Male Tummy Tuck

New York Male Tummy Tuck

“You haven’t lost the weight until you’ve lost the skin.”

Over the last 5 years, I have seen an exponential rise in the number of male patients coming to me with loose skin following weight loss. These men have used a combination of methods to lose the weight: diet and exercise, bariatric surgery, traditional weight loss medications, and now new weight loss medications such as Ozempic, Mounjaro, Wegovy and Zepbound.

But after losing the weight, these men often find that the skin failed to retract as they expected, leaving a deflated, lax appearance to multiple areas of the body. In particular, they are bothered by the loose skin on their chests, upper arms, inner thighs, and, most commonly, the lower torso. The skin often hangs in a ring around the lower torso creating a “spare tire” appearance of loose skin.

This is particularly troubling for our weight loss patients, as they have done the hard work in losing the weight, but they find that they are left with an undesirable aesthetic appearance due to the loose skin. This skin can pool above the underwear or pants, and during consultations, it is not uncommon for my male patients to grab this loose skin and say “I hate this.”

For these men, we have solutions, and the solutions are new and not feminine.

Loose Skin: An Increasingly Common Problem

First, before we tackle this problem, let’s step back and see why this problem exists.

When weight is lost as an adult patient, the skin does not contract the same way it did during childhood. This is because the elasticity of the skin depends on the thickness of the dermis of skin, which is composed of multiple proteins in a cellular network. For skin elasticity, the two most important proteins are collagen and elastin fibers. It is estimated that with every decade of life, we lose approximately 8 percent of these proteins. So, as you can imagine, as someone approaches middle age, almost half of these proteins are already gone, and the skin’s ability to contract is greatly diminished. When a significant amount of weight is lost—by whatever means—the skin just won’t be able to contract fully. This then leads to hanging, loose skin affecting multiple areas of the body, face and neck.

So why are we seeing more of these patients at this time compared to years past? I suspect the answer is four-fold.

First, let’s discuss the elephant in the room—the rise of GLP-1 agonist peptide medications and other similar meds. These medications, including Ozempic and Mounjaro, have already had a profound impact on weight loss in adult patients. Initially developed to help diabetic patients, they are now being used by patients interested in lowering their body fat percentage. And the amount of weight lost via these medications can be quite dramatic. During my consultation days, I estimate that about half of my patients have taken or are currently taking one of these newer weight loss peptides.

Second, as the detrimental effects of obesity on health and lifespan become all the more evident, more patients are undergoing bariatric surgery. Many of these procedures can now be performed in a laparoscopic or minimally-invasive fashion, allowing for a quicker, less painful recovery, and more patients are therefore opting to undergo these surgeries. Weight loss following this can also be quite dramatic.

Third, we live in an age of increasing awareness of fitness and nutrition. We see patients across many decades of life who have decided to make weight management and fitness a priority. The vast majority of my patients now tell me that they exercise often and adhere to a healthy, lower calorie diet and avoid detrimental alcoholic drinks other than during special occasions.

Lastly, and this cannot be overstated, the rise of social media has raised awareness of the above methods of weight loss with influencers and the like promoting the use of medications and dieting / fitness methods, and viewers receiving a constant stream of visual images and videos of other people progressing through weight loss and fitness journeys.

Solutions for Our Male Patients

So with so many men on a weight loss journey, what are we to do with all the loose skin?

Simply put, the loose skin must be removed. This is really the only effective treatment for loose skin. No amount of creams, lotions or potions is going to tighten the skin with any real noticeable effect. Similarly, relying on devices which are applied topically to the skin offer only a modest amount of skin tightening and are often a waste of money and downtime. So for lax skin, we must remove it to get a meaningful result.

Torso Tucks and Lower Body Lifts

A lot of men associate the tummy tuck with women so let’s call it a torso tuck!

For today’s article, let’s focus on the area men complain about the most—the lower torso, with skin hanging over the belly button and down in the pubic area, along the sides of the hips and causing sagginess and deflation to the buttocks.

