Tummy Tuck

Are you constantly on a mission to get your tummy taut and toned? Sometimes all the exercise and dieting in the world can't get rid of a tummy that's showing the results of weight fluctuations, loose skin and/or the effects of pregnancy. Common changes to the midsection, like sagging skin, stretch marks and even muscle separation, which are typical of pregnancy can cause permanent damage. But, a tummy tuck procedure is not limited to postpartum women. Tummy tuck surgery—or abdominoplasty—can improve the appearance of excess abdominal fat, skin and give a more streamlined stomach. Individual conditions of the abdomen vary, and for that reason there are different tummy-tucking techniques to help you achieve a flatter, trimmer waistline.

How Tummy Tucks Work

Deep beneath the skin lies a layer of muscle that can become stretched out with age, pregnancy and weight fluctuation. No matter how much exercise you do, if the underlying tissues are not in good standing, your stomach won’t appear to be thin, trim and contoured.

Even if there is little fat on the stomach, if the muscles have become separated, the lower part of your tummy will most likely look bloated and barrel-shaped. That’s because the muscles that give the stomach definition—the six-pack muscles—have separated internally. Most surgeons say the main culprit is almost always pregnancy. Once the muscles are disconnected, they create this little bulge. Post-pregnancy, your muscles can get stronger, but they can’t contract back to their original shape and position. The only way to correct the problem is to surgically tighten the muscles, with a tummy tuck, which in turn will eliminate the pooch.

A Healthy Weight Is Important

The main goal of a tummy tuck is to refine and contour the stomach, fat bulges and loose skin, and surgeons point out that this procedure is not aimed at losing weight. If you’re not at or close to your ideal weight, your plastic surgeon may suggest modifying your diet and incorporating regular exercise into your routine. Most surgeons recommend that you weigh within 10 pounds of your ideal weight and have a BMI less than 30 before undergoing an abdominoplasty with repair of the stretched out abdominal muscles and liposuction of selective areas, in order to achieve the best long term cosmetic result with the least potential complications. Although some people are genetically predisposed to extra fat on the stomach, this procedure is more for those that are frustrated with loose skin and the separation of the abdominal wall.

Contour Your Body With Liposuction

Liposuction is usually performed in conjunction with a tummy tuck. It used to be that liposuction wasn’t routine during a tummy tuck because it was believed that it could injure the body’s blood supply, but surgeons say there’s been a shift in thinking, thanks to techniques popularized by Brazilian plastic surgeons. It’s actually deemed safer in terms of healing and makes for an easier recovery because the blood supply is preserved and kept intact. The hips, thighs and waist may also be addressed with liposuction.

If you’ve had multiple pregnancies or lost a lot of weight, then you may need the traditional tummy tuck. It involves removing fat and saggy skin and repairing the muscles that have become stretched out. After an incision is made at each hipbone, fat is first removed, with liposuction or by excision, before the skin is lifted and tightened from the belly button down—any excess skin is removed. The muscles are tightened to pull them closer together, which provides a slimmer look.

Pros: Results from tummy tuck procedures are permanent unless extreme weight-gain is experienced.

Cons: A long scar will result. Because excess skin is removed, a new belly button will be created.

If you have loose skin on the stomach and thighs, then you may need the lateral tension tummy tuck. This variation places tension laterally on the abdominal muscles, as opposed to centrally, to address the stomach as a whole. The scar will be similar to that of a traditional tummy tuck and runs from hip to hip. It also addresses skin laxity in the thighs since excess skin is removed through a single incision.

Pros: Improves the look of the stomach and the thighs.

Cons: To achieve your desired results, your doctor may need to pull your tummy tighter, which can make your recovery more painful and difficult.

If you have heavy love handles and deep folds of fat on your back, then you may need the extended tummy tuck (belt lipectomy). Not only is the abdomen addressed during this variation of the standard tummy tuck, but the outer areas of the body, like the love handles, are also taken into consideration.

Pros: The back, flanks and possibly the skin above the buttocks are tackled.

Cons: The scar runs around the waist.

If you have a small amount of loose skin or your stomach needs further refining, then you may need the limited or mini-tummy tuck. A limited or mini-tummy tuck will provide excellent results on someone with minimal loose skin and some fat and separated muscles. The incision is much smaller and less skin is removed, so this is really for someone who has just a little bit of laxity and bulging. Like the traditional version, an incision is made at the upper area of the hair-bearing region (the incision is smaller in length than a traditional tummy tuck), and excess skin and fat are removed. But because the procedure focuses just on the lower part of the stomach, there is no need to recreate the belly button.

Pros: The scar is shorter and limited to the area where a C-section scar would be.

Cons: Because less skin is removed, not as many stretchmarks are removed. It does not tighten loose skin above the belly button.

