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Do I Need Liposuction or a Tummy Tuck?
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Do I Need Liposuction or a Tummy Tuck?

Episode:3 Do I Need Liposuction or a Tummy Tuck?

Today we're going to be discussing the best way to get a flatter abdomen. This is a very common question from folks that have been trying very diligently with diet and exercise, and just aren't able to achieve the abdominal contour that they're looking for. The liposuction versus tummy tuck debate basically comes down to what is causing the abdominal bulging in the first place. This is a question that's most easily addressed from an anatomical perspective. By that, I mean there are essentially three layers that affect the shape of the abdomen. The most obvious one, the outermost one, is the skin. Beneath the skin, there is fat. Beneath the fat, there is the abdominal wall, which consists of muscle and connective tissue. The most important muscular component of the abdominal wall is the rectus abdominis muscle or the six pack muscle. An issue with any one of those three layers can cause an undesirable abdominal contour.

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How can I get rid of abdominal fat?

First of all, in probably the most common scenario we see in our office, there is simply an excess of abdominal fat. If that's the case, we can perform liposuction. With liposuction, we're making tiny, well-hidden incisions. We are introducing numbing medication, and then using a special long, thin instrument called a cannula to carefully sculpt out and suction the fat that we no longer want to be present. In these individuals that have nice, strong abdominal muscles and good skin elasticity, simply removing the fat by liposuction will result in a volume reduction. The abdominal skin will simply shrink wrap itself to the new flatter abdominal form. An excellent result can be achieved with liposuction alone.

What if I have a rectus diastasis or loose abdominal skin?

On the other hand, if there are issues with the other layers of the abdomen, the abdominal wall musculature, or the skin, liposuction alone won't do the trick. Specifically, if there is an issue with the muscular abdominal wall, meaning abdominal wall laxity, or very commonly in the case of postpartum women, the presence of a rectus diastasis, which is a separation in the midline between the two rectus abdominis muscles, liposuction alone will not result in a pleasing abdominal contour because you'll still be dealing with the bulge caused by the rectus diastasis.

Similarly, if there is not good skin elasticity present, which again, may often be the case after pregnancy or in those more advanced in age, simply performing liposuction won't address that issue either. In fact, you may end up with a less pleasing abdominal appearance as performing liposuction alone in these individuals will result in a decrease in volume. However, the skin will not shrink back to a good shape and you'll be left with waviness and rippling that can be unattractive.

It used to be the case until recently that if there were issues at play beyond excess abdominal fat, a tummy tuck or abdominoplasty was the only reasonable way to treat those issues, specifically a rectus diastasis, or abdominal skin excess. Now, however, there are several technologies available that can allow us to treat minor to moderate issues with the muscular layer of the abdomen, as well as with abdominal skin laxity, which we'll discuss in just a moment. However, for truly severe cases of abdominal skin laxity or abdominal wall issues, such as rectus diastasis, abdominoplasty does remain the gold standard and treatment of choice. Let's discuss that one first.

Abdominoplasty

With an abdominoplasty, a long, low incision is made from hip to hip. Excess skin is removed. Often, liposuction is performed at the same time as the abdominoplasty to achieve a very nice contour by simultaneously addressing fatty excess at the same time as we're addressing the skin excess and abdominal wall laxity. Then the abdominal wall muscles, the rectus muscles, are sewn back together in the midline to treat the rectus diastasis. This sewing the rectus abdominal muscles together in the midline is called placation. By following the steps, the abdominoplasty allows us to address skin excess, fat excess, and a rectus diastasis of the abdominal wall.

Now, I mentioned earlier that less severe cases of both abdominal skin laxity and abdominal wall laxity can now be addressed by more advanced modalities, which allow us to take a less invasive approach often in conjunction with liposuction. Specifically for mild to moderate skin laxity, we've been having a lot of success with radiofrequency energy, specifically with the BodyTite system. This device simply passes through the same, very small access incisions that we use for liposuction and heats the skin in a very controlled way, causing collagen and elastin formation and an improvement in abdominal skin elasticity.

Now, for a weakened abdominal wall, we have been seeing great success with Emsculpt, which uses HIFEM, or a highly focused electromagnetic energy, to stimulate the abdominal wall muscles and build significant muscle mass and actually treat rectus diastasis to some degree.

Conclusion

The bottom line with abdominal wall contouring is that it is fairly nuanced and every situation is very different. A consultation with a board certified plastic surgeon is an important first step in designing a treatment plan that will help you achieve the results that you are looking for.

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  • Darren M. Smith MD
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  • Darren M. Smith MD

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