Tummy tuck or liposuction?

Tummy tuck or liposuction? Arguably, this is the most common question of patients who want to do something about their flabby stomach.

Plastic surgery experts have explained the key variables that determine whether tummy tuck or liposuction, or even both, can provide the "best" results.

Skin laxity

If there is a noticeable amount of sagging skin, which generally occurs after massive weight loss, tummy tuck is the right choice. This procedure uses an incision within the lower abdomen (concealed by the patient's underwear) to remove the excess skin tissue.

However, patients with no or very minimal skin laxity can benefit from a liposuction-alone procedure in which 4-6 round incisions as small as a grain of rice are used to eliminate the fat. It is critical for the overlying skin to shrink around the new contour to achieve a smooth, natural-looking appearance.

Muscle laxity

After pregnancy and massive weight loss, the once tight abdominal wall becomes loose, leading to a bulging appearance. However, a physical evaluation is needed to determine if muscle laxity and/or fat is the underlying cause of the "problem."

"Complete" muscle repair is only possible through standard tummy tuck in which a hip-to-hip incision is used.

Patient's cosmetic goals

While some people can tolerate a small amount of excess skin in their tummy area, others feel that it is a significant issue. For this reason, some patients are advised to have liposuction first then wait at least 3-4 months to determine if they would be happy with the result.

The "waiting period" will also allow the skin to shrink to the best of its ability. In general, younger patients who have avoided large weight fluctuations throughout their lives have good skin elasticity.However, liposuction can lead to scar tissue in the fat layer, which could pose some challenges during tummy tuck. But some doctors feel that since the fat has already been removed, skin excision and muscle repair could be performed quicker and more efficiently.

Combo approach vs staging

After careful evaluation, some patients can actually benefit from simultaneous tummy tuck and liposuction. But if there is a need to remove large volumes of fat, the consensus is to stage each surgery to minimize the surgical trauma and bleeding.

Some doctors prefer tummy tuck after liposuction, while others perform it in reverse order. However, the ideal approach boils down to the patient's underlying anatomies and cosmetic goals, and the surgeon's personal experience, skills, and surgical techniques.