Trimming your Tummy: When Diet and Exercise Fall Short

You’ve been watching what you eat. You’re going to the gym on a regular basis. Maybe you are even close to your pre-baby weight. But shape is another matter. Loose skin and stubborn fat pockets can discourage even the most disciplined fitness fanatic. I see many women in consultation with as many questions as misconceptions about what will and won’t restore their figure. And if liposuction and/or a tummy tuck is my recommendation, some are surprised to learn these procedures are not commodities–there are distinct techniques and approaches that greatly influence the final result. If you were to listen in on a consultation, here are the top 7 questions you would hear along with my responses.

How do I get rid of this excess skin?

A significant number of patients believe that working out will tighten loose skin. After having children, most women will have varying degrees of excess skin. And since the vast majority of women stop having children by late 30’s, early 40’s–both excess skin and loss of elasticity are common. Patients are also often unaware of other factors to consider aside from skin. After multiple pregnancies, the abdominal wall muscles can separate, creating an outer bulge that can only be corrected by bringing the muscles together surgically. This is called diastasis recti repair and acts like an internal girdle. All the crunches in the world will not flatten a bulge or eliminate loose skin. Areas of subcutaneous fat must also be assessed. The amount and location of skin and fat and the degree of muscle separation that exists must be taken into account when designing a surgical plan. Yes, there are several popular non-surgical modalities, but despite what you hear, they deliver only modest results if you are indeed a candidate for a tummy tuck. The only way to remove excess skin and tighten the abdomen is by having a tummy tuck.

Can I just get liposuction?

The short answer is “yes.” But I always follow up this question with another question…”What result are you expecting?” Liposuction alone can certainly improve your overall body contour, but if the issue is skin, liposuction can actually worsen your appearance. Liposuction can make minimal changes to the skin, but cannot trigger a rebound when there is considerable amounts of loose skin. My philosophy is that once the patient understands the differences between what liposuction and a tummy tuck can accomplish, it is completely their decision. If a patient has only minimal loose skin and is mainly concerned with shape and contour, I will recommend we try liposuction alone, and wait 6 months. At that point, if the loose skin remains an issue, we can do a tummy tuck as a second surgery. It really depends upon the patient’s anatomy, the problem they want corrected and how they choose to stage their goals.

Will my body be the same as before children?

Here is some good news. With abdominoplasty, alongside advanced body contouring and fat grafting using SAFELipo®, I think many women will not only shed their post pregnancy bodies, but can potentially experience an even better body than they knew pre-baby. If you think about it, even in adolescence young woman deal with “muffin tops” and disproportionate figures. The goal doesn’t necessarily have to be “like before children”–it can be “better than ever before.” That is why tummy tucks and liposuction are such satisfying procedures, giving women a new lease on life.

Are All Tummy Tucks the Same?

The answer is no. There are several variations in types of tummy tucks. Surgical proficiency is the other variable. A tummy tuck is not just about cutting out skin. The attention to detail and an understanding of the nuances are paramount. A good example is scar placement. Not all surgeons get the same scar result. Some surgeons place the scar high – especially out to the side. This can interfere when wearing a bikini or showing off your midsection. I am extremely meticulous where I put my scar. A series of decisions have to be made. Where does it start? Where does it end? Will it gravitate? Where is the tension on the scar and how will it be distributed? I want it to heal smooth and under the bikini line. If you don’t spend the time considering every single detail, you cannot expect the best result. Another example is the belly button. Creating a beautiful belly button takes going the extra mile so it will heal a certain way. Most patients are candidates for traditional tummy tuck versus a mini. In the few cases where a mini is appropriate, I will do a low, abbreviated incision and pull down the belly button. This maintains the blood supply to the belly button in case a traditional abdominoplasty is ever needed at a later time. For the patient, it all boils down to the changes they want to make and the trade-offs involved in each variation. For me, as the surgeon, the bottom line is practicing good judgment, meticulous technique and a keen sense of artistry.

How does the use of SAFELipo® influence the result?

For many years, very little liposuction was done at the same time as a tummy tuck. Traditional liposuction created blood vessel trauma that would influence the blood supply to the flap as the skin was lifted up and tightened, so liposuction was often deferred if desired to a secondary operation. But if you do a tummy tuck first, and then lipo, you can potentially create more loose skin. Yet, a tummy tuck alone solved only half the equation. Skin was pulled down and tightened, but nothing was done about the shape of the torso. SAFELipo® has been a complete game changer. It is much less traumatic to blood vessels, tissue and nerves, so blood supply is not as compromised. It can safely and effectively be done simultaneously with a tummy tuck – and in the areas needed. In addition, the fat collected through SAFELipo® is harvested in such a way as to offer more predictability where it is reintroduced. This advanced body contouring and fat grafting along with skin removal can deliver profound results for the overall female silhouette.

What’s the difference between “spot lipo” and “360 degree lipo?”

If liposuction is intended to contour the body, then “spot lipo” is a bit of a contradiction. There is a big difference in my mind between assessing “spots” or areas on the body versus treating the torso comprehensively. I envision the end result, and mark accordingly. I will mark areas with more fat with cross hatching. These are the “spots” I will more intensely focus upon. The areas adjacent will also be treated, just not to the same degree. Treating all the areas–360 degrees–unifies the entire trunk. It optimizes the result because there is congruency and flow to the contour. In addition, I believe the skin is better stimulated throughout the torso, tightening and conforming to the new abdominal core. Rather than focus on “spots,” you can see the whole blanket of subcutaneous tissue respond in unison using this approach.

Can a tummy tuck and 360 degree liposuction be done in one operation?

It depends. The limitation is time. A tummy tuck takes 2-3 hours. 360 degree liposuction adds time both in terms of positioning the patient and executing the SAFELipo® procedure. I don’t want my patients to go over 6 hours. Patients with minimal fat might indeed be a good candidate for one surgery. However, if a patient needs large volume liposuction, I prefer to do two surgeries. The advantage to separating the surgeries is if we do liposuction first, heal, and see the skin’s response–the patient may opt out of a tummy tuck altogether. But, if skin remains, and the patient wants it eliminated, we have already deflated that skin with the liposuction, so I know the exact amount of skin to remove. In essence, we maximize both the liposuction and tummy tuck by doing the “two step.” Keep in mind this is highly individualized depending upon the location and degree of skin, fat, and muscle separation. Ideally, the end point should be the best contour with the tightest tummy possible, while honoring the patient’s decision to accept trade-offs because their expectations might be met with one less surgery.