When I counsel a patient on abdominal contouring, there are many details that come into the discussion. We begin with what you see when you look in the mirror and really focus on your goals and expectations. Then we proceed into the exam room to evaluate your concerns in the mirror together.
There are 3 areas of the physical exam that are so important before deciding on which treatment to pursue. The skin excess or laxity, the rectus (six pack) muscle laxity or widening (diastasis), and the abdominal wall thickness need to be considered. I will show you in our consultation what a change in each of these domains will do to your final result.
Options for abdominal contouring include nonsurgical treatments such as Coolsculpting, while surgical options include liposuction, or liposuction plus abdominoplasty/tummy tuck. Any surgical treatments should be deferred until you are at your goal weight or you have reached a plateau with the understanding that exercise should continue postoperatively to maintain and further optimize your results.
Nonsurgical treatments will address wall thickness only and will not address muscle weakness. If tightening is your expectation, this will not occur. It may take several treatments and can be costly. Other caveats include heterogeneous results or rarely, a paradoxical fat proliferation can occur, which is what happened to Linda Evangelista.
Liposuction will address wall thickness definitively in a more controlled fashion; however, it is invasive surgery and requires anesthesia. It does provide some tightening, particularly when other modalities are incorporated such as VASER or ultrasound adjuncts. I tend to avoid these adjuncts as liposuction can serve as a donor site for fat grafting procedures to face, breast, or other areas of the body and I prefer to leave these fat cells unharmed. Liposuction will not address skin folds or muscle laxity. It does require a postoperative compression garment for up to a month and lymphatic massage therapy postoperatively for optimal results and healing. High definition liposuction is a popular trend which can contour the abdomen, giving an effect of muscle definition. My preference is to deliver an even thickness abdominal wall and for you to postoperatively exercise your trunk muscles for a more natural, long lasting appearance.
Abdominoplasty is the most invasive method for abdominal contouring. It serves to address skin laxity and muscle laxity, and can be combined with liposuction for best results. It does require a scar placed very low in the underwear line, though the length of this scar is determined by your body frame and extent of skin excess. Personally, I would trade a long, hidden scar for a gorgeous contour, and my patients tend to agree.
Liposuction with an abdominoplasty addresses the abdomen, suprapubic area, hips, and waist to further optimize your final contour. This fat can also be repurposed to fill hip dips or breasts. A rectus muscle plication is always performed with this procedure to tighten any widening that might have occurred from weight fluctuation or pregnancy. An abdominoplast with liposuction does not address visceral fat, the fat behind your muscles near your internal organs. This fat is dependent on your overall weight and diet and can only be addressed with diet modification and exercise. I would encourage you to meet with a plastic surgeon prior to receiving any treatments to optimize your outcome and conserve your costs. But be wary of medical spas with devices that promise powerful results from non-invasives and a great pricing package, because your results may fall short of your expectations.
