Your Questions
Your Questions
Q: Dr. Eppley, I am confused about whether a just need liposuction or a tummy tuck. I am 5’ 3” and weigh 128 lbs. I have had two children but do not have stretch marks, I can only stretch my skin about an inch or two but it definitely is not loose. I have some excess belly fat which looks strange on me given how thin I am everywhere else. My stomach muscles are tight and I don’t think there is any separation in them.
A: I could not think of a better description of the indications for liposuction than in your question. A tummy tuck is needed when one can grab more than an inch or two of skin, have one or more fat rolls, and can feel that there is separation of their vertical rectus muscle in the midline. Improving any or all three of these undesired abdominal features can justify the low horizontal scar that is the necessary sequelae of any form of a tummy tuck. The lack of stretch marks is significant because that signifies that your abdominal skin still has some elasticity…a key element in the successful obtainment of smooth abdominal skin after liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what can be done to fix my muffin tops after a tummy tuck? Six months ago I had a full tummy tuck and and a new belly button made. Right after surgery I noticed these bulges above my hips. My surgeon say it was swelling and it would go away but that has not been the case. They look terrible with my now flatter tummy. When I asked what he could do about them at my last check up, he told me to exercise and do abdominal twists and they would go down. I feel like he is just avoiding my concerns and doesn’t want to deal with me anymore now that she has my money. What are your thoughts on my dilemma?
A: Abdominal contouring for many patients is not just a 180 degree proposition. The excess fat can wrap around the whole way to the back. Thus abdominal and waistline contouring should be thought of as at least a 270 degree or greater approach. A tummy tuck, even a full one, however only affects the front of the trunk and its benefits stop at the front of the hip bones. This is why flank liposuction is a part of many tummy tucks in my Indianapolis practice. If not noted before surgery and left out of the operation, one could be left with very visible muffin tops after a tummy tuck. The goods news is that it is an easily solveable problem with liposuction and those bulgy muffin tops can be turned into a very pleasing inward curve to the waistline. The bad news is that it does require further surgery but it is a much smaller operation with a very quick recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having a tummy tuck later this spring and look forward to a beach vacation this summer with my new body! My question is how soon after surgery can I begin tanning? If I have my surgery in May could I get into the ocean by July? How much time should I allow between surgery and these activities? I don’t want to do them too soon and affect my results but I know I will be anxious to do them.
A: The answer to both questions resolves around the tummy tuck scar and making sure it is healed enough to not be affected by these activities. Getting into ocean water, which will have organisms in it that do not occur in chlorinated water, should be deferred until 6 to 8 weeks after tummy tuck surgery. At this point, you should be well healed including any small areas of potential suture extrusions. The effects of tanning and sun exposure on your tummy tuck incision, however, is a much different concern. Both tanning bed and sun rays can adversely effect how the scar may eventually look so such exposure should be deferred until it is well healed for at least three months after surgery. If you must use the tanning bed, I would cover the tummy tuck scar with tape until then to block these undesired rays.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 32 year old African-American female who is in need of a serious tummy tuck. I have had three children, the last two by c-section. I have a large amount of lower stomach skin with a lot of stretch marks. It makes my belly button look odd and almost buried with the loose skin around it. If I get a tummy tuck will they be able use my c-section scar? I need a tummy tuck so bad that if I had to have a new scar above the c-section scar I could live with it. But I would like if possible to keep it low and just have a longer c-section scar.
A: This is a common question and concern and one I think about when doing a tummy tuck in every women that has a c-section scar. I always want to use the c-section scar whenever possible for two reasons. The first is the one which concerns you and that of the unsavory cosmetic issue of adding another scar to the one you already have. But a more important consideration, and the one that I am most concerned with, is the survival of the skin between the two scars if the c-section scar could not be used as part of the tummy tuck. The intervening skin between these two scars may not have a good blood supply and could either not heal well or actually die…which would obviously create a significant after surgery complication. For this reason every effort is made to use a c-section scar in a tummy tuck and if you have as much loose skin as you describe this would not be a problem to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had several children and am wanting to get my stomach back in shape. I am only 26 years old and I don’t want to live the rest of my life with this stomach. I am too young for that! My question is what will happen to my pubic area after a tummy tuck. I noticed that it got bigger after having children and I would like to see that area flatter as well. Will it be taken care of if I get a tummy tuck? Also I have love handles that I would like to get rid of as well. Will a tummy tuck get rid of those as well?
