This request came in to me today:
“I would like to fix my diastasis, but I don’t want a tummy tuck.”
Can I do that?
The answer is no. Please read on to understand why.
First, to do a true good diastasis muscle repair, you need to tighten the muscle above the belly button and below.
- You can’t get to the upper abdomen muscles well without releasing around the belly button. Yes, you can try to sneak around the belly button, but when you do this, you end up getting a poor muscle repair. Or you don’t get to all of the muscle.
- Yes, you can decide to just tighten below the belly button. But when your muscles are stretched out from weight loss or pregnancies, you stretched the whole belly out, not just the lower belly. If you just tighten the lower belly muscles, then your upper belly will bulge.
Second, when you tighten the muscle, your skin needs help.
- When you suck in your belly, what does your skin do? Does it wrinkle? hang? look loose? or does it look good? Commonly the skin on the belly looks good when the abdomen is stretched out, as the loose muscles are essentially “filling” the loose skin. When we tighten the muscle, the skin will look like you do when you suck it in. If it is loose, you need tighten it. Tightening skin = cutting out skin = tummy tuck.
- When you tighten the muscles, you need to release the skin so the skin can redistribute. You don’t want to pull the muscles together and end up with a speed bump of skin centrally. The more your muscles are split, the higher the likelihood this will happen.
There are variations on the tummy tuck. I have done many “mini” or “hybrid” tummy tucks, where I don’t cut out much skin at all. But when doing muscle repair (not skin only) they all have a scar around the belly button (to allow good access for muscle repair) and in the pubic area, like a generous C section scar. The length of the lower scar depends on if/how much skin I remove.
Some of this depends on how much diastasis you have. The wider the separation, the more these things matter. But most of the time when you seek a plastic surgeon and your diastasis bothers you, you have more than a little.
So in summary, know all tummy tucks aren’t equal. How much separation you have of the muscles, where that separation is, your skin quality and elasticity, and how loose your skin is all varies. That is why there are different types of tummy tucks with different lengths of scars.
But I am always focused on a good solid muscle repair. I do two layers, permanent suture, and interrupted sutures (not running suture). I live in the Bay Area with super active patients. Most of my patients run marathons, hike, do Peleton, etc. I know they are going to stress my repair.
I also think a strong muscle repair is what gives all the gravy of a tummy tuck– the improvements in urinary incontinence, bowel habits, back pain and posture.
So just a diastasis repair? Not without some work to allow full access to the upper and lower muscles, not without redraping the skin so it isn’t bunched, and not without scars at the belly button and lower pubic area.
When a magic skin tightening machine which actually works is out there (and NO, there isn’t one yet, no matter what everyone’s marketing may say), I will be living in it. 🙂