The Liposuction “Tummy Tuck”
A New Approach To An Old Problem

Many women after pregnancy and some men and women after weight loss develop unsightly stretched out, drooping skin of the lower abdomen. This is skin that has permanently lost its elasticity and is often wrinkled with many deep stretch marks. Should anyone with this skin problem gain excess weight, he or she often finds that the fat accumulates under the damaged skin producing an apron of skin and fat that extends downward from the belly button hanging over the pubic area, what physicians call a pannus. Often a pannus shows itself as a telltale bulge below the belt line in tight pants. Pregnancy can weaken and cause a separation of the abdominal muscles in the midline contributing to the overall sagging and bulging out of the lower abdomen. Unfortunately, while dieting can reduce the size of the pannus, no amount of weight loss or exercise can fix the damaged skin or weakened and separated abdominal muscles.dominal muscles.

The Traditional Solution:
The Conventional “Tummy Tuck”

Prior to the advent of liposuction, surgeons developed a procedure known as an abdominoplasty or more commonly, the "tummy tuck" to deal with this problem. After an incision is made low down in the abdomen usually from hip to hip, the entire skin of the abdomen along with the fat layer under it is undermined or lifted off the muscle wall from just above pubic area to the ribcage. If they are weakened or separated, the abdominal muscles are then tightened in the midline. Following this, the damaged skin below the belly button is excised and the remaining abdominal skin is pulled down to cover the defect. A new exit for the belly button is fashioned in this stretched out skin. The result after surgery is a much flatter abdomen without the unsightly damaged skin. With proper patient selection and good surgical technique, patient recovery from this procedure is usually unremarkable and the results quite gratifying.

Limitations and Complications Of
The Conventional “Tummy Tuck”

Currently, most surgeons do little or no liposuction of the abdomen at the same time as an abdominoplasty. Although, this may change in the future, the consensus is to either remove the fat with liposuction or to remove the damaged skin but not both at the same time. For the many who seek this procedure who are above their ideal weight, this can be a real hardship. Recovery time to return to normal activity following an abdominoplasty can be considerable. Sometimes 6 to 8 weeks are necessary before the abdominoplasty patient can resume a regular work schedule. When the entire abdominal skin and fat underneath is lifted off the muscle wall, it is separated from much of its blood supply. This can lead to loss of skin at the incision line, not an infrequent complication of this surgery. Further, blood or fluid accumulations under the healing skin flap can occur. Aesthetically, the appearance of the torso after a conventional "tummy tuck" can look "over stretched," and squared off. In my opinion, this can sometimes leave a woman with a somewhat unappealing masculine look to her abdomen. Gathering of skin at either end of the incision can look like "dog ears" from the mismatch of the excess skin above the incision to that below it. And because of the way the skin is pulled down, weight gain after a conventional "tummy tuck" can result in very large square hips which often can only be improved with liposuction.

A New Approach To This Problem:
The Liposuction “Tummy Tuck”

Innovative cosmetic surgeons from abroad have come up with a new way of dealing with the sagging damaged skin, pannus and stretched out muscles I discussed above. Known as the Liposuction Abdominoplasty or Liposuction "Tummy Tuck," liposuction of the entire torso is combined with skin resection and muscle tightening in one procedure. This is the procedure that I perform.

In the Liposuction "Tummy Tuck," I first liposuction the entire torso front and back, thoroughly: the upper and lower abdomen, pannus, hips, flanks, back rolls, upper buttocks, and occasionally even the inner or outer thighs. After carefully removing the torso fat, I then excise the damaged skin below the belly button. If necessary, the muscles of the abdominal wall can be tightened at this time, but I usually do not do this. After the excision, I pull the skin above the belly button down to close the defect in the abdominal skin created by removing the damaged skin. The skin moved is not undermined or lifted off the muscle wall beneath it and therefore is not separated from its blood supply. It is simply pulled down to its new position with its blood supply intact. This very important difference from the conventional abdominoplasty is why recovery from this procedure is much more rapid and complications much less frequent. As in the conventional procedure, I create a new belly button exit in the skin that has been moved down. 

Advantages Of The Liposuction “Tummy Tuck”

With the Liposuction "Tummy Tuck" excess fat, skin, and weak muscles can be addressed in a single procedure. With the combination of both liposuction and skin removal, I believe the result is more natural looking and aesthetically pleasing. There isn't an "over pulled," squared off or masculine appearance to the torso. Bigger women or men can achieve the goals of skin and fat removal at the same time. "Dog ears" at the ends of the incision are aggressively flattened with liposuction and are usually not seen afterwards. The skin overlying the pubic area which is often lax and droopy in most women needing a "tummy tuck" is substantially lifted and improved with my procedure. Because the skin is not separated from its blood supply, the loss of large amounts of skin at the incision is rare as are fluid and blood accumulations under the skin. While it is too early to say for sure, experience from other physicians and my experience to date indicate that complications from this procedure are fewer than the traditional procedure. Recovery time is just a bit longer than liposuction alone and significantly less than the conventional "tummy tuck." My patients are up and around the day after surgery and usually return to their daily activities and a light work schedule within a week to ten days. I perform this procedure in my office surgical suite under local tumescent anesthesia with additional conscious sedation. Patients are awake but sleepy and quite comfortable throughout the procedure. The traditional procedure is usually done under general anesthesia or unconscious intravenous sedation.

Disadvantages Of The Liposuction “Tummy Tuck”

The resulting horizontal scar from a Liposuction "Tummy Tuck" is higher up on the abdomen than the traditional abdominoplasty. You can view before and after pictures on our website or in the office to see some examples of scar placement. For those for whom a scar as low as possible on the abdomen is very important should consider the conventional procedure. Wide separations of the abdominal muscle wall or severe weakness of it are better addressed by the conventional abdominoplasty, under general anesthesia.

Who Are The Best Candidates
For A Liposuction “Tummy Tuck”

Those women (and men) who desire improvement in the contour of their torso along with the removal of drooping, stretched-out, damaged lower abdominal skin, and in whom the abdominal muscles are not excessively weak or separated in the midline are the best candidates for this procedure. Prospective patients considering this procedure have to be fully aware that the scar from the Liposuction "Tummy Tuck" will be higher up on the abdominal wall than a conventional one. Anyonewho cannot afford a long time off of work and yet still want to improve the appearance of their torso may be better served by this newer procedure with its shorter recovery time. The larger patient who needs significant fat removal along with excision of damaged skin, for whom the conventional procedure would not meet their total aesthetic needs should consider the option of the Liposuction "Tummy Tuck." Finally, there is less risk to smokers of skin loss with the newer procedure than the conventional one due to less undermining or lifting of the skin off of the muscle wall beneath.

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The Liposuction "Tummy Tuck" is an innovative option for those who have the all too common problem of too much torso fat and stretched out droopy skin of the lower abdomen. If you are someone with this condition and desire improvement, consider a consultation with me to see if our new procedure would be appropriate for you.

Richard D. Fisher, MD

Click here to view our Before And
After Tummy Tuck pictures of our patients.