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What Can I Do About My Abdomen Post-Pregnancy if I Don’t Want to Have A Tummy Tuck?
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What Can I Do About My Abdomen Post-Pregnancy if I Don’t Want to Have A Tummy Tuck?

Episode 38: What Can I Do About My Abdomen Post-Pregnancy if I Don't Want to Have A Tummy Tuck?

What can I do about my abdomen post-pregnancy if I don't want to have a tummy tuck? Well, I'd like to introduce a new concept in abdominal rejuvenation or abdominal contouring that we've been working with in our New York City plastic surgery practice and having great success. So the abdominoplasty has always been the mainstay of abdominal rejuvenation. This is because it really addresses all of the different anatomical problems that occur in the abdomen after pregnancy that it is possible to address with a surgical approach. We speak about these issues according to the anatomical layer that they concern. So working from the outside in, after pregnancy, the skin envelope of the abdomen is stretched by the expanding uterus. After the baby is delivered often the abdomen can't contract back, the skin can't contract back to its original height level. So we're left with loose rippled skin after pregnancy. Moving down a level, there's often some fat redistribution after pregnancy and breastfeeding. So there's excess abdominal adiposity that can be very stubborn and very difficult to lose after pregnancy and breastfeeding. Then finally, when we look at the abdominal wall itself, that combination of muscle and connective tissue, specifically the rectus abdominis muscles, those are the vertical six-pack muscles, those often spread apart during pregnancy to make room for the expanding uterus and when they cannot completely come back together after pregnancy we're left with a very common condition called a rectus diastasis. That's when there is space that remains between the rectus muscles after pregnancy. So an abdominoplasty and the liposuction that it's often combined with addresses each of these layers very effectively.

We can directly excise skin excess with an abdominoplasty. We can get rid of excess abdominal fat with liposuction and there's also some direct excision as part of an abdominoplasty. Finally the rectus diastasis or the separation of the rectus muscles in the midline of the abdomen is dealt with by placating the rectus abdominis muscles. That is, we sew them back together in the midline to reconstruct the abdominal core.

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What if I want to improve my abdominal contour but I’m not ready for a tummy tuck?

There's a reason that the abdominoplasty is the mainstay of abdominal rejuvenation and often the centerpiece of a mommy makeover. It works well. However, an abdominoplasty can be a major investment both in time and in recovery and it's just not something that's compatible with everyone's life. For folks that don't have very severe skin laxity or a major rectus diastasis or significant fatty deposition in the abdominal region after pregnancy and breastfeeding, it would be great if there was another approach to start to move in the same direction as the kind of results that we see after abdominoplasty, even if the end result isn't quite as dramatic.

So for these people that have mild to moderate skin laxity of their abdomen, mild to moderate rectus diastasis, and just a small amount of fat redistribution to the abdomen, there is a great combination of procedures that we've been using with which we've been seeing some really nice success. We've covered each of these things individually in earlier episodes if you'd like to hear about them in more detail, but here I'd like to really talk about how they work together nicely to deliver an excellent result for mild to moderate cases of abdominal contour issues after pregnancy. These three technologies are BodyTite, which is radiofrequency skin tightening, liposuction, which we've covered at length elsewhere, which is where we remove fatty deposits through tiny incisions in the selected treatment area and finally Emsculpt, which is a noninvasive treatment that uses HIFEM or high intensity focused electromagnetic energy to provide an intense muscular workout.

By using these three technologies together, we can provide a nice change in abdominal contour and abdominal rehab for women that have given pregnancy and have mild to moderate abdominal contour issues. So by using this combination of treatments while we cannot achieve the result that's quite as profound as what we can get with a true abdominoplasty, we can get a nice improvement in the properly select the patient for a lot less money and a lot less downtime than you would have with a traditional abdominoplasty procedure.

How can BodyTite help if I don’t want a tummy tuck?

So just to move through these treatments one by one, for mild to moderate skin laxity, we have been using the BodyTite treatment, which is radiofrequency skin tightening. This is a device that has two poles. One pole is at the end of a very thin wand. The other pole is at the end of a thicker piece of the device. The thinner pole goes under the skin through a very small three to four millimeter incision. The other pole travels along the surface of the skin following the internal pole and radiofrequency energy is passed between these two poles. That's why it's called bipolar or two pole radio frequency skin tightening, and it heats the skin. It causes a controlled thermal injury. Then as that controlled thermal injury heals by contraction, the tissue tightens. So, whereas with an abdominoplasty, we are directly excising skin by making a big excision, with radiofrequency skin tightening and BodyTite, we can provide some real degree of skin tightening with a truly minimally invasive procedure.

BodyTite and Liposuction Can Treat Two of the Three Issues Addressed by Abdominmoplasty in the Right Patient: Skin Laxity and Fatty Excess

I mentioned that with a tummy tuck, we're often performing some liposuction to address fatty excess after pregnancy. So, between BodyTite for skin excess and liposuction for excess abdominal adiposity, in the right patient we are able to address two of the three areas treated by abdominoplasty without an excisional procedure requiring a long incision.

Emsculpt Can Improve the Third Issue Addressed By Abdominoplasty in the Carefully Selected Patient: Rectus Diastasis

For the deepest layer of the abdomen and to address the changes that it's undergone after pregnancy, with a tummy tuck we are going to sew those rectus muscles back together in the midline. That is, we're going to perform a plication of the rectus muscles to treat a rectus diastasis. With the advent of Emsculpt, we can actually address a rectus diastasis noninvasively by using high FEM or highly focused electromagnetic energy. We're able to perform the equivalent of 20,000 crunches in 30 minutes. By achieving these super maximal muscle contractions, it's been shown that Emsculpt can actually cause an 11% on average improvement in diastasis recti. Now again, 11% is not earth shattering, but it can be a meaningful improvement in the right patient.

Conclusion

For someone with a mild to moderate problem, combining Emsculpt with some liposuction and the BodyTite procedure, we can really achieve some very nice results with a procedure that has minimal downtime and really can be performed at a fraction of the cost of a traditional abdominoplasty. So by no means are we advocating that we can replace or reproduce the dramatic changes of an abdominoplasty with this combination of Emsculpt, liposuction, and BodyTite. However, what we are saying is that for folks with a mild to moderate problem that don't want to have the downtime or expense associated with a classic abdominoplasty, this combined minimally a noninvasive approach may be a reasonable option to consider.

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

All photos are of models except before and after images.

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