Liposuction or tummy tuck (also known as an abdominoplasty) are two different surgical procedures that address the same region. Patients of mine that are seeking these procedures are looking to transform the midsection of their belly. Both procedures have the same end goal that result in a smaller, tighter, and more highlighted abdomen. An abdomen that is aesthetically pleasing with definition, natural curves, and looks amazing from all different angles. In order to achieve such goals, we must first understand whether a patient would most benefit from a liposuction or tummy tuck.
First, when assessing my patients, I have them undress in front of the mirror so we both understand what is needed for me to accomplish the patient’s goal of achieving stunning results. Now, some patients only need liposuction while other patients need a tummy tuck with muscle plication, and some need a tummy tuck with no muscle plication. In order to understand this, I need you to visualize what I would do during our consultation appointment. Yet, before we visualize what is needed it is important to understand two concepts that I use while I see my patients.
When deciding what procedure is right, liposuction or tummy tuck, we must look at the fat distribution on the abdomen as well as the skin. For skin we look at two things specifically, your skin texture and the amount of skin redundancy a patient can have, or in other words the amount of excess skin on a patient. Imagine someone who is 300 pounds who recently lost 150 pounds. They did an amazing job and lost a lot of weight, and a lot of their fat has been removed with hard work and exercise, but unfortunately, they are left with excess skin redundancy and their skin texture becomes more elastic and stretches like a rubber band. Skin is supposed to be smooth and soft to the touch like a flower pedal. That is the goal I set for when I see my patients, to make it harmonious and equal. When discussing fat, we look at the distribution of fat and where it is located on your belly. Now let’s try and visualize this together.
Stand straight in front of the mirror, and it’s better to be shirtless so you are relaxing your shoulders instead of just pulling up your shirt. Now picture your belly as a squared grid similar to the one you use during a bingo game. Your belly button is the center square, then you have two empty boxes to the right and left of your belly button. You also have 3 empty boxes above your belly button and 3 boxes below your belly button. While in front of the mirror start pulling down on your skin around your belly. Take both hands and pull down the skin below your belly. Then do the same thing above your belly. Place your hands on the squared quadrants furthest from each other on the same row. While doing this, if you notice your belly stretches into smoother skin, then you have skin redundancy. Remember where your skin gets smoother and tighter, is it just below the belly button, is it above the belly button only, or is it below and above your belly button? This will help us decide together what the best procedure is for you.
The next thing I do is look at your abdominal muscles. This is because during pregnancy when your abdomen stretches out and it also stretches out your tendons such as the linea alba, the tendon that connects your abdominal muscles together. Therefore, it results in a distended abdomen. Now, it is important to understand that while you work-out or do your physically activity you can strengthen your abdominal muscles. Yet, you can never strengthen your TENDONS!! Muscles are made up of rope like fibers and elastin that allows them to stretch, and just like any ropes you can strengthen it by tightening them (such as exercising), muscles also have adequate blood flow and can repair very easily because of the adequate nutrients it can receive from that blood flow. While your tendons, such as the linea alba, are made up of collagen fibers and connective tissue, thus making them very durable, but they lack elasticity and blood flow. Therefore, when stretched, they are impossible to repair. This is known as recti-diastasis.
To find out if you’re a candidate, for a tummy tuck with muscle repair, also known as muscle plication, stand sideways in front of your mirror and stick out your belly, puff it out, then suck it in, if you can suck in your really good with easy effort, and you have had a couple of pregnancy, then this is proof that your muscles have loosened up because your tendons have stretched out. Therefore, you have recti-diastasis. When your belly is sucked in, is where your new abdomen will be after the surgery.
Finally, using that same squared quadrant on your belly, let’s look at how much fat you have. Take one of your hands and make it into the shape of the letter “C” or a lobster claw. You will be using this hand to pinch your fat located around your belly. Stand right in front of the mirror just like when you pulled your skin down. Using your hand shaped in the letter “C” start gently pinching each squared area just like a lobster claw. While doing this try to notice how much fat is cuffed into your hand. If the fat reaches your palm, then you have moderate to severe fat. If the fat only goes down past your first knuckle of your pointer finger, then you have mild-to-moderate fat.
Now let’s put this all together. If you have skin redundancy just below your belly button, but not above your belly button, then you have mild-to-moderate skin redundancy and will benefit from just a mini-tuck. If you have skin redundancy below and above your belly button, this is moderate-to-severe skin redundancy, and you DO NOT have recti-diastasis then you will need a tummy tuck without muscle repair. If you do have recti-diastasis (again, your belly is distended and can easily be sucked in) then you have moderate-to-severe skin redundancy with recti-diastasis therefore you can benefit from a tummy tuck with muscle repair.
If you have no skin redundancy (again, when you pull your skin down it DOES NOT stretch into smooth skin) and just mild fat then you will benefit from just liposuction. If you have skin redundancy just below your belly button, but only fat above your belly button then you will benefit from a modified abdominal resection with liposuction. This is a procedure I have masted and created. It allows me to remove that unwanted skin with an excision and at the same time liposuction your belly to give you highlights.
In general, this is what I do to determine if a patient needs liposuction or a tummy tuck. As you can see, you can have both fat disruption and skin redundancy, or one of the other. Therefore, after understanding this concept, it is best to consult with a board-certified plastic surgeon like myself to plan together the best results to determine the body you have always wanted.
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