To address this area, we perform either a male torso tuck or a circumferential lower body lift. Whether we perform a torso tuck or a body lift depends on the location and amount of the loose skin. If the loose skin primarily affects just the anterior portion of the torso, we perform a torso tuck. But, in more cases than not, the loose skin extends fully around the waist and lower back and a body lift is required.

As a torso tuck is just one component of a circumferential lower body lift, let’s review the body lift in detail.

This procedure is performed under general anesthesia. In our office we work with an incredible team of board-certified anesthesiologists. Once the patient is safely asleep, I first perform lipo360. This is an energy-assisted form of liposuction where I remove fat from the abdomen, lateral chest, flanks or waist, and the back, while at the same time using care to add additional sculpting to highlight the natural male muscular anatomy. For instance, extra emphasis is placed on highlighting the line dividing the six-pack or rectus muscles from the obliques, while some of the fat obscuring these muscles is judiciously removed. This is a key component of the male torso tuck. Also, we work to achieve a defined, athletic V shape torso with our liposculpting for our male patients. This is in contrast to the ‘hourglass” figure we strive for with our female tummy tuck patients.

Once the liposuction portion of the procedure is completed, I then remove the extra skin from just above the belly button to the pubic region. The “spare tire” of skin is removed in a large ring around the lower torso in this fashion. The remaining skin is brought together and sutured in multiple layers with absorbable sutures. A new opening is made so that the belly button can be preserved. Taken together, this gives the effect of a tummy tuck along the anterior abdomen, an outer thigh lift along the sides of the torso, and a butt lift and rejuvenation along the posterior aspect.

Scar

Ultimately, the tradeoff for this powerful procedure is the scar. We make every effort to keep the scar low so that it can be hidden by underwear, swim trunks or a Speedo. Likewise, we diligently try to make the belly button scar as natural in appearance as possible.

For my male patients, I have found that a more linear, straight scar is preferred over the traditional, curved “bikini-style” incision of the classic tummy tuck. This scar can easily be hidden below a pair of boxers or briefs.

These male patients easily hid their scars undr their boxes or Speedos!

Long term, patients routinely tell me that they are so incredibly happy with the loose skin removal, that they do not care about the scar. The internal happiness that is achieved after a body lift with all of the excess skin removed greatly outweighs the external scar.

That said, we take extra measures to ensure a nice scar, including the addition of the Prevena incision management system. This vacuum type device lies atop the incision and improves blood flow to the area while clearing the wound of small debris. This has the effect of improving the scar appearance long term. We also recommend particular silicone scar strips, scar creams, and offer steroid injections and laser treatments to scars as needed. We take scarring very seriously.

Avoiding Muscle Repair

For the vast majority of my male patients, the underlying musculature is perfectly intact, unlike my female post-partum patients who often have significant rectus diastasis causing bulging and needing to be repaired. So for male patients, they can avoid this step in the procedure, which traditionally causes the most discomfort during the recovery period. It is also this step which requires very strict lifting restrictions on postoperative patients, so male patients have less activity restrictions after surgery.

Recovery

I find that my male patients have a lower requirement for strong pain medications given that we are able to avoid the underlying muscle repair. On average, male patients may use additional pain medications for 2 to 3 days after surgery. Some report using only Tylenol and being sufficiently comfortable. During the procedure, I inject a long-acting pain relieving medication called Exparel along the incision line to further decrease discomfort during the early recovery period.

If drains are placed during the procedure, I remove them at the one week postoperative visit.

Male patients are placed in a compression vest which hides nicely under a shirt. This is worn to assist in reducing and alleviating natural swelling to the area.

I encourage lymphatic massages after a few days of recovery to accelerate the healing process and clear the area of some of the associated edema, or swelling.

I encourage taking two weeks off of the equivalent of an office job; however, most men find they can return to work remotely as soon as they are off pain medication.

For workouts in the gym, I recommend taking 3 to 4 weeks off, with a gradual increase in exercise intensity.

Results

This 37-year-old male adhered to a strict diet and exercised daily and dropped weight. He was left with loose skin on his abdomen which impaired his self confidence. I performed a male tummy tuck with lipo360 and renewed his self confidence.