A common aesthetic goal today is to have a flat and well-toned abdomen. While many of us try to achieve this through diet and exercise, for a range of reasons people can be left with permanent excess fat and skin on the abdomen.
A tummy tuck is a surgical procedure that removes excess skin and fat and restores weakened or separated muscles to create a smooth and firm abdomen.
Tummy tuck surgery must be customized for each person, so choosing your plastic surgeon is an important first step. A surgeon who has specialized training and experience in aesthetic plastic surgery will have the necessary skills to ensure you have the best outcome.
A good surgeon will listen to your vision for your body and discuss which tummy tuck procedure will give a final result that meets your needs.
Dr. Ginger Xu uses her technical expertise and artistic sense to make sure each person’s appearance aligns with their unique identity. Dr. Xu is a Board-certified plastic surgeon with specialty training in aesthetic plastic surgery from Harvard. She is now based in the San Francisco Bay area.
A tummy tuck entails a variety of surgical procedures designed to remove excess abdominal skin and fat as well as tighten and contour the muscles of the abdominal wall. A tummy tuck addresses sagging and excess skin, rolls, or skin folds.
Many of the people who desire a flatter abdomen are women who have given birth and found their abdominal area did not return to its pre-birth form and appearance. Even with weight loss and exercise after pregnancy, women can be left with sagging skin and excess tissue, and their abdominal muscles can be weakened or separated causing this area to protrude.
While the overall aim of surgery is to create a smooth and flat abdomen, procedures involving removal of the skin can also remove C-section scars and some stretch marks.
In addition to pregnancy-related body changes, other reasons for a protruding or sagging abdomen that cannot be improved with exercise and/or weight loss include:
A tummy tuck can dramatically improve the contour of your midsection, but it is important to understand that you will have scars and that the initial recovery process involves a period of swelling, tightness, and discomfort.
While a natural look is always the goal, sometimes the final contour after surgery is not 100% like a body that has never undergone surgery. This also depends on your starting anatomy and is something that will be reviewed in your consultation.
Tummy tuck procedures are best performed in people who are at their ideal weight. The surgery does not replace a healthy lifestyle and weight loss and is not designed to “thin out” a large tummy. People who are overweight and considering a tummy tuck should first try to lose weight naturally through diet and exercise.
It also is best to have a tummy tuck when your goal weight has been maintained for at least one year. Significant weight changes after surgery or subsequent pregnancy can affect your results. In these cases, you might consider waiting until your weight has stabilized and you have finished having children.
For those who want fat reduction of specific areas or “spot reduction”, liposuction might be a better option. Liposuction might also help enhance tummy tuck results in people with thicker abdominal wall tissues because this aspect is not fixed by tummy tuck alone.
People who are the best candidates for a tummy tuck:
There are several possible techniques for tummy tucks. During a consultation, Dr. Xu can recommend the best technique for you after she examines your body and has a good understanding of your vision and goals. The limitations and benefits of different tummy tuck procedures are described below:
A mini tummy tuck (mini-abdominoplasty) is focused on only tightening the skin and abdominal muscles in the lower abdomen, between the belly button and the pubic region. None of the skin or muscles above the belly button are tightened. This involves a short incision along the pubic hairline, with no incision around the belly button. This method is typically used for people with a small amount of excess skin in the lower abdomen only, and not much excess skin above the belly button.
In a standard tummy tuck, an incision is made along the pubic hairline that curves upward toward each hip. From this incision, the excess abdominal skin is undermined, pulled down, and smoothed. A hole is cut so the belly button can be re-positioned in a natural-looking location. Abdominal muscles are repaired, the core is tightened, and the excess skin and fat are removed from the lower abdomen.
This is the most commonly used approach and allows for correction of loose skin both above and below the belly button. It also achieves greater internal tightening of the muscles and a more contoured waistline. Compared to a mini tummy tuck, the tradeoff is having a greater scar burden.
In an extended tummy tuck, the incisions extend further out to the sides (compared with a standard tummy tuck) so that excess skin on the flanks can be removed. The length of the extended incision depends on the amount of excess skin present.
This method is useful for people who have experienced significant weight loss and have a considerable amount of excess sagging skin that extends beyond just the front part of the body. People with more extensive sagging might also need a belt lipectomy or lower body lift.
The fleur-de-lis tummy tuck is named because of the shape of the incisions. A vertical incision above and below the belly button is used in addition to the standard horizontal incision along the pubic hairline. These two incisions allow excess skin to be removed in both the horizontal and vertical dimensions.
This is a very effective method to reduce excess skin for people who have experienced massive weight loss, although this procedure is more extensive and therefore has an increased risk of complications (see below).
This technique is for people who have excess skin in the upper abdomen with no loose skin in the lower abdomen. This body type is rare so this procedure is not often performed. The incision for a reverse tummy tuck is in the crease under the breast and extends across the body. The skin is lifted to give the surgeon access and muscle correction can be performed along with liposuction to remove additional fat.
Liposuction only removes fat and does not address excess or sagging skin. Sometimes, liposuction can even make sagging skin worse. A tummy tuck is designed specifically to remove excess skin but does not decrease the amount of fat, or the thickness of the tissues. These two procedures are often done together so patients can experience the benefits of both.
Liposuction alone is most useful for women who have firm skin and intact, strong abdominal muscle tone. Women who meet these criteria or are planning to have a family in the future may be candidates for liposuction alone.
Yes, these two procedures can be done at the same time but Dr. Xu prefers to perform liposuction in moderation on the abdominal skin elevated during a tummy tuck. Excessive liposuction can damage the blood vessels to the abdominal flap and this could lead to skin death.
On the other hand, liposuction to other areas of the body (flanks, side rolls) at the time of tummy tuck is safe for body contouring to improve the overall appearance of the body.
