Tummy Tuck Totally Confused After Two Consultations? (photo)

I had 2 consultations both with board certified plastic surgeons. I seem even more confused. I was hoping you guys would shed some light. 1. One said lipo on abd with tuck was fine, the other said no it causes healing issue? 2 Next was my incision, one said I might have vertical and horizontal what causes this? 3. I attached a photo cause one said I would have a slight bulge the other I would be flat?? Where on a tummy tuck is it safe to lipo?

Doctor Answers 15

Surgeons have different techniques and experiences; choose wisely

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In regards to the differences in the approach of two or more plastic surgeons, this is frequently seen because different surgeons have different experiences and perform operations with different techniques.  In some cases, it’s not possible to take all of the lower segment of the abdominal skin and fat out and end up with no vertical scar, but in some cases it is.  Additionally, a small bulge can be seen after tummy tuck because there is fat that still remains, and sometimes it is a little bit relaxed and appears to be like a small bulge.  The usual is that there is no vertical scar between the belly button and the pubic area, and there is usually a flat tummy and the incision is horizontal from the anterior hip on both sides down in the crease above the pubic hair area.  The scar is usually inconspicuous except in unusual cases where someone might have a keloid.

Virginia Beach Plastic Surgeon

A full tummy tuck with or without liposuction is likely your best option.

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Thank you for your question and the photos.

A full tummy tuck with or without liposuction is likely your best option. I do not think that you would need a vertical scar.

To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery. I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews


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Every PS is different and each has their own techniques on doing the procedure. Having a full tummy tuck with Liposuction of the upper abdomen is reasonable depending on the situation. Without an exam it will be hard to determine what type of incision you would require.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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Tummy tuck and liposuction

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A tummy tuck can be done with liposuction of the hips and thighs. Some surgeons also liposuction the central abdomen but limit undermining of the abdominal flap to maintain the blood supply to the abdominal flap.  It is really a case by case issue. 

Steven Wallach, MD
New York Plastic Surgeon
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Tummy tuck with lipo

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I frequently perfrom liposuction of the hips and thighs with a tummy tuck.  If you lipo the upper belly you may have wound healing issues after the surgery.


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From the single photo you have posted, it seems you would benefit from a combination of transpositional abdominoplasty and liposuction /liposelection (ultrasonic/vaser) of flanks. During these operations the accumulated and undesired fat will be suctioned from flanks ( "love handles" ) and around your belly botton , your streched out abdomonal muscles will be tightened and excess skin will be removed through a horizental incision above your pubic area. In your case a vertical incision is not necessary. I hope this would help you.

Tummy Tuck with Lipo

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Looking at just the one photo that you submitted, it would be unwise to NOT do lipo at the time of your tummy tuck.Yes there is a continuing debate about safety when these 2 procedures are done at the same time but I can assure you it can and should be done.Over 20yrs ago, the concept of doing a lipoabdominoplasty was introduced and the details of how to combine the 2 procedures safely have been available to any informed plastic surgeon since then.With regards to your incision, the vertical extension is reserved for cases of extreme laxity of the entire abdominal wall as in patients following massive weight loss.Again, looking at the one photo you included, it appears a major part of your situation is the fatty tissue throughout your tummy whereas your skin laxity is typical for an abdominoplasty patient. For these reasons i think you would be best served by combination procedure with a conventional horizontal or "bikini" incision.Neither liposuction nor tummy tuck alone will fulfill your expectations; in my opinion.

Bernabe Vazquez, MD
Miami Plastic Surgeon
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Lipo of upper abdomen during tummy tuck safe or not?

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Sorry, you have stumbled in on an evolving issue amongst plastic surgeons. The older amongst us were trained to avoid it at all times or risk necrosis of the lower central skin, but the younger ones learned how to do it sparingly but safely. I was once "older" but now I've joined the newer approach. Every surgeon recommends what works best in his hands and both camps are right. From the looks of your photo, I would recommend the modified inguinal scar tummy tuck with muscle repair to the lower abdomen and lipo of upper abdomen and love handles. 

Dr Foster

Lawrence Foster, MD (retired)
Sacramento Plastic Surgeon

I Sense Your Frustration And Understand Your Confusion

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Board Certified Plastic Surgeons are trained at different institutions across the country, and even in foreign countries.  They gain their basic information from their professors who were trained at various institutions.  Add to that, each plastic surgeon has his or her good and bad experiences which shape their belief systems.  Hopefully, you have done your due diligence and chosen to consult only with quality Board Certified Plastic Surgeons.  It becomes your responsibility to choose which surgeon you want, not which technique you want.  Credentials, before and after pictures, quality of staff, quality of surgery center, all of these are important, but your gut feeling about the plastic surgeon is the most important criteria.  Don't be impressed by crystal chandeliers, or well spoken staff.  Be sure the doctor makes sense and communicates well with you.  This is how you choose a plastic surgeon.  

Plastic surgery is 75% technical and 25% artistry.  Pure technicians will do everything right by the book and leave you with an unattractive result.  Pure artists forget which medium they are working with and can become a danger to you.  The most important quality of a plastic surgeon which should be easy to discern is, DOES HE OR SHE CARE?   

Abdominoplasty vs. liposuction

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First off if you see 10 plastic surgeons you will get 10 different opinions on what should be done/how it should be done. That does not mean all of them but one is wrong. Different approaches can yield similarly good results.

Doing liposuction at the same time as the tummy tuck is controversial for some surgeons, a definite no for some and routine practice for others. It is clear that if your liposuction is very aggressive and the dissection to elevate the abdominal skin fat flap is broad the risk of problems healing go up. On the other hand many surgeons do conservative liposuction of the flap (upper abdomen) at the same time as the tummy tuck and rarely have problems from doing so. If liposuction is indicated and it is not done at the time of the tummy tuck the patient will need another surgery down the line to do it. That does not make much sense to me.

All tummy tuck patients have a horizontal scar at the bottom where the upper skin flap is pulled down and the excess skin and fat removed down below. In patients who have lost a lot of weight such as after gastric bypass surgery some surgeons remove an additional wedge of skin in the midline which is closed as a vertical line, hence the vertical scar. In some cases there is not sufficient excess skin above the belly button for the skin at belly button level to be pulled all the way down to horizontal scar line. In such cases a new belly button hole is made and the old one is sutured closed, hence a small vertical scar below the level of the belly button.

Your posted photo shows a bulge of upper abdominal skin that hangs over the belly button and another lower bulge that hangs over the upper edge of the undergarment when standing. Clearly that would make you a candidate for a regular tummy tuck. It is unclear how far towards the back the roll of the lower bulge extends. If it goes all the way to the back you will need the tummy tuck extended onto the back. If you just do it on the front you will end up with a muffin top appearance starting at the outer edges of the horizontal scar. I suspect that some liposuction of the love handles might help but cannot tell from this photo alone if any liposuction of the abdomen is indicated. As long as your weight is stable I doubt you would need to lose any weight before undergoing this procedure.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.