Abdominoplasty Methods: How Much is Enough?

A complete abdominoplasty, or “tummy tuck”, is a major surgical procedure that removes stretched skin and excess fat, flattens the abdomen by tightening underlying muscles, and improves the overall contour of the waist. It has the toughest recovery of all plastic surgery procedures associated with it and leaves the biggest scars. However, in the right person it is worth it. Fortunately, there are also less radical options that are effective for less severe problems. The challenge lies in selecting the best procedure to achieve the desired result while minimizing the procedure scope and extent of scarring as much as possible.

Three groups of women

Young women who have slightly protuberant abdomens prior to child bearing usually only need liposuction (Figure 1). The scars are typically insignificant, the recovery quick, and the results predictable.

Post-partum women usually require both skin removal and muscle tightening. The number of pregnancies and the type (twins worse) influence the severity of the damage caused. Most require a complete abdominoplasty but some will qualify for a modified technique that has a lower and shorter scar, and leaves no scar around the navel. The muscles are still tightened top to bottom with this method. Therefore the recovery is just as challenging as it is with a complete abdominoplasty. Moreover, less skin can be removed and the navel position moves lower, which can sometimes look odd. The trap with this choice is applying it to someone who wants less surgery and scars but actually needs more. They will be disappointed if not enough skin has been removed and are faced with the prospect of repeat surgery. Borderline conditions are therefore best treated with a complete abdominoplasty.

Older women in their fifties and sixties sometimes find the appearance of their abdomen has changed due to a combination of weight gain, fat redistribution from hormonal changes, and abdominal shortening from vertebral compression. These individuals are less focused on muscle tightening than they are on removing thick skin folds (Figure 1). They can frequently be offered a complete abdominoplasty without the muscle tightening component. This will still remove a maximum amount of skin and fat but with a much easier recovery.


Two groups of men

Thin men with excess and fat in the lower abdomen, commonly associated with excess fat in the hip area (“love handles”) are well suited to liposuction of the abdomen and hip area alone.

Older men who are overweight and have significant abdominal protrusion are usually not good candidates for an abdominoplasty of any type. Most of the protrusion is due to high fat content inside the abdomen. Tightening skin and muscle in this group is not very effective.

Which procedure is best for you?

Abdominoplasty consists of a spectrum of overlapping procedures that address changes resulting from factors such as excess weight, pregnancy, hormonal changes, and aging. Thoughtful consideration is required to select the most effective procedure that will create the least amount of scarring while minimizing the recovery process.

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