These procedures are discussed in greater detail in
Dr. Engler’s book, BodySculpture – Plastic Surgery of the Body for Men and Women.
As always, it all starts with the Anatomy and, in this case, we’re going to focus on the abdomen (the tummy) and the Love-Handles (also called the Hips, although that can also refer to the Outer Thighs).
You have to start by assessing the upper and lower parts of the abdomen separately: look at the areas above the belly button, and below the belly button, and then try to see whether you have relatively more extra skin there, or more extra fat (or both!). In general, liposuction is effective when you have extra fat but the skin tone is relatively good; a tummy tuck (or other skin tightening procedure or method) is necessary when you have a relative excess of skin, or poor quality skin (i.e., poor elasticity). This is common after pregnancy, with age, and with weight gains and losses – so the more of all of these you’ve had, the more likely that you’ll need a tummy tuck rather than just a liposuction alone.
So now let’s talk about each of these procedures:
1) A Tummy Tuck, (officially called an abdominoplasty), removes excess skin and fat from the stomach (abdomen). A horizontal (transverse) incision is made near the lower portion of the abdomen, usually just above the pubic hair. The incision (and the resulting scar) extends across the front of the lower abdomen, nearly from one hip bone to the other. In most cases, it is either gently curved or W-shaped, with rounded points. Once the incision is made, the skin is separated from the muscles underneath (the “abs”). Starting from that point, the skin is lifted up as far as the ribs (an incision is made around the belly button, which is left in place…it is reshaped later). The abdominal skin is then stretched and pulled down (like a window shade), the excess is removed, and the skin is sewn back together. An incision is made in the skin and the belly button is brought through and sewn into place so that the patient keeps her own belly button. In most cases, all of the skin between the belly button and the lower incision can be removed, and sometimes even more. The pubic mound can also be lifted and tightened, as indicated (another one of the wonderful things that can happen with…time!). The muscles of the abdomen (or more precisely the connective tissue covering them) are usually tightened as part of this procedure.
Despite the scar this procedures leaves, there are many cases in which it is the best option; sometimes it’s the only one. Many different variations of this procedure, in terms of precise location and pattern of the incisions, as well as additional minor procedures and maneuvers that can be performed to tighten the connective tissues further, are in use. The basics of the operation, however, are the removal of excess skin and, if indicated, the tightening of the abdominal muscles. Liposuction of the hips and thighs can often be performed at the same time as a tummy tuck; liposuction of the remaining areas of the stomach (e.g., the upper stomach) is often deferred to another time (several months later) for safety concerns since the healing of the entire tummy tuck may be affected adversel. This is particularly true for smokers, patients with certain medical conditions and extensive procedures, but can apply to anyone.
2) A Mini or Modified Tummy Tuck is a variant of this procedure that removes and tightens skin only below the umbilicus (belly button). It is usually combined with a liposuction of the entire stomach and, if indicated, the hips and thighs. The scar may look the same as the scar that you get with the tummy tuck, but it’s a much less involved procedure, and with many fewer risks. For that reason, I try to do this procedure whenever it’s an option. It does not tighten the skin above the belly button – but if that’s basically okay, and the main problem is the skin below the belly button, then this can be an excellent option. Safer, less discomfort, faster recovery.
An existing scar, such as from a C-section, is usually removed with either of these procedures. These scars are the result of an understandably hurried procedure (the C-section!) so it’s not surprising if the scar turns out to be less-than-perfect. Fortunately, there are lots of choices on how to “fix” them. Whether you choose to have the scar revision alone (i.e., just try to make the scar look better) or combine it with more liposuction and/or a skin tightening procedure is, of course, up to you. As always, you need to know what’s good and bad about each of the options, and then you’ll figure out what’s best for you.
3) Liposuction alone (i.e., no skin tightening). Liposuction is a GREAT procedure, but you have to know what it will and what it won’t do. It will remove excess fat; it will not “remove” excess skin. You do get some skin tightening as part of the healing process but not enough to make up for what would be accomplished with a skin removal technique such as either of the two procedures discussed above. If you have some excess fat but the skin tone is reasonably good, then lipo is the perfect choice. It is associated with many fewer and smaller incisions than a tummy tuck is, and has a much less complicated healing process. As long as it’s the right procedure!
Liposuction of the Love Handles (hips, “muffin tops”) can usually be done at the same time you’re having either of the skin removal procedures (a tummy tuck, or a modified tummy tuck) BUT you can typically have much more lipo, and of more areas, with the modified procedure than with the more formal, full tummy tuck. This has to do with concerns for safety, and the blood flow to the remaining tissue. In general, increased and aggressive amounts of lipo can impair the body’s ability to heal in the case of the full tummy tuck. In that case, additional lipo may be deferred to a second procedure, some months after the first.
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