The Benefit of combining liposuction and “Mini” Tummy Tuck

When it comes to your belly, liposuction is not always as straight forward as it appears.
What’s more, with so many competing modalities of treatment claiming comparable results, I want to take this opportunity to clarify some of the misunderstanding and confusion about what can be achieved with liposuction surgery vs. liposuction surgery in combination with “Mini” Tummy Tuck vs “Full” Tummy Tuck.

Probably the most important concept that the patients interested in liposuction surgery need to understand is the difference between “subcutaneous” fat versus “visceral” fat. Subcutaneous fat is the fat pouch below the skin but superficial to your abdominal muscle. Visceral fat is the fat stored in your gut deep to the muscle. Chances are if you eat healthy diet and have a regular work out routine, you will have your visceral fat under decent control. In contrast, no matter how good you are with your diet and work out regimen, you may not always be able to reduce the subcutaneous fat, and this is where liposuction plays an important role. This is the reason why even Aerobics instructor and Yoga instructors have little fat pouches in their belly and in their flank area. Liposuction has been offered traditionally to healthy patients with good eating habits and sound exercise regimen who simply wishes to better contour and trim down their belly by getting rid of those pesky subcutaneous fat. Ideally patients need these two qualities to have favorable results:
 

1. good skin elasticity (confirmed with pinch test)

2: enough subcutaneous fat (confirmed with pinch test),

 
You can easily tell if you are a good candidate for liposuction surgery simply by bending forward and pinching the subcutaneous fat layer superficial to your abdominal wall. If there is an adequate grab of at least one inch or more with body mass index (BMI) no greater than 30 and if the skin snaps back into place within 2 seconds, you will definitely be happy with the outcome as long as your surgeon is well versed in the art of liposuction. What’s more, with the advent of laser assisted Smart-Lipo, the elasticity of the skin can be further tightened with the laser at the same time the fat is being melted by the laser and suctioned out with the cannula.

Enough patients are bothered by their stretch marks and very often, the associated loose, saggy skin which begins to hang over their bikini tops. As a result, many seek consultation with their Plastic surgeons. At this junction, some patients get lost in the shuffle and end up receiving the classic “full” tummy tuck. This is the most common type of tummy tuck which carries with it many consequences that patients are not always fully prepared for. It is a very comprehensive surgery which addresses the entire belly. It requires usually one incision in the lower abdomen as well as second circular incision around your belly button. This comprehensive surgery allows adequate skin removal from both the upper and lower abdomen as well as suture tightening of your weakened or separated abdominal wall muscle (diastasis recti), to achieve a more tight and toned midsection. It is truly a life altering procedure for patients with severe sagging of their skin resulting from major weight loss or severe weight fluctuation during multiple pregnancies as well as for those with persistent “mom pooch” from the weakened abdominal muscle wall that didn’t heal after pregnancy. But it also carries with it heavy consequences and road to long recovery:

1. Incision of the lower abdomen usually extends from hip bone to hip bone and chances are if you have thicker, darker skin, you will experience segments of hypertrophic scarring or even keloids requiring more close aftercare. Ultimately, it can take up to a year before the scar calms down to appear acceptable.

2. The second circular incision made around your belly button is done to reset your skin downwards to remove as much of the belly skin and the stretch marks as possible. In the process, your belly button is relocated into a new skin opening. Even though everyone has slightly different belly button, the circumferential suturing around the newly located belly button often renders it artificial appearing compared to your original belly button.

3. The worst part is that the recovery process in no longer in matter of days, but significantly longer. Expect to have moderate to severe pain and limited mobility for one to two weeks before you can return to your daily activities. Even then, no strenuous activities or core exercises are recommended for four to five weeks following surgery.

4: Finally you will require a drain for a few days to drain out the accumulating fluids. The post-operative swelling from “full” tummy tuck will be much greater compared to liposuction alone, and will also trigger generalized swelling to the rest of your body and face. Even after the initial global swelling has resolved, you belly will remain indurated (hardened) and swollen for many weeks to months requiring usually from six months up to a full year for all the swelling to resolve.

5. Unless adequate liposuctioning was done especially around the flank area during or prior to tummy tuck, you can end up with small but noticeable fat pocket jut behind where the incision ends in the hip area.

As an alternative, if your main issue is subcutaneous fat and stretch mark scars mainly below your belly button, my recommendation is comprehensive laser-assisted liposuction to contour out your belly combined with “Mini” Tummy Tuck, which removes an ellipse of the redundant and saggy skin containing the worst portion of the stretch mark scars. The incision usually takes advantage of an existing C-section scar, concomitantly improving the appearance of the original scar. Usually the incision is extended so the entire length becomes roughly double the origin C-section scar. If the patient doesn’t have existing C-section scar, incision will be designed in a similar fashion. Either way, the incisional scar almost never extends up to the hip bone and therefore is easily covered by most bikini wear. If the patient has significant weakening of the abdominal muscle wall with visible “Mom Pooch” the muscles are strengthened at this time. But in my practice, this is rarely the case as most of my patients retain relatively good abdominal muscle tone. The best part about “Mini” tuck is, there is no severe swelling of the belly lasting for months. Patients still need to be careful with the incisional scar for about a week, but within a few days, most patients can return to their daily routine similar to just undergoing liposuction surgery alone. This is a huge contrast to the traditional “Full” tummy tuck where the entire recovery time is significantly longer and painstaking in nature. Finally, patients are always relieved to hear that they can retain their own belly button as is.

In conclusion, Liposuction combined with “Mini” Tummy Tuck provides excellent contouring of the belly as well as improving most of the issues related to stretch mark scars and associated saggy skin with recovery period much closer to Liposuction than substantially longer recovery associated with “Full” Tummy Tuck. When you are ready to tackle this relative complex issue of tightening and toning your belly, weigh out (no pun intended) all your options and speak to an experienced Plastic Surgeon about which combination of procedure would be the best for you.