A: A tummy tuck will only solve the problems that lie within its zone of tissue excision. When looking at the markings of a tummy tuck, you will see that the love handles and the pubic area lies outside the excision zone. However, the addition of flank liposuction is a part of most tummy tucks with the recognition that the goal is an extended waistline reshaping that wraps around to the back. Pubic or mons reduction, if needed, can be incorporated as part of the tummy tuck procedure whether it is reduced with liposuction or it is lifted as part of the tummy tuck design. You can see in planning a tummy tuck that the entire area must be taken into consideration to get the best overall result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 22 year old female who is 5’6″ and weighs 165 lbs. I used to weigh 220lbs. I seem to be at a plateau for weight loss over the past year of which I am comfortable with that. But I have a remaining overhanging stomach pouch (I think it is called a pannus ??) that has not really gone away that much with the weight loss. It has gotten less full but now hangs down more. I have very large breasts and thick thighs and butt so I know I will never be tiny, but I would like my overhang gone and to have a flatter stomach area. Should I get liposuction or have a tummy tuck?
A: This is classic question posed by many patients who have some amount of a stomach overhang. By definition, the description of an overhang signifies that there is a skin excess problem as well as too much fat. Liposuction alone will only magnify the prior result of what weight loss has done, it will deflate the overhang (aka pannus) further but it will still leave a flap of skin. You need this cut off by a tummy tuck. Liposuction is only useful in your case when combined with a tummy tuck, as it may help contour the waistline better to the sides where the tummy tuck excision does not go.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am 32 years old and two years ago I weighed 220 pounds. By diet and exercise, I have been able to get down to 170 lbs and I seem to be stuck at this weight now. It won’t budge no matter what I do. The skin on my stomach is very loose and I have old stretch marks that I want removed. I want a tummy tuck but do I need to lose more weight before having surgery?
A: Your question is both a good and a common one. While many people have been successful with a fair degree of weight loss, they sooner or later ‘hit the wall’ and can just not lose anymore. Ideally, I tell my patients that if you are within 15 to 20 lbs of the weight they desire then a tummy tuck is reasonable. If you weigh much more than that then you should wait until you lose the extra weight so you do not create loose skin after surgery should you undergo more weight loss. Realistically, however, once the weight wall is hit for most people that is as far as they will usually get so that has to be taken into consideration. Most patients that I see for tummy tucks appear when they are frustrated with their ongoing lack of weight loss results. You should also understand that only the stretch marks from your belly button to you pubic hair line will be removed. Any stretch marks above the navel will still be present after surgery, they will just be moved lower to a new position below the belly button.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 28 years old and I have lost about 95 pounds over the past year and a half. While I am very happy with my weight loss, I now have.a bit of loose skin around my stomach area. I work out a lot and do a lot of core work and abdominal crunches but this loose skin won’t go away. Is there some type of cream or device that will tighten this skin or do I need plastic surgery?
A: You are to be congratulated on your weight loss efforts and results. Reduction of fat can be rewarded with diet and exercise but your loose abdominal skin will not. Skin is not metabolically responsive like fat nor can it be toned like muscle. Do not waste your money and hopes on miracles in a jar or an exercise device. Only the manufacturer will benefit from your purchase. You will need to consider some form of a tummy tuck to get rid of this loose skin and tighten your abdomen. Whether the scar and the surgery expense is worth it merits a thorough discussion with a board-certified plastic surgeon.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a big overhanging belly that I want to get rid off. I have two small children and have lost over 30 lbs since my last one but the sagging belly persists. Will exercise be enough or do you think I need a tummy tuck?
A: While I have not seen a picture of you, your description alone of your belly has already answered the question. The idea of an overhang suggests a lot of loose abdominal skin. If some weight loss has not made a difference in its size, then you know exercise is not the final answer. Undoubtably some form of a tummy tuck is what you need. You can’t exercise off loose skin no matter how hard you try. Just ask any gastric bypass patient who undergo a lot more weight loss than you have. This is a surgical problem. When it comes to exercise and weight loss, however, I would recommend that you get in the best shape as possible for a tummy tuck. Preparing for such surgery, like training for an athletic event, will have you recover faster and may also help you achieve a better result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting rid of my lower abdominal pooch. The skin has some stretch marks which become really apparent when I lean over. The wrinkly skin really sags when I do this and it is very unattractive. I am wondering if I can just exercise this area away (my husband says I can) or whether this needs liposuction to make it better. (which I think it does) What are your thoughts?
