Liposuction or Abdominoplasty? How to Decide

Jeffrey Rosenthal, M.D.

by Jeffrey Rosenthal, M.D. | August 10, 2010 @ 09:00AM

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Sometimes, patients are confused about exactly what procedures they need to under go in order to take care of a bulging stomach. Many come to me after childbirth and when their families are complete to regain the figure they had before pregnancy.

I remember one patient who told me:

"Choosing clothing in the morning used to be a daily chore. Now, after my contouring surgery, it's a non-issue. Whatever I pull out, I can wear. What a pleasure, one less thing to think about."

That patient, Karen, bore great frustration and displeasure about her hips, wide thighs and buttocks that did not fit the upper half of her body. Despite an active exercise program, she could not reduce these bothersome areas. Buying clothing a size larger was necessary to accommodate the discrepancy between her top and bottom. Moreover, her pants were snug in all the wrong places, making her uncomfortable and self conscious.

The answer for Karen? Liposuction.

Liposuction vs. Tummy Tuck

Morgan, too, was disenchanted with her body. After multiple pregnancies, her belly never returned to the flat, toned shape she was used to seeing in the mirror. Nor did sit ups seem to be the answer. Skin draped over her pants, her muscle tone was gone, and she contemplated never wearing a bathing suit in public again.

"Liposuction is ideal for women with localized fat deposits."

Morgan's solution lies with a tightening procedure known as abdominoplasty, or more commonly called a "tummy tuck."

Body contouring is a permanent solution to improving both your shape and body image. Both liposuction and abdominoplasty remove fat from the belly, but that is where the similarities diverge.

Body Contouring

If you are old enough to remember the Special K cereal commercial, you may recall that if you could "pinch an inch" you were told you can lose some weight by diving into their cereal.

Additionally, this ad pitch can be used to determine which areas of the body to contour. Areas of the belly that show localized fat beneath the skin can be removed -- forever -- using either procedure.

So what's the difference between liposuction and an abdominoplasty? Why can't you just suck away the pounds?

Generally, neither procedure is appropriate for very overweight people until they have lost weight and have reached a healthier state. The path we surgeons decide to take is determined not only by the amount of fat present but its location.

Other determining factors are how loose the skin is, how stretched and floppy the overlying skin appears, whether the muscles that support the inner organs are saggy or snug, if there are large areas of unsightly stretch marks, and if the belly button is cute or has been widened.

Local Fat Deposits

Showing these areas of concern to a plastic surgeon may be disconcerting at first because no one likes to bear it all, but the only way to choose the right course of action is through a complete examination.

Liposuction is ideal for those women and men with localized pockets of fat. It is an amazing procedure that sculpts away selective fat deposits previously resistant to diet or exercise. Frequently, these bulging zones are genetically predetermined and easily found somewhere else in the family tree. Those with ideal body weight, who are unable to contour genetically pre-determined areas, benefit greatly from this procedure.

Remove Fat Cells

Don't despair, help is on the way! Universal areas of concern such as the hips, inner and outer thighs, abdominal area (belly), knees, waist, back, and neck can be contoured with great success. Smoother, shapelier bodies are the end result.

Either general anesthesia or sedation is followed by placing local anesthetics under the skin to numb and soften the areas to be suctioned. Tiny, well-placed, barely visible incisions allow for sculpting using various thin tubes (known as cannulas) attached to a medical vacuum device.

After the procedure, supportive, elastic compression garments are worn for a few weeks to keep the areas snug. Mild discomfort is treated with simple pain medicine and a period of bruising and swelling is tended with cold packs. The difference in your new body is apparent in weeks. Thereafter, your shape continues to improve as the swelling subsides. Since we are born with a finite number of fat cells, once they have been removed they do not return. This allows for a permanent contour improvement.

So, why not just do liposuction?

Again, a careful examination will often be the telling factor. Patients with loose skin, poor muscle tone of the abdomen, or bulging of the belly from protrusion of the inner organs will usually not be good candidates for liposuction because simply removing fat from these areas will not afford optimal shaping.

Mommy Makeover

Although pregnancy brings new life and love to your family, it usually results in stretching of the tummy skin and underlying muscles with accumulation of unwanted fat. The tummy tuck is part of the "mommy makeover" procedure.

Think of a deflated balloon that will never again retain its original shape once it has been inflated. Like a balloon, the belly of woman after extensive weight loss or pregnancy is often loose, floppy, and wrinkled. This is especially true of a woman with a narrow pelvis allowing for the front and bottom of the abdomen to enlarge disproportionately.

Muscles that support the front of the abdomen, running vertically from below the ribs to the pubic area (the rectus muscles), are pushed apart and stretched like a rubber band and may be made worse after c-sections. It's very similar to pulling on an elastic band until it no longer snaps back. The result is what we fondly call a potbelly. The crunch machine will not help much in this situation, nor will dieting and exercise significantly improve these areas. But the tummy tuck can.

An abdominoplasty is a far-reaching procedure that requires you to be asleep under general anesthesia. Extra fat and sagging skin are removed while the underlying loose rectus muscles are tightened.

Hip, Thigh Bulges

Stretch marks along the lower front of the abdomen are also removed as the abdomen is toned and slenderized. The belly button is also contoured to fit your new appearance. Often, liposuction can be added to reduce troublesome bulges of the thighs or hips, as well.

The scar is hidden within underwear and swimsuits along the lower belly and usually around the belly button. There is more discomfort for the first week or two than with liposuction, but then again, muscles and skin have been tightened. Activities after this surgery are limited to prevent swelling or other harmful side effects. You will be pleased to note that this includes such mundane activities as house cleaning and cooking or any activity that would increase your heart rate and blood pressure. During these weeks, you will be wearing an elastic binder to aid in comfort and decrease swelling.

Why have an abdominoplasty? You probably already know the answer. Your body is proportioned once again, posture is corrected and a new wardrobe is attainable! And best of all, the extra lower belly skin is no longer hanging. Although swelling and healing takes a while to disappear, you will note in a few weeks how well you look and feel.

Plastic Surgery: An Art Form

You need to be comfortable with your body and the decisions you make to reshape it. Seek out a board certified plastic surgeon who can explain the various options to you and one with whom you are at ease.

Remember that plastic surgery is also an art form that brings together both sculpting and science. During your consultation, ask questions and look for honest answers. You should be shown before and after photos of other patients who have had similar procedures. Being realistic in what can be achieved and what you can expect will only heighten your satisfaction and allow you to delight in your new body. It is an amazing adventure that can offer a lifetime of joy.

Just look at the difference in one patient's stomach:

A 37-year-old patient with two children shows the state of her tummy before her abdominoplasty procedure, left. After three months, the patient shows the results of her tummy tuck, right. Note the great improvement and lack of scarring in her belly button, which has actually been surgically moved to a higher position. (Photos, courtesy of Dr. Rosenthal.)The national average surgeon fee for liposuction in the United States during 2006, the most recent year for which statistics exist, was $2750. The national average surgeon fee for tummy tuck, also during '06 was $5,063. Be sure and ask your surgeon about other plastic surgery costs like anesthesiologist fee, operating room fee, pre-surgical testing, medications, and compression garments, among other possible charges.

About the doctor: Jeffrey S. Rosenthal, M.D. is a board certified plastic surgeon in private practice in Fairfield, Connecticut. Dr. Rosenthal is also an artist and sculptor, and chief, Section of Plastic Surgery at Bridgeport Hospital.

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