A Tummy Tuck is Not a Tummy Tuck is Not a Tummy Tuck

In my years as a plastic surgeon, I find that the term tummy tuck (abdominoplasty) is often used in a way that suggests it is a standard procedure that is done in a similar way for all patients. In reality, this could not be further from the truth. Just as every patient is different, every tummy tuck is a little bit different in one way or another, and sometimes a lot different.

The Classic Tummy Tuck

The “classic” tummy tuck technique involves an incision that is low in the abdominal area and spans from hip to hip. The skin of the tummy is lifted up off of the muscles all the way up to the ribs, leaving the umbilicus (belly button) attached. In some instances, the muscle may be separated, usually due to pregnancy. If this is the case, the muscle is sewn back together. The skin is then pulled downward – think like a window shade – and the excess skin is trimmed. Drains are placed, the belly button is sewn into position, and the incisions are sutured.

Tummy Tuck to Abdominal Contouring

As techniques get better and better, the tummy tuck has evolved into abdominal contouring surgery. So what is different about this? Abdominal contouring allows surgeons to tailor their procedure to the patient’s specific needs. It can vary by the type of incision, by whether or not liposuction or fat grafting is done, and by additional procedures that may help improve the results or the recovery.

Types of Incisions

While the classic hip-to-hip incision pattern is still commonly done, there are patients who benefit from shorter or longer incisions. In an endoscopic approach, the incision can be as small as two inches or even less, hidden low in the pubic area.

In instances when there is skin laxity that extends around the sides of the abdomen, an extended abdominoplasty incision may be the best option. In this technique, the scar typically goes around the side and into the flank area. This type of incision not only allows for additional improvement of the flank area but it can also improve the upper outer thighs.

In cases where the skin laxity is even more severe, the tummy tuck incision can be carried all the way around the back until the right and left incisions meet. This is a “circumferential” abdominoplasty and is most common in patients that have lost significant amounts of weight, such as after a gastric bypass. This helps smooth the lower back and can lift the buttock area.

Tummy Tuck with Liposuction

Over the past several years, abdominal contouring surgery has also evolved as related to how much “undermining” – the separation of the tissues from the deeper layers – is done. Because of this, it has become safe for liposuction of the abdomen to be included with the tummy tuck procedure. This is typically termed “lipoabdominoplasty,” and it can be a powerful tool. This allows the surgeon to not only remove the loose skin but also effectively decrease the thickness of the tissues.

Supplementary Techniques to Tummy Tuck

Additional procedures are often now included with a tummy tuck as well. For example, liposuction can be used to harvest fat, which can be used to smooth or enhance other areas, such as the buttocks. In some patients, the pubic area has become full, and this can be reduced to create a harmonious relationship with the rest of the abdomen. Treatment of other adjacent areas, such as the breasts or thighs, can further enhance the overall appearance.

There are also things that your surgeon can do “under the hood,” so to speak, to enhance your recovery. Progressive tension sutures (or quilting sutures) are dissolvable stitches that are put on the inside to tack the elevated tissues down to the muscle layer. When progressive tension sutures are used, surgical drains are no longer necessary, which is a huge plus.

Another technique which can be incorporated is the injection of long-term anesthetics into the tummy tuck site during surgery. This can significantly reduce the amount of post-operative medications the patient requires and makes it easier to get up and move around post-surgery.

Emory Aesthetic Center

Tummy tucks have grown significantly in popularity over the years, in part because these newer techniques and approaches allow surgeons to tailor their procedure to the patient’s specific needs. If you are interested in finding out the best way to shape your tummy, schedule a complimentary consultation with one our expert cosmetic surgeons at the Emory Aesthetic Center.

About Dr. Eaves

Felmont F. Eaves III, M.D., F.A.C.S., leads the Emory Aesthetic Center as Medical Director. He is double board-certified by the American Board of Surgery and the American Board of Plastic Surgery.

Dr. Eaves’s leadership is apparent in his impressive accumulation of distinctions. He serves as Director of the American Board of Plastic Surgery, the board that certifies plastic surgeons nationally. Previously, he served as President of the American Society for Aesthetic Plastic Surgery; he is currently a Trustee.


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