A: Many women, who are not overweight, have developed a little pooch in their lower abdomen between their belly button and their pubis. Its relatively small size suggests that it is a non-surgical problem that can be exercised away. Usually I see women who come in after they have proven to themselves that they can not get rid of it on their own. Your wrinkled skin that sags when you bend over is the key in answering the question of whether this is a surgical or non-surgical problem. This tells you that there is too much skin and it will not shrink down on its own. Excess skin most certainly can not be exercised away. The only real solution is that of some form of a tummy tuck, particularly if you are using the criteria of how it looks when you bend over. Stretch marks are a sign that the elasticity of the skin has been destroyed and no recoil or shrinkage of it can occur. Only surgical removal will solve this loose saggy skin condition.
Dr. Barry Eppley
Indianapolis, Indiana
The stomach area is the number one region that almost all women, and some men, would like to improve. Many have discovered, however, that improving that body area is not as easy as one would like. Many people work hard at it but eventually ‘hit the wall’, get frustrated and may even quit their diet and exercise routinue with no more changes are seen. But the fault may not be your own. Loose stomach skin and fatty bulges at the waistline from pregnancy or significant weight loss are not amenable to internal calorie or fat burning. This brings some to the conclusion that the only way to a more shapely torso is a surgical one.
Everyone knows that a tummy tuck is the removal of skin and fat with muscle tightening to get a flatter stomach and better waistline. While it is almost always a very satisfying procedure, and many patients say afterwards they wish they had done it sooner, it is major surgery and is not just a weekend recovery. When considering a tummy tuck, be aware of the following considerations.
There are two basic types of tummy tucks. If your excess skin and fat is mostly located below the belly button, you may do just fine with a mini tummy tuck. Because the skin and fat removal is done below the belly button, there is a shorter incision that can be placed very low and the belly button is not moved. There is also a slightly shorter recovery with emphasis on the word ‘slightly’. If the loose skin and stretch marks are above the belly button, only a full tummy tuck will do. With that comes a longer scar, a bellybutton scar and a longer recovery.
I have seen recent treatment approaches, particularly online, that tout a ‘scar-free tummy tuck’. There is no such thing and this is just marketing spin to say they are offering stomach liposuction. That raises a question that many people would like to pursue…liposuction instead of a tummy tuck for their flabby and sagging stomachs. That has become a popular request, particularly since Smartlipo (laser liposuction) technology has become available. While it is true that Smartlipo does have some skin tightening ability, it is quantitatively different than what many people need. Smartlipo tightens skin as measured in millimeters, most people need stomach skin tightening as measured in centimeters. With this understanding, it is easy to see that liposuction is not a substitute for a tummy tuck.
Liposuction, however, is very often a part of a tummy tuck. But it isn’t necessarily used to make the tummy part looking better. It is used to shape the areas outside of where the effects of the tummy tuck occur…the outer waistline and back. (i.e. muffin tops) A tummy tuck alone is a 180 degree or frontal torso change. By adding waistline and back contouring with liposuction, the results becomes more of a 270 degree torso change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am in need of an abdominal panniculectomy but my insurance has denied me saying it is cosmetic. They denied me saying it is not medically necessary because it is not preventing me from being functional. I have plenty of documentation with all my medical care providers in support of this need. What can I do?
A: The request for abdominal panniculectomies , or an amputation of overhanging abdominal skin and fat, from insurance companies is very common. As a result, they have a very specific set of criteria to be eligible for coverage. These typically include the following; a pannus that hangs down onto the thighs (photographs are required), a documented history of recurrent skin infections underneath the pannus that requires topical medications, and a six month history of these recurring skin infections that has failed non-surgical treatments.
If a proper predetermination has been done and the insurance company has denied it, then there is nothing you can do. You are legally entitled to an appeal of which they tell you how to do it on their denial paperwork. But once an appeal has been denied then that debate is over. The insurance company controls what they will pay for or won’t pay for. Their determination is based on their policy requirements and the determination of their medical director. They obviously have determined, no matter how unfair you think it may be, that your abdominal pannus does not qualify. Your only option is to have the procedure done on a cosmetic fee basis.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I’m 46 years old. I have a spare tire around my middle. I don’t want to lose weight because I end up losing my breast and butt. What procedure do you recommend?
