Liposuction Vs. Tummy Tuck - What's the Difference?

My medical philosophy is to do the least invasive procedure first, whenever possible. It is pretty well established that tumescent liposuction of the abdomen (using only local anesthetic) has far fewer risks for the patient that a tummy tuck procedure (larger surgical procedure done under general anesthesia).

When considering liposuction vs. tummy tuck, many patients mistakenly think that they have to choose either one or the other. I give them a third option - do a simple liposuction first, and move on to an invasive tummy tuck later, only if truly necessary.

I let my patients know that the two procedures are complimentary, and are commonly performed together - for example, during a tummy tuck surgery a surgeon may first perform liposuction to remove excess fat and then move on to removing excess skin and tighten muscle, if necessary.

My advice: split the liposuction-tummy tuck surgery into two:

• Part 1: tumescent liposuction.
• Part 2 (only when necessary): tummy tuck.

I encourage my patients to start with the less invasive, less risky, safer procedure first. I tell them to choose tumescent liposuction, which is the safest way to perform liposuction.

Having taught liposuction for years at the University of Southern California Keck School of Medicine, I know that tumescent liposuction is effective and has a remarkable safety record, especially when compared to the alternatives. Tumescent liposuction is done with the person awake, using local anesthetic, and avoids the risks associated with general anesthesia.

Liposuction can remove a substantial amount of fat and can dramatically improve a person's shape and silhouette, especially in the stomach area. More often than not, this is enough to solve the main concerns of many of my patients. Their shape improves and they look better in and out of clothes.

For those few patients who are not fully satisfied and truly need abdominal muscle tightening and skin resection - they can move on to Part 2 -the more invasive part involving general anesthesia, a lengthy scar, and a much longer recovery time.

Should Part 2 really be necessary, the patient will not have lost any ground by having the liposuction done first. With the fat already removed, the skin removal and muscle tightening may actually be done faster.

In short, the two part approach gives patients the option of starting with a safer, less invasive procedure, and moving on to a major surgery only if necessary.

The decision on whether to do an abdominoplasty (tummy tuck) vs. LIposuction is actually quite simple if you can just break it down to answer 3 questions

1. How thick is your "fat layer" ? is it too thick for your liking ? Can you grab it in your hand and feel excess fat ? If this is true, then you need to either lose weight by dieting or you may be a candidate  for liposuction to reduce the thickness of this layer
2. Do you have excess skin that is a significant issue for you ? Women are individuals and tolerate certain amount of lax skin differently, but if it is intolerable to you then skin tightening is mandatory. The gold standard for tightening skin is through an abdominoplasty in which the entire abdominal skin is elevated along with the fatty layer and the excess skin is removed. 
3. Is there abdominal wall / muscle laxity. This assessment often requires your surgeon's evaluation to be sure. However if you feel below the fat layer and can tell that not only is your abdomen bulging due to fat, but also due to a protuberant abdominal wall, then the muscle layer must be tightened. 

Tying these concepts together you would benefit from 

• Liposuction : if you only have fat excess only with minimal to no skin laxity accompanied by abdominal wall firmness. 
• Skin only abdominoplasty : if you have skin excess only with great abdominal tone and flat muscle layer. the recovery for this type of tummy tuck is much less painful with much less downside.
• Full abdominoplasty with muscle tightening : if you are a typical mom who has had her muscles and abdominal wall stretched out of position resulting in a lax abdomen and excess lax skin

A final question is what do I do if I have all 3 problems. Personally I will carefully in some patients perform both  liposuction and tummy tuck at the same time. With experience I feel it is possible to carefully perform such a combination with excellent and dramatic improvement. However if you have a significant amount of fat to be suctioned, I strongly recommend that you do the liposuction AFTER the tummy tuck. There is a common misconception that you should have the liposuction first. At first glance this makes sense, thinking that there would be greater skin laxity you could then tighten with a secondary follow up tummy tuck. However, 25 years of experience and teaching has proven to me that after liposuction you create stiff scar tissue in the fat. Fat is usually very very mobile which allows the skin to be stretched maximally. However I can never get all the excess skin out after liposuction due to the scar tissue contraction in the fat layer after liposuction. there is no question in my mind that the order should be tummy tuck first followed by liposuction. This combination yields dramatic results. 

I hope this helps. It is a very important and common question. 

It really is difficult to say without an exam, but typcially, once you have had children, it is more likely that you will experience a better result from a tummy tuck.

I have explained this in greater detail below.

An office visit/consultation (complimentary) is mandatory prior to scheduling the procedure. There is no way to give you an accurate quote via E-mail. We have 300lb individuals and 120lb individuals who ask about liposuction. It would not be fair to give both the same quote. What you may consider is one body part such as the LEGS may actually represent a combination of inner or outer thighs, legs/calves, flanks, hips, buttocks, knees, etc.). If you are considering the STOMACH/ABDOMEN area, it may consist of upper and lower abdomen, hips, flanks, upper buttocks, back, etc.

It would be two or more distinctly different operations despite being performed on one body part. Fees vary accordingly. During the consultation, we may determine that other procedures are better suited for your optimal outcome such as a thigh lift or tuck.

An office visit/consultation (complimentary) is mandatory prior to scheduling the procedure. There is no way to give you an accurate quote via E-mail. A tummy tuck (abdominoplasty) describes 3 or 4 different types of operation based upon the condition of the skin (scar, stretch marks), fat (amount and location), muscles (loose, weak, or separated following pregnancy), as well as your general body weight and shape. A tummy tuck in a 150lb individual who smokes and has lost 100 lb and has had 3 children (one of which was delivered by a c-section) is not the same as 110 lb individual with localized fullness of the lower abdomen.

