In cases where a large amount of excess skin is present in the form of folds, liposuction alone will not give satisfactory results. The excessive skin must be removed along an incision which is usually located within a bathing suit line at the level of a crease. Stretch marks may be improved, but can never be entirely eliminated.



Some of the above noted conditions (surgeries such as Cesarean sections, pregnancy related weight gain, for instance) not only stretch the abdomen, but can also result in ruptures or hernias. In addition, the fat-containing organ inside the abdomen (called the omentum) can become enlarged, adding to the protuberance.

Although weight control through diet and exercise is most important, many structural changes cannot be corrected through any method other than surgery. Stretching and widening of the diastasis recti (separation of abdominal muscles); abdominal hernias; scar retraction from previous surgery; isolated, unyielding collections of fatty tissue; and stretched, excess skin require surgery for satisfactory resolution.

Often the presence of these entities causes embarrassment and emotional distress. In addition,, physical problems such as pain, rashes under the skin folds, inability to wear supportive clothing, danger of further rupture during pregnancy, discomfort or the inability to perform exercise, etc., may be present.

Abdominal, thigh and buttocks procedures are usually performed separately for two reasons. First, few people require more than one type of surgery and second, these operations may vary from relatively simple skin tightening to extensive skin and hernia repairs. These procedures are performed under general anesthesia with the addition of a long-acting local anesthetic for postoperative comfort and are followed by several days of recovery care. Each of these operations consists of several steps. One or all may be performed in order to achieve the best results, with surgery lasting from one and one half to three hours.

Many patients now have an alternative to the classic tummy tuck - the modified tuck. With the modified procedure, a smaller incision is made in the abdomen than the traditional tuck. This incision often is compared in size to a C-section incision which heals with a bikini line scar. Even with the small incision, fat can still be removed, skin tightened and muscles sutured.

These surgeries are used to correct extensive tissue laxity or excesses. Whenever feasible, simpler means should be tried first. Additionally, the patient considering surgery should be in general good health and weight should be reasonable. The surgery is not a weight control measure though it may be helpful after a large amount of weight is lost and residual sagging skin remains. He or she should not smoke and should be on some type of exercise program. (Running or walking is recommended) The time and expense involved in recovery must also be considered.

Of greatest importance is the trade-off of excessive laxity and tissue for resultant scars which are rarely terrible, but never fully inconspicuous. Due to the location and the degree of tension of the incision line, a certain degree of scar fullness or thickness may result as well as numbness, itching and swelling. Most of these, however, resolve with time.