A: When someone has a ‘spare tire’ around their middle, they could be referring to two basic types of waistline problems. The first would be fat only. They have thickness around the middle and waistline due to a fat collection but there is no loose or overhanging skin. The other problem is one in which there is both too much fat but with excess skin as well. Each requires a different solution. The fat only problem is treated by liposuction of which Smartlipo (laser liposuction) is my current choice. For a fat and skin problem, a tummy tuck or an abdominoplasty is needed. Often liposuction must be added to the tummy tuck to get those muffin tops which wrap around the sides of the waistline into the back.
You are correct in assuming that some surgical intervention is needed if you are not willing to try some weight loss efforts. Such ’spot’ body contouring changes require surgical treatrment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I saw a tummy operation on a TV show the other day that got me reallly excited. It was a new operation called the Smooth Tuck. It was a impler way of doing a tummy tuck because no muscle repair is done and it uses a much smaller scar above the bikini line. The recovery is only one week. This sounds great! I was scheduled to have a full tummy tuck and I was dreading it. This sounds so much better. Do you think I should have this tummy procedure done instead? Is it too good to be true?
A: While I have no idea what your tummy problem is or looks like, I can make a predictive statement that it is too good to be true. The Smooth Tuck is nothing more than a mini-tummy tuck wrapped up with a slick sounding name. Whether the smooth refers to how your tummy will look after or what it is like to go through and recover from is unknown to me. And I am not saying that it is a bad operation. The key question is whether this is an operation for you. Does the solution it can provide match the size of your problem? If you are better suited to a full tummy tuck, then this lesser operation will leave you disappointed no matter how smooth it sounds. There are some tummy tuck patients who are ideally suited for this approach but it is usually only a minority of them. You understandably are interested in something that sounds easier than the traditional tummy tuck approach. Just be certain that the real limitations of this marketed operation do not leave you with the opposite of your desired result…an unsmooth tummy that should have had a different tummy tuck technique done.
Dr. Barry Eppley
Indianapolis Indiana
Q: I had a tummy tuck recently and as part of it my muscles were sewn back together. I was told there were several inches apart. My tummy now is very flat in the lower half but the upepr half still has somewhat of a bulge. Do you think that is because the muscles weren’t sewn up togethere this high. I am confused as I thought the whole tummy would be flat from top to bottom. What are your thoughts?
A: The purpose of sewing the vertically-oriented rectus muscles in a tummy tuck together is to help correct one part of the tummy bulging problem. How much tummy skin and fat you have makes up the other components of the bulge. This muscle sewing is usually done from just under the rib cage in the middle (top of the inverted V) the whole way down to the just above the pubic bone. But it is up to the plastic surgeon’s discretion as to whether it is beneficial to cover this entire vertical length or not. More pain after surgery comes from more muscle sewing so there is no reason to do more than is really needed. Not every patient needs the entire vertical length of the muscles swen together as tight as possible.
It is extremely common to see a different amount of improvement in the tummy bulge from that above the belly button to that below it.. The best result is seen between the belly button and the pubis because this is where the skin and fat have been completely removed and replaced with skin and fat from above. Between the rib cage and the belly button, there still may be some remaining bulge as this skin has just been pulled down and stretched but not removed. That is likely the reason you have some bulge remaining in this area, not because the muscle hasn’t been sewn back together. In thin women, this issue may not appear. But in those patients that had thicker amounts of fat under the skin in the upper abdominal area to begin with, the upper tummy area will not be as flat as the lower. This can be improved later with some liposuction to thin out the tissue thickness in this upper tummy area.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am a 35 year-old mother of four who is tired of my stomach hanging over my pants. I need some type of surgery to help shape up my stomach area. I don’t know whether it should be just liposuction or some form of a tummy tuck. The main reason I want this surgery is that no matter how hard I work out or diet, it just won’t go away. I’ve got a very persistent pooch and it really needs to just go away! Which do you think is better, liposuction or a tummy tuck?
