The tummy tuck, otherwise known as an abdominoplasty, is a surgical technique used to improve the appearance of the abdomen or belly. It is not the intent of this article to describe the alternatives between abdominoplasties and liposuction, this we will do in another article. Rather our goal is to describe the many options available for patients considering a tummy tuck.

Many changes to the abdomen can, may, or will occur, as a patient gets older. Three basic components change: the laxity or looseness of the skin, the protrusion or bulging of the muscular wall of the abdomen below the skin, and the quantity and distribution of fat.

The key component in choosing a body contouring procedure is the surgeon analyzing what condition the patient has, and assessing what the patient’s goals are. Lets first consider fat distribution. With most abdominoplasty procedures, some liposuction is performed. It is not just enough to flatten the abdomen, the torso must be contoured. This usually requires some liposuction being performed on the flanks and the hips. The surgeon must be very careful where the liposuction is performed because suctioning in regions where the skin is going to be pulled tight can cause poor healing and even death of some skin regions. Skillful, meticulous suctioning of the subcutaneous fat will help bring in the waistline and contour the hips so that they match the newly shaped abdomen.

The muscle wall also needs to be carefully evaluated. If there is bulging of the muscle wall, the plastic surgeon can tighten appropriate areas in order to flatten it. Some patients have a bulging of the lower abdomen. This is common. However, others have a bulging of the muscle wall throughout the abdomen. It is not actually the muscle that is tightened, but the outer covering to the muscles that is called the fascia. Many patients try and do abdominal exercises to flatten their "abs". This will get the muscles stronger and perhaps larger, however, this does not tighten the critical fascia that has become stretched out. The "muscle plication" performed as a component of the abdominoplasty is a key component in creating a flatter belly.

Aging, pregnancy, weight loss or weight gain, and environmental effects such as smoking will change the elasticity and laxity of the abdomen’s skin. The skin can loosen either in just the lower abdomen, it may loosen only in the upper abdomen, or it can loosen throughout the abdomen. Where the skin has become lax and the quantity of laxity, determines our surgical approach. Abdominoplasty incisions for skin laxity vary significantly. In fact, we perform 5 differently located incisions based on the problem.

The endoscopic abdominoplasty uses the smallest incision, slightly shorter than a c-section scar and located in the same place. The procedure is only used in patients who have no skin laxity. Through this incision, liposuction and muscle plication is performed.

The mini-abdominoplasty procedure uses an incision a little bit longer than a c-section scar and enables us to remove small amounts of laxity of the lower abdomen.

A full abdominoplasty scar also lies low in the torso’s natural skin creases but extends to the hips. It allows the surgeon to remove the skin from where a c-section scar would be located to above the umbilicus (belly button). This produces tightening of both the lower and upper abdominal skin.

A reverse abdominoplasty incision is located under the breasts. There are some patients who only have skin laxity in the upper portion of the abdomen. This incision is ideal for this patient.

Finally the last incision occasionally used is the vertical midline incision. It may be used in patients who have had an extreme amount of weight loss and have significant laxity or in the rare patient who only has significant stretch marks located centrally around the umbilicus but these extend both above and below the belly button.

Understanding the options is critical and choosing the right operation. You want to be happy with your results and know what to expect.