If you have excess skin and fat in the upper abdomen from massive weight-loss, then you may need the reverse tummy tuck. One of the more rarely performed variations—a reverse tummy tuck involves essentially doing the procedure upside down. Instead of the incision being made down at the pubic bone, it’s made under the breast, and the excess skin is pulled from the bottom up, not from the top down.

Pros: The entire abdominal area is improved.

Cons: A scar runs under the breasts and across the chest.

Those who have hanging, loose skin on their stomach, especially on the lower part; weak abdominal muscles; and stubborn fat that just won’t budge. Those who have tried dieting and exercise, but are still left with a little bulge on the bottom part of their tummy, and their skin is too loose for liposuction.

If any of the following factors affect the way your stomach looks, you may want to talk to your doctor about a tummy tuck.

1. Stretched Skin: The texture and quality of the skin changes due to pregnancy, weight-gain, weight-loss and age. Stretchmarks are common, which signal that the skin has been damaged to some degree, as is loose skin. Loose skin is also a post-pregnancy problem.

2. Weight Change: Whether you’re losing or gaining, fluctuating weight can cause your stomach to expand and deflate like a balloon.

3. Muscle Separation: During pregnancy, the muscles of the abdominal wall expand and separate to some degree. For those women whose muscles don’t return back to a normal shape, a pooch in the lower stomach develops. Pregnancy is the most common reason for muscles that have separated.

Those who are not at a stable weight. Weight fluctuations will affect the long-term results of your tummy tuck.

If you are considering having more children, wait to have a tummy tuck.

Many women correlate tummy tucks and C-sections, but the only similarity is placement of the scar and maybe intensity of the recovery. Many patients feel that there is less pain than with a C-section because the surgery is limited to the area in front of the muscles and not deep into the abdomen.
One of the most important things to know about a tummy tuck is that there will be a scar left behind. Even though you can cover it up with clothes and it’s rarely seen in a bathing suit, it’s not a scar that’s in a crease like when a breast augmentation or facelift is performed.

Whether you have a traditional tummy tuck or a modified version dictates what your scar will look like. But, for the most part, scarring is similar and may get worse before it gets better. Your scar will fade over time. It can take up to a year, if not more, for it to become less visible, although it will always exist.

Did you know?

Transforming your tummy comes with some known and not so well-known risks that you need to educate yourself about when you start to consider having a tummy tuck.  Some additional things you should know before you commit to surgery are:

1. A tummy tuck shouldn’t be performed at the same time as a C-section.

Despite the fact that the scars may be similar, a tummy tuck procedure and a C-section are two totally different surgeries that should not be performed simultaneously. When you’re pregnant, there is a surge of hormones, fluid and weight—it’s hard to decipher how much fat was the result of pregnancy, how much will be lost and how slack the skin really is. Any doctor who offers to perform a tummy tuck directly after a patient has given birth should be viewed with extreme caution. “You really need to wait a good six months and let your body heal before considering any type of surgery,” says Salt Lake City, UT, plastic surgeon Renato Saltz, MD.

2. You may have a smaller appetite.

After the muscles have been tightened, it’s common to feel an internal tightness in the stomach that temporarily can restrict your appetite. “A lot of patients don’t eat as much for the first three to six months post-procedure and even lose more weight after the surgery,” says Great Neck, NY, plastic surgeon Kevin Tehrani, MD.

3. You may experience some numbness post-procedure.

While not all tummy tuck patients feel burning or numbness, Dr. Renato Saltz says that it’s the result of trauma to the small sensory nerves, which usually happens after any type of surgery, cosmetic or not, to this area. “The nerves naturally repair themselves, which can take upward of a year,” says Marlton, NJ, plastic surgeon Evan Sorokin, MD.

4. Your doctor may suggest liposuction to the surrounding areas

Since the waistline, hips, thighs and pubic area all border the stomach, it is routine for them to be addressed if you’re having your stomach operated on, too. “You don’t want to have this really flat, tight stomach and heavy saddlebags or thighs or heaviness in the pubic area,” says Dr. Evan Sorokin. The main goal is to create a streamlined look, which is why it’s important that those parts of the body are taken into consideration. “That’s why we almost always do lipo in those areas.” And you won’t need an additional incision since your doctor can use your tummy tuck incision.

While the time it takes to fully recover from a tummy tuck varies, most plastic surgeons will advise you to take it slow for the first few days. There will be some swelling and bruising, which will dissipate over the next week.

Don’t be surprised if the skin on your stomach is numb. This is totally normal and happens because a lot of the little nerves have to be cut in order to get to the muscles. Any diminished sensation will generally return within one year, if not sooner.

You may have drains at the incision sites (you’ll need to empty them daily), which will be removed about one week to 10 days post-procedure.

Because some skin has been removed, the skin needs to stretch back out, and the body needs to adjust, which is why it’s difficult to stand up straight during the first week. Although you won’t be bedridden, you may be most comfortable sitting or lying down, and you should walk around a lot to prevent blood clots from forming.