Tummy tuck eligibility - Subcutaneous fat or visceral fat

A tummy tuck, or abdominoplasty, primarily addresses excess skin and subcutaneous fat in the abdominal area, along with the tightening of abdominal muscles.  

Here's a breakdown of how different types of fat relate to tummy tuck eligibility:

Subcutaneous Fat:

This is the fat located directly beneath the skin, the kind you can pinch.  
Tummy tucks can directly remove a significant amount of subcutaneous fat along with the excess skin.
If you have a noticeable amount of subcutaneous fat contributing to a protruding or sagging abdomen, a tummy tuck can be a suitable procedure to address this.  
Visceral Fat:

This type of fat is located deeper within the abdomen, surrounding the internal organs.  
Tummy tuck surgery does not directly remove visceral fat, as it lies behind the abdominal muscles.
A "beer belly" appearance in men is often an indication of higher visceral fat.  
While a tummy tuck can flatten the stomach by tightening muscles and removing subcutaneous fat and skin, it won't reduce the amount of visceral fat.
Eligibility Considerations:

Plastic surgeons consider several factors for tummy tuck eligibility:

Excess skin and subcutaneous fat: The primary concern addressed by a tummy tuck.
Stable weight: Ideal candidates are at or near their target weight. Significant weight loss after a tummy tuck can lead to new excess skin.  
Good overall health: You should be free of medical conditions that could increase surgical risks.  
Realistic expectations: Understanding the procedure's limitations, including its inability to target visceral fat, is crucial.
Non-smoker: Smoking can impair healing.  
BMI: Many surgeons prefer a Body Mass Index (BMI) under 30 or 35, as a higher BMI can increase the risk of complications.  
How to Determine Visceral Fat:

While only imaging tests like CT scans or MRIs can precisely measure visceral fat, there are simpler ways to estimate if you have a higher amount:

Waist circumference:
Women: A waist circumference of 35 inches or more is associated with a higher risk.
Men: A waist circumference of 40 inches or more is associated with a higher risk.  
Waist-to-hip ratio: Divide your waist circumference by your hip circumference. A ratio above 0.85 for women and 0.90 for men may indicate more abdominal fat, including visceral fat.  
Body shape: An "apple" shape (larger waist compared to hips) is often associated with more visceral fat than a "pear" shape (larger hips than waist).  
In summary, while a tummy tuck is effective for removing excess skin and subcutaneous fat, it does not target visceral fat. Your eligibility for a tummy tuck will depend on several factors, including the amount of excess skin and subcutaneous fat, your overall health, and realistic expectations about the outcome. Consulting with a board-certified plastic surgeon is the best way to determine if a tummy tuck is the right procedure for you. They can assess your individual situation and discuss the potential benefits and limitations.  


Sources and related content

From your photographs, it seems that you probably have quite a bit of visceral fat. Depending on your health and other factors, you may be a candidate for abdominoplasty, even with a BMI of greater than 30. If you could drop your BMI to 30, yes, you could expect a nicer result. For now, you may be happy with liposuction and skin removal and consider muscle tightening in the future if you can decrease the visceral fat.

Hello, and thank you for your question regarding tummy tuck eligibility and whether you have subcutaneous or visceral fat. I appreciate your history and the pictures you provided.

Based on your pictures, you have excess abdominal skin and fat, along with a combination of subcutaneous and visceral fat. While you do have a noticeable amount of subcutaneous fat, most of the fat in your lower torso and abdomen appears to be visceral fat. Visceral fat is located deep inside the abdomen, surrounding the organs, and cannot be removed with liposuction or a tummy tuck.

Most experienced, board-certified plastic surgeons would recommend further weight loss before proceeding with surgery. Ideally, it would be best if your BMI were below 30 to ensure the best and safest results. If losing weight through diet and exercise alone has been challenging, you may consider medically assisted weight loss options. FDA-approved GLP-1 medications like Ozempic, Mounjaro, Zepbound, or Tirzepatide can be highly effective in promoting further fat loss, including a reduction in visceral fat. For patients looking for a more aggressive and long-term solution, vertical gastric sleeve surgery is another option that could significantly help with weight reduction.

It is important to note that liposuction (including 360 lipo) can only remove subcutaneous fat and does not address visceral fat or skin laxity. If you proceed with 360 liposuction alone, you would likely be left with hanging skin, requiring a tummy tuck for optimal results. Therefore, most plastic surgeons would suggest losing the weight first, reducing visceral fat, and then undergoing a tummy tuck to achieve the best contour.

I hope I have answered your questions regarding tummy tuck eligibility and the difference between subcutaneous and visceral fat. If you have any more questions about a lower body lift, circumferential 360 body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please consult an experienced, board-certified plastic surgeon specializing in these procedures. Since body lifts and tummy tucks are major procedures, it is crucial to research your surgeon carefully. Ensure they have performed at least 100 lower body lifts, have extensive before-and-after photos, and have positive reviews on RealSelf. If you are unable to find an experienced lower body lift surgeon in your area, consider traveling out of state for the best possible care.

Good luck, and I hope this helps answer your question!

Sincerely,
Dr. Katzen