The first would probably require a tummy tuck and the second would probably require liposuction. It would not be fair to give both the same quote. It would be two distinctly different operations despite being performed on one body part. What you may consider is one body part (hips) may actually represent four (abdomen, flanks, hip, buttock).

In my practice near San Francisco we encourage patients to think of their abdomen as two parts. The first is abdominal volume, the second is the skin envelope around the abdomen. Each may have a need for cosmetic improvement and the approach for managing a particular patient must be carefully tailored for that patient.

Lipo is great for targeted permanent fat removal but not as good for skin envelope reshaping. Even with new gadgets like "laser lipo" most of the time if there is significant excess skin it needs to be removed by excision. Lipo is also not always appropriate in situations where there is a great deal of fat and in these situations excision of the fat or additional weight loss prior to surgical treatment gets patients better results.

In many cases patients after pregnancy may need an abdominoplasty. The way to think about the process is to consider the following parts of your abdominal contour:

1. Intra-abdominal contents (organs, bone) - this part you can't change
2. Muscle separation - Separated muscle can cause significant weakness resulting in abdominal bulge of the intra-abdominal contents. This requires a tummy tuck to correct.
3. Subcutaneous fat - this is typically what liposuction targets but is also resected at the time of tummy tuck
4. Skin - Again, an abdominoplasty is required for this.

A tummy tuck traditionally deals with both the skin and the abdominal contour by removing tissue and repositioning the muscles. Some argue a greater ability to "shape" the underlying fat with lipo but few would argue the ability to remove redundant skin with an abdominoplasty and reposition the abdominal muscles.

Hope this helps!

The key is the amount of loose skin and fat in the abdomen following pregnancy. If the problem is primarily loose skin with very little fat, then a tummy tuck alone will remove loose skin and tighten the tummy.

However, if there are significant amounts of fat then a liposuction will also be needed.

Another important issue is whether the loose skin is below the belly button. If it is then a mini tummy tuck may be all that you need.

New laser assisted liposuction also tightens skin as well as remove fat. In cases where loose skin is minimal and small pockets of fat are the main concern, then the laser liposuction may be all that is needed.

If a full Abdominoplasty or Tummy Tuck is done, adding Liposuction can increase the risk and should be done before the Tummy Tuck.

Liposuction (whatever method is used) primarily removes fat from below the skin surface and provides a moderate amount of skin tightening due to scar contracture.

A tummy tuck does several things:

• Removes abdominal skin that is in excess, and resets the tone to the remaining skin
• Removes some fat from the abdomen
• Redistributes skin and fat from the upper abdomen to the lower, effectively thinning the abdominal wall skin/fat thickness
• Tightens the abdominal wall musculature, which both flattens the stomach from the side view as well as pulling in the waist to improve the "hour glass" shape

Very simply, the tummy tuck reverses the changes caused by childbearing, and is typically the appropriate operation for mothers or individuals who have undergone significant weight fluctuation. Liposuction is for fat contouring in individuals who have resistant areas of localized fat and also have good skin tone. If skin tone is bad (lax, or with stretch marks), the results from liposuction may be disappointing.

I hope this helps in your decision process. My advice is to visit with a board certified surgeon who performs both operations, and ask their opinion regarding the pros and cons of each approach in relation to the areas that you want to improve.

Best of luck!

Usually someone who has had three full term pregnancies will have excess skin. Liposuction alone really does nothing to address this problem. A full tummy tuck, on the other hand, involves removal of both skin and fat as well as tightening of the abdominal muscles which often have some laxity, especially after multiple pregnancies.

Pregnancy really takes a toll on a woman's abdomen.  When evaluating a patient such as yourself there are three areas that must be evaluated to determine which operation is best for you.  First is the skin.  Pregnancy really damages your abdominal skin.  If there is a lot of loose skin this is best corrected by a tummy tuck.  Second is the state of the muscles. Pregnancy causes a widening of the abdominal musculature which can only be addressed with a tummy tuck.  Finally is the abdominal fat.  If the problem in your abdomen is only fat then you would be a good candidate for liposuction alone.  In  my experience however, most patients who have had three children get the best results with a tummy tuck. 

Liposuction is sculpting and selective removal of some of the fat between the skin and muscle in the tummy and hip areas.  A tummy tuck is removal of the loose skin that can be left behind after the changes from pregnancy with tightening of the muscle "fascia" to improve the appearance as well as function of the rectus abdominis (six pack muscles).  This is also done usually in conjunction with some liposuction throughout the hips and thigh areas. If you have had three kids already then the abdomen has changed likely with each pregnancy.  Most patients meet criteria for a tummy tuck from an anatomic standpoint but not every woman decides they want to undergo a tummy tuck, at least in the first go around with plastic surgery.  The "homerun" to restore a woman's abdomen after changes from pregnancy is a tummy tuck.  I utilize a low lying incision that is concealed within swim suit bottoms and patients are happy with their final appearance; however, I tell my patients upfront that they need to plan on giving themselves two weeks off for recovery.  Some patients either are not ready for that or they simply cannot get help with their kids, etc. and in these patients I think liposuction can be a great alternative.  Contouring the abdomen and torso will give improvements in shaping and clothing will fit better.  Many of these patients may technically "need" a tummy tuck but there is no problem "wading in the pool" with liposuction rather than "jumping in the deep end" right away.  Liposuction does not "burn and bridges" to come back at a later time point and complete the restoration with a tummy tuck. I hope this helps!

Sincerely,

James F. Boynton, M.D., F.A.C.S.