Luck

	Dr Gavin Sandercoe

Deborah Ekstrom, MD · Answer

In select individuals, yes the muscles can be tightened without removing skin.  These individuals: 1) have spread muscles but no extra skin, 2) do not have much fatty tissue in around the organs (tightening the muscles puts pressure on the internal abdominal contents which can push on the diapragm making it hard to breath or cut off circulation from pressure on the large vessels inside the abdomen).

	The procedure requires an incision at the lower abdomen to get at the muscles in the lower half, and an incision at the belly button to get at the upper half.  The skin and subcutaneous tissue needs to be separated off the muscles and the muscles sewn together.  Sometimes this can lead to bunching of the skin if it is inelastic.

	In your pictures your abdomen protrudes.  If it also has fatty tissue inside, you would not be a good candidate.  If your tummy sticks out just from loose muscles, you might be.  Seek out an experienced board certified plastic surgeon to see what you might qualify for.  Good Luck!

Douglas McManamny, MBBS, FRACS (retired) · Answer

Hi,

	The answer to your question is 'yes, the abdominal muscles can be tightened as an isolated procedure'. The operation can be performed using a short lower abdominal incision similar to a Caesarian incision and usually another incision at the level of the umbilicus.

	I think the other question you might ask is 'would this operation be suitable for me?'

	Muscle tightening or repair operations work well if a gap has developed between the Rectus muscles in the midline of the abdominal wall or if they have stretched. But for the operation to provide a long term result the pressure pushing out on the muscles needs to be minimal.

	So if there is a significant amount of intra abdominal fat present, the operation won't work well. While you are standing if your abdominal wall bulges forward and feels firm or hard this is not good. While you are lying flat if your abdominal wall still bulges forward this isn't good either. Both these signs suggest there may be too much visceral or intra abdominal fat present to achieve a satisfactory result.

	An examination by an appropriately qualified Plastic Surgeon should be able to sort this out for you.

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