How to have a yummy tummy

For patients with excess skin or stretch marks, who’ve done all they can with diet, exercise and a healthy lifestyle, a tummy tuck may be in order.

In an era of “selfies” and social media postings, many people are self-conscious about appearance — a major reason why body-contouring procedures are becoming more popular. The best way to improve abdominal shape is via diet, exercise and a healthy lifestyle. However, patients who are still unhappy with the shape of their abdomen despite already being at or near their ideal body weight can consult with an experienced, board-certified plastic surgeon. He or she can help patients determine whether procedures such as a tummy tuck, liposuction or a combination may be able to help enhance their appearance.

Liposuction is designed for removal of excess fat deposits and is most successfully performed on young fit patients with good skin elasticity. It can also be a useful adjunct to help finesse results of other body contouring procedures by smoothing out and sculpting targeted areas to look more naturally proportionate.

For patients with excess skin or stretch marks, however, a more extensive surgical procedure, such as an abdominoplasty, also known as a tummy tuck, will most likely be needed. Stretch marks are a sign that the dermis has been damaged and the skin has lost its elasticity in that area. Exercise cannot force the skin to revert to its original shape.

Many people increase in abdominal girth as they age. In particular, the abdomen of a pregnant woman stretches enormously to accommodate a growing new life. If the skin is overstretched, it cannot snap back to its original form. 

Since liposuction does not involve removing skin, a patient who has saggy skin and undergoes abdominal liposuction will not achieve an optimal cosmetic result. In fact, the procedure may only make the area look worse.

An abdominoplasty not only removes unneeded skin, it can smooth the tummy “bulge” that develops in some patients, primarily women, by correcting and tightening abdominal muscles that have thinned, separated and weakened — a condition called rectus diastasis. 

This makes it difficult for a patient to lift objects and may cause lower back pain, weakened pelvic alignment and altered posture. A study published in a 2018 issue of Plastic and Reconstructive Surgery reinforces the idea that abdominoplasty is not simply cosmetic.  According to the study’s authors, tummy-tuck surgery with abdominal-muscle repair can reduce back pain and urinary incontinence in women after their child-bearing years.

Meanwhile, earlier studies tout the benefits of lipoabdominoplasty — a combination of tummy tuck and liposuction — to enhance cosmetic results and minimize surgical trauma to tissues. With lipoabdominoplasty, surgeons perform both abdominoplasty and liposuction to eliminate loose skin and excess fat deposits. 

The American Society of Plastic Surgeons reports tummy tucks are among the top five cosmetic surgical procedures in the United States, with more than 130,000 of them performed in 2018.  Liposuction procedures exceed 250,500, but this total includes removal of fat from areas of the body other than just abdomen, such as hips, thighs, buttocks and neck.

But, back to “selfies.” Not only does the right surgical approach improve personal appearance and correct physical problems. For some people it can also offer psychological benefits, including enhanced self-image, self-esteem and perceived quality of life. In the August 2019 issue of the Journal of Plastic, Reconstructive & Aesthetic Surgery, a study of 38 patients who had undergone aesthetic liposuction found improved emotional stability, reduced anxiety and higher satisfaction with their life and general state of health when compared to their preoperative state.

Sometimes, patients practice healthier lifestyles following a tummy tuck or a liposuction because they want to maintain their new “look” by avoiding future weight gain.

To those who are potential candidates for cosmetic surgery, I offer these tips:

• Don’t consider cosmetic surgery as an alternative to exercise and healthy eating for weight reduction.

• Understand the risks, including infection and permanent scarring, associated with any surgical procedure.

• Know that cosmetic surgery like liposuction can permanently eliminate fat deposits from targeted areas but not stop one’s ability overall to gain weight.  

• Delay a tummy tuck if another pregnancy is possible in your future.

Whether liposuction, tummy tuck or both, the end goal is to feel good about what you see when looking in a mirror. Ultimately, however, surgery is limited in what it can accomplish. Maintaining a healthy lifestyle is the key to both inner and outer beauty.

Constance M. Chen, M.D., is a New York City-based, board-certified plastic surgeon with expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She operates out of Lenox Hill Hospital in Manhattan’s Upper East Side and is clinical assistant professor of surgery (plastic surgery) at Weill Cornell Medical College and clinical assistant professor of surgery (plastic surgery) at Tulane University School of Medicine. For more, visit

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