A person who has an apron or pouches of fat in their abdomen that they simply can’t get rid of either through diet or exercise may consider the options of liposuction or abdominoplasty, also known as tummy tuck. These procedures also help patients who have excess skin and tissue due to the rapid weight loss that occurs after bariatric surgery. But what is the difference between them, and which one is best?
Tummy tuck is surgery that gives a person a flatter and tighter abdomen by tightening the skin and the muscles of the abdominal wall and removing unwanted fat beneath the skin. The procedure not only results in a slimmer silhouette but halts the slackening of the tummy that is simply a function of age. The attractive results of tummy tuck can last a long time, especially the patient eats a healthy diet and exercises.
A person who undergoes a tummy tuck needs to know that it is major surgery. It is an inpatient procedure, and the patient will need to spend at least a night in the hospital and have a recovery period of between three and six months. There’s also some scarring with tummy tuck, though most of it is hidden under a bathing suit or underwear.
There are different types of abdominoplasty:
In the standard abdominoplasty, the surgeon makes incisions just above the patient’s bikini line, cuts their belly button away from the surrounding skin, tightens slack muscles and stitches them into place. The skin is then pulled down, and the surgeon trims away any excess and repositions the belly button. They suture the incisions and strap the abdomen with bandages.
In an extended tummy tuck, fat and excess skin is also taken from the patient’s back. In a mini-tuck, the surgeon only removes skin and fat below the patient’s belly button.
A good candidate for tummy tuck is an otherwise healthy person who has tried and failed to lose weight to get rid of their unwanted fat. They should not choose abdominoplasty if they are thinking of becoming pregnant again. It’s also not a good choice if they are obese and/or diabetic, if they smoke and can’t quit or if their circulation is poor. Patients who have had other abdominal surgeries may not want even more scarring due to an abdominoplasty.
Liposuction treats more areas than the abdomen. During liposuction, the surgeon uses a vacuum cannula to remove stubborn fat from many places, including the hips, breasts, buttocks, underarms and jowls as well as the abdomen. It is also used to correct male breasts, or gynecomastia. Liposuction is not as invasive as abdominoplasty, and the recovery time is shorter and a bit easier, depending on how extensive the liposuction was.
A good candidate for liposuction is an adult in good health who doesn’t smoke and who can’t get rid of unwanted fat in some areas of their body. Liposuction may not be suitable for people who have a compromised immune system, diabetes, cardiovascular problems or a history of circulatory problems or blood clots.
During conventional liposuction, the patient can be put under general anesthesia or have twilight sedation, where they feel no pain but are not unconscious. The doctor injects a numbing agent into the area to be treated then makes tiny incisions for the vacuum cannula. The doctor inserts the cannula into the layer of deep fat beneath the patient’s skin then uses a sweeping motion to break up the fat and suction it away. With conventional liposuction, the cannula also gets blood, fluids and other tissue, and the patient may need intravenous fluids during and after the operation.
The surgeon may suture the incisions or simply put a dressing over them after the liposuction. Scars are nearly undetectable after the incisions heal.
Newer types of liposuction do not remove as much blood and tissue from the patient. In tumescent liposuction, the treatment area is flooded with a solution of lidocaine, salt water and a vasoconstrictor. This makes the area swell up and go rigid, which gives the doctor a better “feel” as they use the vacuum cannula. The patient also does not need general anesthesia, and being awake preserves their muscle tone. The lidocaine is a pain killer while the vasoconstrictor narrows the blood vessels and reduces blood loss.
Fat can be emulsified by lasers or ultrasound delivered by the cannula. This makes the fat easier to remove while sparing the tissue and blood vessels around it.
Liposuction is an outpatient procedure, but the patient should be on the safe side and plan to stay overnight in the hospital or clinic if they have a large amount of fat removed. Whether they have an inpatient or outpatient procedure, they will need someone to take them home, and stay with them for the first day or so.
Dr. Anurag Agarwal is a specialist in facelifts, rhinoplasty, eyelid surgery, fat transfer, skin cancer reconstruction and other procedures. He is board certified by the American Board of Otolaryngology – Head and Neck Surgery and the American Board of Facial Plastic and Reconstructive Surgery.