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Cosmetic Surgery Basics – Abdominoplasty or Liposuction

I have decided to do a series on basic cosmetic surgery education. After seeing over 10000 patients in my New Jersey plastic surgery practice I believe I have a pretty good grasp on what the common questions and presenting concerns are. Thus, I am going to start a daily series (at least my intent is to do this daily) which goes over the basic questions that are asked of me daily by NJ cosmetic surgery patients.

This is post #1 and I encourage any questions that you may have in order to make this an interactive discussion.

I get this question literally almost on a daily basis: “Do I need a tummy tuck or can I get away with liposuction?”

This question stems from several concerns. First of all, nobody wants a long scar from an abdominoplasty. Second of all, the recovery from liposuction generally is easier. Thirdly, many ladies simply don’t realize the difference between the procedures.

So, what does liposuction do? In general terms, liposuction removes fat. There are many types of liposuction, and we will go into them in other posts, but at the end of the day, with whatever machine is being used, liposuction simply removes fat. It does not do anything to remove loose skin, make loose skin shrink to any significant degree, or address structural muscle issues. Liposuction therefore works well in an area with good skin elasticity.

For instance, the lower back “love handles” usually respond very well to liposuction. This skin tends to be elastic and thick enough to tolerate weight gain and weight loss.

Abdomens on the other hand, do not necessarily do as well with liposuction. The abdominal wall often has stretched out skin from pregnancies and weight loss/weight gain which results in stretch marks and excess skin. If the skin is loose and stretched out, it is unlikely to do well with liposuction. If the skin already hangs down over the pubic area or over a caesarian section scar it is not going to respond to liposuction. Finally, the abdominal wall muscles often separate during extreme weight gain or pregnancy and there is no physiologic mechanism (or amount of exercise) which will bring these muscles back together. An abdominoplasty (or tummy tuck) addresses excess fat, removes excess skin, and allows for tightening of muscles. Thus, most post pregnancy belly bulges require abdominoplasty not just liposuction.

Arms may respond quite nicely to liposuction if they are simply “a little thick” but if they have loose skin that swings back and forth, liposuction is not the answer. In this case, skin removal, via a brachioplasty is the proper treatment.

Newer techniques of laser liposuction and skin tightening lasers have not lived up to their promises (in my opinion) of shrinking the skin. I am aware that the laser companies selling the hundred thousand dollar machines claim that they shrink skin and allow patients to avoid abdominoplasty but in my experience (after purchasing and using one of these expensive machines) they do not perform as well as the hype. I do not offer laser liposuction when someone needs an abdominoplasty. In fact, I see patients often who have been treated elsewhere with laser liposuction only to be disappointed by the result.

So, this is my basic explanation of the difference between liposuction and abdominoplasty. Liposuction only addresses fat while abdominoplasty gets rids of fat, skin, and tightens muscle. I hope this information is useful!

Stay tuned for post #2, “Smoking and Plastic Surgery”