Dr. Nein Answers: Tummy Tuck or Liposuction?

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Cosmetic surgeon spells out the purposes of these common procedures, and when either may be right.

The first thing you should know is that plastic surgery is not a substitute for a good diet or exercise...

WebMD posted an article on post-weight-loss surgery, on March 23, 2013, entitled “Plastic Surgery After Weight Loss” (on Nashville Plastic Surgeon Responds Liposuction or Tummy Tuck).

The article offers thumbnail sketches of several common weight-loss-related procedures, including the tummy tuck – also called abdominoplasty. It notes that liposuction is sometimes necessary with a tummy tuck. While helpful, the article leaves many questions unanswered.

Dr. Alexander Nein, a board-certified cosmetic surgeon in Nashville, Tenn., realizes that such questions are in the minds of most who consider these stomach procedures. So he offers his own clear-cut expert’s guidance on what these abdominal-area procedures can do and when a patient may need them.

Dr. Nein summarizes: “Basically, there are three different things that can be done to improve the shape and appearance of the stomach. We can perform liposuction alone, we can perform a ‘mini-tummy tuck,’ or we can do a standard tummy tuck.

“Each of these procedures is different and accomplishes different things, so each is best suited for different situations. It’s important to realize that these procedures address only the stomach; additional liposuction, or other procedures, can be combined to further improve your overall appearance.”

Dr. Nein, who did his plastic surgery residency at Vanderbilt University Medical Center, explains what can happen to the abdominal area over time. “Our bodies go through many changes throughout our lives. Aging, weight increases and losses, pregnancy, periods of exercise, periods when exercise is avoided or isn’t possible, all have an effect on our bodies. Sometimes our stomachs pay the price for our lives and just don’t look the way we want them to.”

One may have loose stomach muscles, excess skin, or excess fat. Or, all of them. “That is where plastic surgery can play a role in getting back to our desired condition,” Nein says.

Such surgery is not a free pass from a healthy lifestyle: “The first thing you should know is that plastic surgery is not a substitute for a good diet or exercise,” the doctor insists. “It is a contouring and reshaping procedure to change the things that a healthy lifestyle cannot. Plastic surgery can make dramatic improvements to the appearance of the stomach. [It] cannot replace a healthy lifestyle, but it can improve the things that diet and exercise will not.”

So, accepting that surgery is only part of the goal of looking and feeling great, the question then becomes, “What type of plastic surgery procedure should I have done to improve the look of my stomach?”

Liposuction: this procedure removes fat from underneath the skin and above the muscles of the stomach wall. If there is a modest fat pooch below the naval and some excess fat of the upper stomach, waist and hips, this can be an excellent way to achieve a nicely contoured and slim stomach. With liposuction there is generally some skin contraction. This contraction is limited, however, and is usually better on younger patients. Skin that has been significantly stretched in the past often does not contract well.

Liposuction does not help the stomach muscles. During pregnancy, if the stomach muscles or linea alba are stretched out, liposuction will not affect this, either. “Lipo” will not change loose skin that won’t tighten naturally, or a widening to the linea alba, as may be caused by pregnancy or significant weight change. In such cases, another surgical option, commonly called a tummy tuck, is considered.

Abdominoplasty, or Tummy Tuck, Options: The linea alba is a strip of tissue in the middle of the stomach wall extending from the bottom of the breast bone to the pubic bone. Normally, it is about one half-inch wide. Dr. Nein explains that there is no muscle associated with the linea alba, so, while exercises will tone and tighten the stomach muscles to a degree, the exercising will not improve the linea alba.

The surgeon says that the linea alba will not naturally return to a more slender span. “Pregnancy – especially multiple pregnancies – or excessive weight gain can cause the linea alba to widen. Because there is no muscle connected to it, there is no way to tighten it up, even with exercise. So, to [tighten it], surgery is the only option,” Dr. Nein says. He adds, “I have seen some cases in which the linea alba has been stretched to four or more inches.”

A tummy tuck places an incision low across the stomach, roughly where a C-section incision would be. The incision is made in order to lift excess skin and fat from the stomach wall. With the muscles of the stomach wall exposed, the flexible muscles are stitched to tighten them up. Any excess stretched muscle or linea alba can be tightened up.

A mini-tummy tuck is “best suited for those women who have excess skin primarily below the belly button and who don’t have too much stretching of the muscle layer,” Dr. Nein says. Skin and fat is lifted up from the stomach wall to the belly button level. The muscle below the naval is then tightened (if necessary), and excess skin is removed. The remaining skin is pulled down and smoothed.

“Some liposuction may be performed along the incision, the waist and above the naval, to remove excess fat in these areas as well,” Dr. Nein says.

“Often, we see situations where there is excess skin and fat above the belly button as well as significant stretching of the linea alba. In such situations, we would want to perform a standard tummy tuck.”

A standard tummy tuck is applicable when liposuction alone or a mini-tummy tuck will not satisfactorily treat the excess skin or tighten the stomach wall. A standard tummy tuck removes excess skin and fat, and tightens the stomach wall to a flat, smooth contour.

“The incision for this operation is similar to that of a mini-tummy tuck,” Dr. Nein explains. “However, instead of stopping the operation when we get to the naval, we continue to lift the excess skin and fat off of the stomach wall all the to the bottom of the rib cage.”

The procedure “allows us to tighten the stomach muscles all the way from the top of the stomach to the bottom,” he continues. “All of the excess stretched muscles and linea alba can be tightened and a nice flat stomach can be achieved.

“A small incision is made just inside the naval opening so that the naval remains attached to the stomach wall at its original location. Then, the excess skin is removed, and remaining skin is brought down to the incision, smooth and snug.”

Another incision is made where the naval is. “As a part of a standard tummy tuck, we perform liposuction along the incision to make sure that everything is nice and smooth.”

The decision to have these surgeries should be made as part of one’s other life decisions, notably, child-bearing. “We do not recommend either tummy tuck procedure for women who are planning future pregnancies,” Dr. Nein says. “Future pregnancies will effectively reverse many of the benefits of a tummy tuck. Thus, we recommend these procedures only after women are done having children.”

About Alexander Nein, M.S., M.D.:

Dr. Alexander Nein is a graduate of Purdue University and the University of Alabama, where he earned his Doctor of Medicine degree. He completed his plastic surgery residency at Vanderbilt University Medical Center and is certified by the American Board of Plastic Surgery. He has a solo, private plastic surgery practice in Nashville, Tenn. Dr. Nein is a member of the American Society of Plastic

Surgeons, American Society of Aesthetic Plastic Surgeons, International Society of Aesthetic Plastic Surgeons, and the International Confederation of Plastic and Reconstructive Surgery.

You may learn more about Dr. Nein online, at http://www.DrNein.com. His practice is located at 2400 Patterson Street, Suite 202, Nashville, Tennessee 37203; call his practice at 615-327-0201.

  • Jon Osterholm (for Warehouse Multimedia, Inc.)

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