A: While an actual examination with a plastic surgeon is the only way to know for sure, there are several key statements in your inquiry that give it away. The mixture of having had four children and a stomach that hangs over your pants indicates one key thing…you have too much stomach skin.While there no doubt is some fat under there as well, the key indicator of the choice between liposuction and a tummy tuck is how much extra skin is there. Liposuction can effectively remove fat but it has little skin tightening capability. A tummy tuck very specifically addresses the excess skin issue that exists from one hip to the other. Liposuction is quite often part of many tummy tucks in a complementary role as it helps reduce the muffin tops that most people have off to the sides of the tummy tuck. The combination of a tummy tuck and hip/flank liposuction creates a better waistline result that wraps around to the back.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have had two babies in three years and have lost nearly 50 lbs through an aggressive diet and execise program. While I have defnitely seen some body changes, I am not happy with the way my breasts and stomach look. I thought with all of this working out that my stomach would look better. I have loose skin and stretch amrks around my belly buttonm and my breasts droop and are floppy. I have read about a plastic surgery procedure called the Mommy Makeover. What is sone in this procedure and can it be done all in one surgery. I am worried about recovery time and getting back into the gym for my workouts. Thanks!
A: The Mommy Makeover has become a popular plastic surgery procedure amongst mothers between the ages of around 25 to 45, although it can be done at any age. It has gotten this catchy name because the procedures involved help reverse the effects that pregnancy has ravaged on a woman’s body. These procedures have been commonly done for many decades so they are not new. They have just been put together and ‘packaged’ for this specific set of female body problems, that being the breasts and the stomach areas. Breasts frequently have lost volume (deflated) and sag and the tummy has loose skin and stretch marks. The combination of breast reshaping (implants with or without a lift) and some form of a tummy tuck (with or without liposuction) is the backbone of a Mommy Makeover. They are almost always done together if a patient’s economics permits. While this combination of a breast augmentation and tummy tuck will have a dramatic change on one’s body, you must tone down the concern about getting back to working out as soon as possible. This is a setup for after surgery problems. It is understandable that you have an addiction to working out as you would not have gotten this far without doing so. But that same addiction, which you think is good, is not so good after this kind of surgery. You must mentally plan on 6 weeks before getting back to working out like you are now. Remember that in a span of a few hours you are going to make changes that you can’t do by working out for the rest of your life. The risk is not worth it for a few extra workouts that, in the big picture, will gain you nothing.
Dr. Barry Eppley
Indianapolis Indiana
Q: I came across your website, while doing research on cosmetic surgery. I currently have depression. After three pregnancies, I feel like my body is mangled. I know that my self-image is what brings on most of my depression. I know that depression alone is not a reason to have surgery. I have been treated for depression for about three years now. I have thought about cosmetic surgery just as long. After the pregnancies and losing weight, gaining weight, and losing weight, my belly definitely needs a tuck. I breastfed all of my children. I breastfed only for about 2 months with the first child but about a year with the last child. With breastfeeding and losing weight; I barely have any breasts at all.
I am only 28 years old. I want to feel young and beautiful again! I know I deserve to and my husband deserves to have a wife who feels good about herself again. My kids deserve a mother that feels comfortable enough to take them swimming. I would love to be able to eventually wear a bikini.
I know that some people may get depressed after they have surgery; whose to know how I will be after surgery. Seeing that a lot of the causes of my depression are due to the way I feel about myself or view my body. I know surgery could not make my depression worse; if anything it will help improve the way I see myself and think about my body. The only way surgery would worsen my depression is if I had surgery by a surgeon who did a lousy job.
I am not interested in looking fake. I just want to look normal again. I would like to either be a full C or small D regarding my breast.
I suppose a ‘Mommy Makeover’ is what I am really looking for. What are your thoughts?
A: Of your situation and feelings, I understand completely and could not be more emphatic. Pregnancies can definitely take a toll on your body, and between the skin stretching and shrinking and the inevitable breast involution (loss of breast tissue), some women can not even recognize the current skin and body that they now have.
As you have correctly pointed out, surgery is not a cure for depression. But at least it can improve one recognizeable and understandable cause of it…the way one looks. The body problems can definitely be improved and, hopefully with that, one’s self-image elevates. In my experience with women and these type of popular ‘Mommy Makeovers’, patient do report a dramatic improvement in their self-confidence and clothing options.
The classic ‘Mommy Makeover’ is some form of combined abdominal and breast rehaping plastic surgery procedures. This is usually a tummy tuck with or without liposuction and breast implants with or without a lift. In about a four hour surgery (or less), a dramatic body transformation can occur.
