Abdominoplasty (Tummy Tuck) or Liposuction:

Choosing the right operation for the right patient.

Improvement in the appearance of one's abdominal area is one of the more common areas that individuals hope to improve. Women and men often wonder what would be the best choice for them.

Dieting and working out are the first steps to achieve a thinner, leaner look. These address the two principal correctable problem areas. Dieting reduces excess fat, and can build up protein that muscles need to grow. Cardio exercises burn fat and build up our endurance and strengthen our hearts. Strengthening exercises build up and improve the muscle contours that are considered most attractive. When these efforts do not accomplish enough, the next option for correction may be cosmetic plastic surgery (also know as aesthetic plastic surgery).

Recognizing where the problem lies helps decide what the best solution will be. The skin can be too loose or it can have stretch marks, such as after pregnancy or weight change, or it may have scars from previous surgery, such as a C-section. The layer of fat can be too full in the subcutaneous tissue layer between the skin and the underlying muscle and connective tissue layer (This more rigid layer is sometimes called the internal girdle). The body stores fat beneath our skin and also in a deeper layer within the abdomen, called the omentum. Sometimes this is caused by our genetics where some people store more of their fat in the truck of the body. Settling and redistribution of our fat stores can also occur. The abdominal muscles and the muscles provide the strength of our trunk that provides the stable platform for our arms, legs, and neck and head. This inner girdle also surrounds everything within our abdomen. Within the abdomen the woman's pregnant uterus and the mass of fat storage of the omentum can enlarge and stretch out the compact, tight internal girdle. Following pregnancies or weight loss this internal girdle many not rebound as tight as it was earlier, which can leave a budging contour, even if the patient returns to a previous weight.

Cosmetic plastic surgery offers the options of an abdominoplasty, commonly called a tummy tuck; and liposuction, also called suction assisted lipoplasty (SAL), liposculpture, or simply lipo. An abdominoplasty removes excess stretched skin, including the stretch marks and any scars, the underlying fatty layer, and tightens the internal girdle's connective tissue. Liposuction removes fat from beneath the skin of the abdomen and in various other areas. Liposuction does not rally tighten the skin, but the skin's own elastic capabilities may take up the slack possibly. Skin that has been stretched to the point of developing stretch marks has very limited potential to rebound following weight loss or pregnancy. Following loss of fat either by weight loss or liposuction, if there is remaining loose skin, then surgical removal by an abdominoplasty will take away the excess skin and stretch marks. Only an abdominoplasty can get down to the connective tissue layer of the internal girdle to tighten it to the way it would have been before a pregnancy.
Patients who have had the benefit of massive weight loss by dieting or weight loss designed-surgery (lap band or gastric by-pass) are also candidates for an abdominplasty or even a belt lipectomy or body lift.

While tissue is removed with both of these operations, they are designed basically to remove localized problem areas of one's figure and not to reduce one's weight. Dr. Wermeling likes to say, These operations are designed to reduce inches in the problem areas, not to loose pounds. These operations recontour the body.

During the abdominoplasty operation, the skin and underlying fat layer are cut down to the muscle-connective layer to begin exposing the inner girdle. Next, the skin and fat layer are separated from the lower abdomen up toward the lower edge of the rib cage. The belly button is separated from its skin attachments. The muscle-connective layer is tightened. The skin is pulled down to tighten it and remove the excess. A new opening in the skin layer is made to keep the belly button in its normal position. The surgical incisions are then closed in layers. The result is a tighter abdomen with fewer stretch marks and possibly a narrower waist. The scars are hidden beneath the coverage of bathing suits.

During liposuction, tumescent solution is injected through the skin into the fat layer. The solution is made of IV fluid plus local anesthesia and epinephrine to firm up the tissues and decrease bleeding and post-op pain. Several small incisions are made to permit the suction cannula a bullet-shaped hollow rod to be introduced to suction out the fat cells. As the fat deposits are reduced in volume the overlying skin redrapes. The success of this type of recontouring is dependent on the skin's elasticity to shrink down to the new contour. Skin that has lost much of its elasticity will become looser and may show sagginess, dimpling or increased cellulite appearance, or increased prominence of stretch marks. If that is going to be a problem or if it develops, then the skin tightening of an abdominoplasty can help. Once those fat cells have been removed, the body does not replace them. Usually a post-operative compression garment is required to help decrease swelling and to help redrape the skin over the lower contour.

Because both surgical techniques affect the blood supply to the skin in different ways, aggressive liposuction cannot be done in the same area that is treated by a full abdominoplasty. However, in properly selected patients a Limited abdominoplasty with liposuction can be done satisfactorily in properly selected patients. Liposuction in areas away from the abdominoplasty treated areas, such as hips and thighs may be possible.

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