The belly.
After babies and pregnancy. After weight gain and loss. After the changes of perimenopause and menopause. After Ben & Jerry’s makes some awesome you can’t-stop-eating-it flavor. No matter the reason, your belly is something we all focus on. And unlike other parts of your body, you can always see it.
So when it doesn’t look pretty anymore, how do you know how to fix it? And if you are in a grey zone, where a tummy tuck seems a bit too much but liposuction may have issues, can you just do liposuction and see how it goes?
FIRST. What is the issue? (If only fat, do lipo. If any issues of skin laxity or muscle diastasis separation, do a tummy tuck)
- fat?
- loose skin?
- loose muscle?
SECOND. How is your skin tone? (If it’s good lipo may be your fix. If your skin tone is bad, you need to tighten skin, and the only way we have is a tummy tuck. No diet/exercise/laser/or cream can “tighten” it)
- How old are you?
- Do you have stretch marks?
- Have you gone through menopause?
- Have you had pregnancies or big weight changes?
THIRD. Tummy tuck vs. Liposuction?
- A tummy tuck is a big procedure, with a big scar. But it also has big rewards, and is reconstructing your core muscles on the inside (you don’t get to see this part, but the muscle tightening is what gives the improvements in back pain, posture, urinary incontinence, and bowel habits.) It also is tightening your skin.
- If you have loose skin above your belly button, you almost always need a tummy tuck.
- If your belly muscles are separated a lot, you need a tummy tuck.
- If your skin hangs (what we call a pannus or apron), you need a tummy tuck.
- If you have those issues above – back pain, urinary incontinence- there is a health benefit to tummy tuck.
- YOU CAN CONSIDER LIPOSUCTION: if you biggest issue is fat, your skin tone is okay (not hanging and loose), and your belly muscles aren’t blown out.
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- You may choose lipo, even if it isn’t ideal, if you scar poorly OR if you just are not down with having the big scar.
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WHAT IS THE NEGATIVE OF DOING LIPO, seeing how it goes, AND THEN DO A TUMMY TUCK IF YOU NEED IT?
Ah. This can be an issue. When you do liposuction you create scar under your skin surface. You can’t see it, but it is there. When you do a tummy tuck, you need to pull the skin down to stretch it. If you do liposuction first, the skin won’t be as stretchy- think of it as if you changed the tissue from being stretchy like a bathing suit to stretchy like a leather jacket. When you do a tummy tuck, you want to stretch the skin as much as you can so you can 1. remove more skin and 2. get the scar as low as possible.
I have been burned by this in the past, when I did a tummy tuck on patients who had done abdominal liposuction in the past and forgot to mention it to me. When I took them to the operating room on what should have been a straight forward tummy tuck, when doing the surgery I could see a scar plane in the fat layer. And then when I pull on the apron of skin to advance it, I pull. It doesn’t move like it should. I pull. It doesn’t move. So then the final abdominplasty scar ends up much higher than it would have been. I don’t love high abdominoplasty scars. You really want them as low as possible so they hide well.
So If I know someone is going to do a tummy tuck, I strongly prefer to do the tummy tuck first.
For those of you who really really really don’t want to do the tummy tuck (which I get- it is a bigger surgery), you can do lipo first but know:
- If I warned you about loose skin following liposuction, it is because I think you will have loose skin. You may think “I don’t care- it’s under clothing/I’m not going to wear a bikini/etc”. Which is all true. But it doesn’t change the fact that the skin may look like rolls, bumpy, cellulitic, irregular when the skin is now too loose for your now smaller size. And you may *think* it won’t bug you until you see it and then you realize it really does bug you. (Please read the issue of doing lipo first then a tummy tuck above)
- Anyone who tells you their laser/ultrasound/coolsculpt tightens the skin is almost always exaggerating what it can do. (In photos showing how great they look, make sure they are the same age and skin quality, lighting before and after are the same, their arms aren’t pulled up higher to try to make it look better, etc)
- The more fat we take out, the more we are asking your skin to shrink to the smaller size. (Look at skin tone issues listed above)
- Coolsculpt works from the skin down, so it is removing the superficial fat first. If you have any issues with skin tone, PLEASE do not do it. It can leave wrinkling in the skin which I cannot “pull out” later with a tummy tuck.
So conclusion?
It’s one to really think about. You need to be honest with yourself about what you are okay with and what your goals are.