Dr. Barry Eppley
Indianapolis Indiana
Q:Hello, I am 58 years old and I had a full hysterectomy in May and then another surgery a few weeks later when all my stitches ripped out and I totally opened up. My son is in Afganistan (fourth time) as well as my daughter in law. I also served in the Navy years ago. Anyway, as I cannot afford the smart lipo on my abdomen (upper and lower) presently, I was wondering how much of a discount the patriot plan saves on this procedure and how long will this promotion go on? Also, does the skin actually tighten up and not sag? This email is just a question about the future possibilities and any information you can give me would be appreciated. I really want to get rid of my stomach and maybe next year I would be able to afford it. Thanks for your time – I appreciate it.
A: Thank you for your inquiry. The general discount in the Patriot program averages around 25% off the full procedure and the program continues without any deadline. What type of procedure is best for your stomach area, however, remains unclear based on your description. My concern is that the description of your problem sounds more like some form of a tummy tuck than that of Smartlipo. If there is any substantial skin excess, then no form of stomach liposuction is the way to go. One of the great misconceptions about Smartlipo is that it is a great skin tightening method. It is not and is highly overpromoted that way. While it does have some skin tightening ability, it will tighten inches of loose abdominal skin which many people that come in for it have. Between a hysterectomy and its after surgery problem, multiple pregnancies and your age, I suspect that the skin issue is beyond what Smartlipo can improve. A tummy tuck in some form is likely more appropriate for your problem.
Feel free to send me a picture of your stomach and I can answer that question very quickly.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hello, I have several questions regarding cosmetic surgery. First off I want to say I am a single mom of four wonderful children but they have destroyed my once nice looking tummy. But I HATE how I look. I have suffered an eating disorder since my first child being born, to the point I was approx. 90 lbs and I am 5′ 5″. I still do not eat right as I am petrified that I am going to gain weight and make my stomach even bigger. I am also a full time student so I know I cannot afford surgery. There is simply no way. Is there ANYTHING I can do? I hate the way I look, I hate to take showers, I hate to be seen by my fiance naked!!! I literally HATE my body. I currently weigh 135 lbs. So I have done very well maintaining weight. I am at a loss as to how can I rid myself of this awful belly? Please help!!
A: Unfortunately, the short answer is that only surgery can offer any help. After multiple pregnancies, your abdominal wall has been irreversibly changed. The abdominal muscles are no doubt separated along the midline and are lax which accounts for the protruding appearance of your belly despite being at a good body weight. In addition, the overlying skin has been stretched beyond its elastic limit as evidenced by stretch marks. All you can do with your weight is keep the fat layer thin but that will not change your skin and muscle of the abdominal wall. Perhaps one day you will be able to have the tummy tuck surgery that can provide the solution that you are looking for.
Dr. Barry Eppley
Indianapolis, Indiana
Q:I have had a c section with my son and I have no feeling toward the bottom of my belly. I have lost 52 pounds but still over weight. I am so frustrated but I think the only thing that will work is plastic surgery. Based on my readings, it looks like liposuction and a tummy tuck will do the trick. What has been your experience with the amount of improvement that thees two procedures can do?
A: Your question is a bit of a loaded one but the answer is in most cases very well. In fact so well for some people that it can be considered a ‘waistline’ miracle. This may seem a bit of an overstatement but for many tummy tuck patients it is not. The sheer removal of a full-thickness piece of skin and fat (either above or below the belly button) does something that no diet and exercise program ever could for someone who has lost a lot of weight. (50 lbs count as a lot!) When this skin and fat removal is combined with liposuction around the waistline and into the back, significant mid-trunk reshaping is done.
Already having a C-section scar (with numbness) and the extra skin created by your weight loss makes the consideration of a tummy tuck a fairly easy one as there are no viable alternatives. It is hard to predict how many inches may be lost around your waistline but it is fair to say at least 2 to 3 inches and maybe more. As impressive as the frontal change may be, I am always excited to help create the narrowing of the waistline by aggressive flank and back liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have had 2 c-sections and they were emergency so they cut me the “old” way- and my abs have never recovered. So my main question would be, what areas will show the differences of before and after? It seems like I currently have 2 “tubes” around my belly. The top where my abs used to be (and even when I have lost a lot of weight still seemed to appear puffy) and then my belly button kind of creates a line that goes into the bottom innertube. The idea of a tummy tuck in my head will smooth everything down so I would not have these 2 rolls of fat around my waist as well as the fat that is on my back. Does that sound right?