This depends on whether your concerns are isolated to the abdomen, or if there are other body areas that you would like to treat.
The effects of pregnancy are different for each woman and each woman has different concerns about her body after giving birth and breastfeeding. A mommy makeover is a more extensive combination of procedures customized to address each woman’s particular set of concerns. This usually includes changing the appearance of the abdomen and breasts because these areas are most affected by pregnancy and breastfeeding. A mommy makeover can include a range of techniques such as:
Busy women with families should consider the extended recovery time of combined procedures as physical activity during healing will be limited.
Depending on the needs of each individual, a range of procedures can be combined with a tummy tuck. Dr. Xu has vast experience in aesthetic surgery and can advise you of the techniques that could give you the desired results for your body. Techniques that can be combined with a tummy tuck include:
A good time to have a tummy tuck is when you have reached your goal weight and maintained that weight for one year. Women who have had children should wait at least one year after they have had their last child to allow their skin to fully recoil and recover and for their body weight to stabilize. People considering a tummy tuck should also choose a time when they are not busy because they will be unable to engage in demanding activities during the six-week recovery time.
While fat and skin are permanently removed during a tummy tuck, pregnancy or any significant weight changes in the future will affect the appearance of the abdomen. Dr. Xu recommends people who are thinking about losing weight or having more children postpone their plastic surgery until their weight and skin conditions have stabilized.
CoolSculpting® is an alternative to liposuction. It’s a non-invasive procedure to spot-reduce fat by “freezing” the fat between two paddles placed around a problem area. The recovery time for this technique is very short.
CoolSculpting® does not address any sagging or excess skin so it has limited usefulness for abdominal skin contour changes, especially after pregnancy or significant weight loss. From an aesthetic perspective, the technique is not precise or reliable and may not give the desired improvement.
From a financial perspective, you may need multiple rounds of treatment to see an effect that could ultimately be less cost-effective than liposuction.
Note, Dr. Xu does NOT offer CoolSculpting®.
You and your surgeon must communicate and work together so you have a good understanding of the process that will give you the best results. The goal of a good surgeon should be to arm you with the knowledge to understand the factors affecting your tummy tuck.
Dr. Xu can discuss how your age and the condition of your abdomen and skin affects the choice of surgical technique and the results you can achieve. It is important you have a realistic understanding of:
Different tummy tuck techniques create different levels of scarring, although most are hidden below the bikini line. Dr. Xu can explain which technique she would recommend for your situation and the level of scarring you can expect.
While some techniques cause more scarring (such as fleur-de-lis tummy tuck), they might also give you an abdominal contour closer to your goals. Dr. Xu can give you the information you need to weigh the benefit of a more aesthetic abdominal contour with the level of scarring.
Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Photos of your desired look can help her understand your needs. Your medical history is also important, including any information about pregnancies, breastfeeding, weight loss or other medical conditions. Things to also discuss with Dr. Xu include:
Dr. Xu understands the responsibility of transforming a person’s appearance to better reflect their identity and build self-esteem. Her top priority is understanding your vision and desires.
Once Dr. Xu has examined your body, she will use her artistic sense and technical expertise to recommend an approach to your surgery that will best suit your goals. During your consultation, Dr. Xu will explain:
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least six weeks prior to surgery.
Depending on your medical history, you may need to get a blood test or undergo additional tests. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages you to ask any questions about your surgery or the recovery process.
After your tummy tuck surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:
Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
Recovery occurs in phases. Your incisions will initially be tight and require that you keep your hips and waist flexed or slightly bent, in order to reduce tension across the incisions. You will need to sleep, sit, and walk slightly bent at the waist until you can slowly straighten out safely over two to three weeks.
During this time, you should also avoid lifting any heavy weights or doing any strenuous activities. Returning to work will depend on the nature of your job and how physically demanding it is. Ask your surgeon when you can return to the full range of activities.
If you have had a combination of surgeries, Dr. Xu can advise you of any additional recovery needs.
Most scars will be hidden below the bikini line, along the pubic hairline. For more extensive skin removal, you might have a horizontal scar extending to the side and, for fleur-de-lis tummy tucks, a vertical scar extending above and below the navel.
Dr. Xu uses surgical techniques to decrease the risk of scars spreading or thickening. Scars never disappear but they will fade and become less obvious with time.
After a tummy tuck, you will have a circular scar around the belly button. This can often be hidden so that it is not visible on the outside, but this varies by person. The scar usually fades, but this also depends on your skin type and healing ability. You will typically have an “innie” belly button in a natural position on the abdomen. Some people find they are happier with the appearance of their navels after surgery.
Depending on the technique used, tummy tucks can be done with or without drains. Drains help to prevent the build-up of fluid and air in the wound. Drains need to be regularly emptied and can limit movement due to discomfort, but are sometimes necessary.
Yes. A C-section scar can be completely removed. Read more about tummy tuck scar revision here.
Your risk for complications will depend on the specific technique used and Dr. Xu will make you aware of these before you have surgery. The risk of some common complications (such as infection, bleeding, and wound separation) can be decreased by following your surgeon’s post-surgery instructions. Potential complications after surgery for a tummy tuck include:
The cost of tummy tuck will depend on the type of technique used and whether it is performed alone or in combination with other procedures such as breast lifts, reductions or full mommy makeovers.
Combination surgeries are more complex and will cost more. The best way to understand the costs of surgery is to schedule a consultation with Dr. Xu–a Board-certified plastic surgeon with a high level of technical expertise and the sense of artistry necessary to help people achieve their aesthetic goals.
Many people are unaware of the full scope and possibilities of plastic surgery. Dr. Xu will listen to your vision for your body, review the options available to you, and advise you on an optimal surgical plan that will best meet your needs.