Cosmetic treatment of the Abdomen
There has always been a demand for improving the shape and appearance of the abdomen. The growth in consultation has been due to an increasing public awareness of the possibility of cosmetic correction. Cultural and media pressures for the perfect “belly”, the unrelenting rise of the body mass index (BMI) in the general population and consequent body changes and reaction to diets have no doubt been other factors.
As a cosmetic and plastic reconstructive surgeon I am a firm believer in “reverse planning”. This means truly understanding the goals and aims and then choosing the appropriate technique. The common problems that can be treated are re-shaping for moderate fatty excess, removal of redundant and excess skin following pregnancy or dietary weight loss, treatment of damaged skin after pregnancy, revision of scars following previous abdominal surgery. The success of intervention is the correct selection of technique.
The most frequent problem encountered are patients with moderate fatty excess in the abdomen and love handles that cannot be somehow shifted with exercise. Liposuction, in the appropriate patient, is an effective method of treatment provided that there is enough skin elasticity to conform to the desired shape after fat has been removed. Certainly some non–invasive techniques such as fat cooling may find a place for relatively small problems but this is still under evaluation. To confuse patients there are several types of liposuction such as laser lipolysis (which employs laser energy) and Vaser (ultrasonic energy). The heat energy generated by these methods can affect the collagen and may tighten damaged skin. Unfortunately these methods probably have higher complication rates simply because of the learning-curve needed to use them safely. However in my experience, good results can be achieved with simpler and safe liposuction techniques in the appropriately selected patient. The vast majority can be carried out under local anaesthetic with or without sedation as day cases.
Patients with excess skin or redundancy need surgical treatment. The type of surgery really depends of how much and where the excess is. For moderate excess skin in the lower abdomen (often following pregnancy with or without cesarian section), a mini-tuck can be carried out. This does not involve alteration of the position of the belly button. For larger excess then a full abdominoplasty maybe needed. This will tighten the whole of the anterior abdominal wall and reposition the belly button to the appropriate place. The laxity (looseness ) of the skin as well as muscle can be addressed. Both these techniques will result in lower abdominal scarring. If correctly positioned it should be well hidden by bikini and underwear. Surgery can be combined with liposuction and carried out as day cases under sedation and local anaesthetic.
Neither cosmetic surgery nor liposuction is appropriate for the obese. Nor is this form of surgery a method of weight loss. These patients will have to loose weight first to a BMI that is safe for surgery. This is usually regarded as 30 or under but much controversy surrounds this figure. Sometimes huge excesses prevent mobility and weight loss and therefore exceptions can be made. However this is in the realm of “bariatric surgery” which is a specialised and non-cosmetic field.
With cosmetic procedures, the patient has to be “fit” for surgery. They must be aware of possible limitations and complications. The choice of technique as described above is critical and therefore, a practitioner with experience should carry out evaluation. Complications such as bleeding, infection, seroma and thick scarring are quite rare but perhaps one of the greatest difficulties is when there is a mismatch or mis-understanding between expectations and what is safely possible. Therefore the consultation, communication and evaluation are so very important.
It is easy to calculate your BMI
The equation is BMI = Weight in Kilograms divided by your height in metres squared Kg/m2
The Real Self website has several questions from patients about abdominoplasty, you might like to read the consultant’s answers on who should get a tummy tuck (note: this link will take you to their website).
Can I have a tummy tuck if I might have more children?
Yes, but pregnancy can undo the cosmetic results of a tummy tuck.
Can you recommend anything to help make my scar invisible?
There will always be a scar following abdominoplasty. There can be complications concerning its maturation. It can become thick but usually it will settle so that it less obvious, but I am afraid it will be a permanent feature.
Will I still have a belly button after a tummy tuck?
Yes, you'll still have a belly button after a tummy tuck, although sometimes it may be repositioned depending upon the extent of the abdominoplasty.
Will my belly button change after a tummy tuck?
In a full tummy tuck the position and the shape of the belly button is likely to change, and can be improved.
Where will my tummy tuck scar be?
The scar is usually designed to run just above the pubis in an area that can be hidden with underwear. The extent of the scar outwards (laterally) really depends on the type and extent of the tummy tuck (abdominoplasty).