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Abdominal Liposuction vs. Tummy Tuck
Confusion between the two are common. The abdomen may have an excess of skin, fat and muscle distension. Singly or in combination. The surgery of choice depends upon the patient's condition. If fat is the problem, the treatment is liposuction only. If it is an excess of skin, the treatment is a tummy tuck, mini or full depending upon the skin above the umbilicus. Excess of skin above the umbilicus is an indication for a full tummy tuck. On the contrary, if the skin excess is below the umbilicus only, the indication is a mini tummy tuck. In case of muscle distention only, which is rare, since it is usually associated with an excess of skin or an excess of fat, or both, the muscle needs to be tightened up. The skin incision is like for a tummy tuck but without excision of excess of skin. The tummy tuck is the most extensive procedure in plastic surgery. It has the most complications. It should be reserved only for people that need it, that is to say they need to correct an excess of skin with or without muscle distention. To the contrary, liposuction is far from being as major as the tummy tuck with less pain, shorter recovery and many fewer complications than a tummy tuck. Most people that would like to have a tummy tuck actually need a liposuction since for most of them their problem is a fat deposit without an excess of skin. Liposuction done for the abdomen consists more of debulking than sculpting though both are combined for a better contour. After the liposuction you need to wait a good 3 months for the swelling to come down completely and for the skin to retract. The skin after the liposuction will always retract. The question is how much? In a large measure the amount of skin shrinkage status post liposuction, has to do with the type of skin. If the skin has not lost its elasticity, a lot of retraction will take place and there will not be any excess of skin left, i.e., no need for any other surgery. The muscle, however, if distended prior to liposuction, will remain distended. It is up to the patient to undergo a tightening of the muscle 3 to 6 months status-post liposuction. Likewise if, 3 to 6 months status-post liposuction, there is some redundant skin a procedure can be that would vary with the amount of redundant skin ranging from a minor skin incision in the supra-pubic area to a mini tummy tuck up to the umbilicus or a full tummy tuck. The difference between mini and full has to do with the presence of excess of skin above the umbilicus. If there is no excess of skin above the umbilicus a tummy tuck up to the umbilicus is enough. It's a mini tummy tuck. If the excess of skin extends above the umbilicus, the surgery needs to go up to the rib cage. It is a full tummy tuck.
A second surgery for an excess of skin or a distended muscle is decided on a case to case basis. This would be decided on a case to case basis. However it must be emphasized, that after most liposuction of the abdomen, there is no need for any other procedure, due to the skin shrinkage. It is difficult for many patients to imagine that liposuction might take care of the skin without tummy tuck but we see it often. However, it is not possible to say with certainty pre-operatively. That is the reason why we need to wait 3 to 6 months after the liposuction has less to do with the amount and the type of fat than they type of skin and the condition of muscle. If the patient has good elastic skin and a non-distended muscle, they will not need a tummy tuck. The liposuction will suffice in most cases.
Presently, the standard in the U.S. is:
Liposuction no more than 5 liters removed in 1 session. Over 5 liters is not recommended in the state of California. That figure is kind of arbitrary since there are too many parameters such as the size of the patient, the size of the pocket and the patient's medical condition that comes into play but it is the official figure.
The abdominal liposuction with a full tummy tuck would amount to malpractice. Indeed, the risk of combining these 2 major procedures is too high, the recovery too long and the cosmetic result is rather poor.
The tummy tuck without defatting the abdomen in a first stage is contraindicated by plastic surgeons. It is important to know that if you consult a plastic surgeon or a cosmetic surgeon. Please call the Board of Plastic Surgery. A good number of "Cosmetic" Surgeons, meaning not certified by the American Board of Plastic Surgery, are not trained or qualified to do a tummy tuck besides being surgically limited. Should you do a tummy tuck without defatting first, the surgical risk of the tummy tuck is higher and the cosmetic result second rate. Indeed, the tummy tuck with an excess of fat in the way increases the surgical risk and compromises the cosmetic result.
Besides, after the tummy tuck you would still have the fat and need a liposuction later on, in second stage. Therefore, 2 surgeries are still necessary. It is important to undersand that liposuction after a tummy tuck cannot give as good results as liposuction before. Indeed the tummy tuck creates scarred tissue that makes the liposuction more difficult and less effective.
Furthermore, doing the liposuction after a tummy tuck might create more redundant skin. This excess of skin resulting from the liposuction would require another tightening of the skin, i.e., a third surgery. Only people with a good elastic skin will avoid a third surgery.
The proper way is to defat first and 3 to 6 months later take care of the skin and the muscle, if need be. Most of the time the patients will save themselves a full tummy tuck, i.e., a major surgery.
For the above reasons, the standard is:
First surgery is liposuction. Wait 3 to 6 months, re-evaluate the situation and decide if a second surgery is indicated. In most cases, nothing else is needed. If not, that second surgery would be a full tummy tuck or a less extensive procedure depending upon the case.
By adhering to the standard, it will save time, money, risk and obtain a better cosmetic result. Doing the reverse is simply a surgical mistake. We don't need to be doctors to understand these things that are common sense.
Liposuction of the abdomen and the flanks is more of a debulking procedure than a sculpting one. Sculpting applies more to the extremities than to the abdomen. I usually do liposuction under general anesthesia. It can be done under local anesthesia with some discomfort on the operating table. The liposuction under local cannot be as aggressive as under general anesthesia precisely because of that discomfort.
In conclusion, the advantages of doing the liposuctions first are obvious in terms of:
1. Surgical risks minimized
2. Cosmetic results optimized
3. The need for a full tummy tuck eliminated in many cases
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Abdominoplasty
Abdominoplasty is designed to smooth and flatten the abdomen when the muscles of the abdomen have become distended and the skin is loose. The surgery consists of making incisions either horizontally above the pubic area outward toward the hips or a smaller incision above the pubic area and incisions vertically up both hips, as if you would be wearing a French-cut bikini. Working through the incision, your surgeon may tighten the underlying muscles by pulling them together and stitching them in place, and any excess skin will be trimmed. After surgery, Dr. Carli usually recommends his patients have a one-night stay at the hospital, after which you will go home. A large bulky dressing is applied and drains will be in place fore a few days. The first week after surgery you will need to walk hunched over to avoid any tension to the suture lines. After two weeks you may resume most normal activities, but any strenuous activities such as exercise must wait approximately three months. During this time you are required to wear a corset.
The surgery itself is about 2.5 hours under general anesthesia, after which you will be in recovery for about 2 hours before Dr. Carli and his staff transport you to the hospital, if you require hospitalization.
Prior to surgery, lab work will be performed and possibly an EKG and/or chest x-ray. These tests are included in the price of your procedure. You will also receive a medication bag with pain meds, antibiotics, sleeping pills, and nausea medicine. After your dressings and drains have been removed, a compression girdle must be purchased and worn day and night for 3 weeks, then at night only for 3 more weeks. You will see quite a difference after surgery, and as the months pass your incision line will fade. Abdominoplasty produces long-Iasting results. Unless you gain or lose a significant amount of weight, you should expect to retain your new shape for many years.
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