I totally get it, having liposuction just sounds better than having a tummy tuck.
Every day, moms come to me and ask me this question.
Lets talk some basics.
Liposuction
Liposuction has been around for over 50 years now. Liposuction has evolved from simple fat removal to a dynamic procedure that can highlight muscles and dramatically change the shape of someone’s body. Liposuction technology has also evolved dramatically over the years. We use VASER which is ultrasound based liposuction technology on every case to melt the fat so we can get more out and get smoother results. The final frontier in liposuction technology is skin tightening and it remains elusive. The current technology available for skin tightening with liposuction is Jplasma which is also known as Renuvion and is made by a company called Apyx. This liposuction technology uses plasma technology to help collagen tighten in the bottom layer of the skin. The other liposuction technology that is available for skin tightening is called Bodytite and it uses radio frequency technology to help tighten the skin.
Here is what I know from over 8,000 cases: if you have loose skin, taking fat out will make the skin looser. Adding heat with Jplasma or Bodytite will cause lumps and bumps.
To be crystal clear, liposuction is great for people who do not have loose skin or for areas of the body that does not have loose skin.
One procedure I do a lot for moms is liposuction of the waist but I do not touch the abdomen.
I don’t know much but I do know this if you perform liposuction of the abdomen after babies you will make the area look worse and the mom will be really unhappy. I mean, you still have to go through the downtime, cost, and risks, so why do the wrong operation?
Do the procedure that will get your goal, it’s better to not do any procedure than to do the wrong one.
Here is a super busy mom who came to me for lipo of the tummy after kids but decided to just sculpt her waist and back and leave the tummy:
I have to be honest, this mom is super happy but this procedure gave her the confidence and courage to do the tummy tuck because she knows what results she truly wants and is scheduling a date around her super busy schedule to have it performed by me.
I promise you and I am writing this blog to save people from my next example. If you have loose skin from babies, weight loss, menopause and you want a flat stomach, do a tummy tuck when you are physically, emotionally and mentally ready for it.
Tummy Tuck
When I started my career I really believed that liposuction and liposuction’s technology would make this procedure a relic in the armamentarium of plastic surgery. I tried every possible way to help women with loose skin avoid a tummy tuck. I learned through years and years of letting people down that at the end of the day the tummy tuck was the only procedure that would help. So what did I do? I embraced this fact and have spent the majority of my adult life figuring out how to do this procedure as well as humanly possible.
I have never made more positive impacts on peoples lives and I mean truly improving the quality of their lives than with tummy tucks.
Ok, so what did I do? I decided I had to figure out how to make tummy tucks not just acceptable but really exquisite and elegant something people wouldn’t just settle for but something they would desire.
My evolution of the tummy tuck
1. People want the most amount of skin removed. I realized that the modern tummy tuck of doing liposuction on the abdomen than doing minimal undermining or dissection under the area of liposuction didn’t look nice. It gave odd shapes. Think of sheets all crumpled up on the bed and you just pulling at them. Sure they look better but they don’t look as good as when you fling the sheet in the air so you can get a smooth tight crisp contour. So I modified the procedure to not doing lipo on the abdomen and lifting the entire abdomen off the abdominal wall and removing as much skin as possible.
2. People were so worried about the scar. I mean who wants a big scar. So we added progressive tension sutures and this was a game changer. Instead of just pulling the skin down and sewing we sequentially off load tension on the incision by sewing the skin down to the muscle all the way from the ribs down. This maneuver is challenging and time consuming but when we get down to the incision the skin is just kissing so the scar heals really beautifully. We have added an incision management system which increases blood flow to the tummy tuck incision and this has also been a game changer in the quality of the scar.
I have never once had a women complain about the scar when she got the results she wanted.
Of course from time to time we have to do touch ups on the scar to improve it but people and I mean this from the bottom of my heart simply don’t care. Even my single patients who worry about what a partner will think consistently tell me it’s a non issue. Probably because they are so happy and confident in their own skin that the scar itself is irrelevant to the partner who is enamored with the person.
3. Belly buttons. Its funny belly buttons are one of those things that we don’t really think about but when it comes to a tummy tuck its all people think about. I get it who wants a weird wonky obvious belly button. I travelled the world and saw every expert and all the gimmicks and tricks everyone have tried. What I ultimately realized is that the belly button is a beautiful and unique anatomical structure that is different in every person. So instead of trying to create a perfect belly button my goal is to use my huge tool box of plastic surgery maneuvers I have learned from performing 1000’s of tummy tucks to make a beautiful and natural belly button.
My goal is when you are in a crop top or bikini nobody will know you had any surgery at all!
4. Liposuction with the tummy tuck. In training I saw most attendingS and most surgeons now use a curved cannula while the patient is lying on their back to “carve” out a waist. This works ok and takes maybe 30 minutes. I decided I want my patients to look long, lean and elegant. This means turning the patient side to side so I can perform liposuction from the thighs to the back created a long lean look. This takes about 90 minutes to 2 hours. Think about how much more beautiful the results can be when you spend 2 hours compared to 30 minutes on the work.
5. Recovery- recovery sucks. I mean you’re bent over and you are in pain. It takes people a week to be able to care for themselves and a month to feel normal so we wanted to make this part more appealing. We started by creating a team of aftercare nurses and trained them not only in how to care for the patient medically but how to support them emotionally. Our patients tell us that the aftercare experience with two nights and three days of private nursing takes away the stress of recovery. Unfortunately healing is complicated it involves a matrix of things that need to be done every hour and I can promise you your husband, friend, mother cant do it the way we do it and why add stress to recovery.
6. Doctor-patient relationship: my team and I want to be part of your life, we come see you everyday while healing. These check ins are not just to examine incisions and make sure everything looks good but we want to get to know you better and really make you feel loved and cared for. We have added nurse practitioners to each surgical team so there is always a masters level person to reach while your surgeon is in the OR. This is another game changer. Gone are the days of feeling alone in recovery
Here is a cautionary example of what happens if you do liposuction when you needed a tuck
This mom was left with loose skin lumps bumps and deformities:
She was devastated and embarrassed because she tried to do something positive and it made her worse. This is really disheartening because friends and family can be vicious and people can get a lot of the “ I told you so” comments which can really hurt people. Its also really hard to trust another surgeon again. So she had the courage. She is a vibrant amazing person and she wanted to get her life back
My game plan was to have her do hyperbaric oxygen and lymphatic massage to soften up all the scar tissue so we would be able to move and stretch the skin after her complex revision tummy tuck
A brief aside as to why tummy tuck revision is so hard. I have had the luck of doing this 100’s of times so I am very comfortable but normally when you are operating its like a sandwich the human anatomy you can clearly see where the bread is, the turkey, the cheese, the lettuce (you get it). In these revisions all of the landmarks are gone we operate at a snail pace to ensure we are in the right place. Most surgeons will never attempt this because it is that hard.
After surgery she did more massage and more hyperbaric and I can proudly say we have brought joy and love back in her life.