A: I think you have hit the general concept right on the head. You are right for two specific reasons. First, to get rid of what is not desired between your belly button and the pubic region, it has to be cut out. That is the definition of a full tummy tuck, a horizontal excision of skin and fat that goes just above the belly button. Secondly, the only way to unravel the excess tissue around the belly button is to allow the skin and fat above it to be stretched down over it, again the definition of a full tummy tuck. The only concept you have in error is the rolls of fat along your waistline and into your back. A tummy tuck will not remove those, only liposuction will. That is why most tummy tucks incorporate liposuction into the flanks area as well to avoid the dreaded ‘muffin tops’ afterwards if it is not done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am a 31yr old mother of two kids. I got out of a five year relationship where I got too comfortable and gained a lot of weight. About six months ago I started working out and lost over 30lbs along with a strict diet. I still have about 25lbs to go to reach my goal weight but I know that dieting alone will not give me the final results I want. I am interested in a tummy tuck, a monsplasty, and breast augmentation. I was born with one breast about 1 cup size bigger. I would like them to be equal in size along with a lift. Can all of these procedures be done in a single operation?
A: Congratulations on the results you have obtained so far. It is always surprising what effort and discipline can do for one’s weight. You should be proud that you have gotten this far. In pursuit of your goal weight, think of the plastic surgery as an incentive to get there.
The first step in body contouring is weight loss but this alone is often not enough to get the shape that one wants. There is no better combination than a combined breast and abdominal procedure to change a woman’s appearance between the shoulders and the waistline. In a few hours of surgery, some dramatic changes can be obtained. Putting these two operations together is very common and I have done it many times in my Indianapolis plastic surgery practice. Breast enhancement and tummy tucks together can still be done as an outpatient procedure.
Many larger tummy tucks require reduction of a large mons at the same time. It is done as part of the tummy tuck by modifying the location and orientation of the lower incision. Complete mons reduction may still require a secondary liposuction procedure for optimal flattening. Breast enhancement in most significant weight loss patients requires a combined lift with an implant, known as an augmentation mastopexy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi, I am in the military and am unable to make tape or weigh ins. I had two c-sections and my stomach looks like I am still pregnant. I am also having trouble passing my sit ups. I will not be able to be promoted until I am able to make at least tape and pass my fitness test. I have tried everything to lose the weight from my tummy but I haven’t had any luck. Not even basic training has helped slim my tummy. I am desperate to do something and I think a tummy tuck may be the only answer. How long does it take to recover from this procedure?
A: This is a tummy story that I have heard quite often in my Indianapolis plastic surgery practice. Women often come in for a tummy tuck (abdominoplasty) when they have exhausted all of the conventional options for trying to make it look better. Most women do view a tummy tuck as a last ditch effort.
When you have suffered the ravages of pregnancy, no amount of dieting or exercise will improve stretch out loose skin and muscles. The protruding floppy stomach is not just a ‘fat’ problem. It is tissues that have been irreversibly damaged. While I think it is prudent to get in the best shape as possible before undergoing a tummy tuck, those efforts will not repair the tissue damage which exists.
While a tummy tuck is a wonderful body shaping operation, it should be considered major surgery. With major surgery comes a significant recovery. While recovery can be defined different ways, complete recovery that would allow one to perform strenuous activities will take six weeks for most people.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in getting a tummy tuck. I have had two children and do not want any more. I can not get rid of this lower stomach pouch no matter what I do. A tummy tuck would do the trick but I am concerned about the scar. I am Hispanic and I am afraid I might scar badly. My c-section scar looks great so I seem to scar well. Will my tummy tuck scar look the same? I know it will be longer but will it look so fine and narrow?
A: While there are many factors that influence how a scar will ultimately look, one of the most important is that of tension. How tight is the wound on closure. A wound closed under tension will usually develop a scar that is somewhat wider than one that is not.
The concept of wound tension is what differentiates the c-section vs an abdominoplasty scar. C-sections are closed under absolutely no tension. They literally fall together loosely because of the expanded abdominal skin. This is why they usually look so good no matter how or by whom they were closed. A tummy tuck, however, is quite a different story. It is closed under considerable tension and requires the closure skills and training of a plastic surgeon to get a scar that may approximate that of a c-section. A good c-section scar is not necessarily a good predictor of what a tummy tuck may look like.
While scar outcomes are not always predictable, darker pigmented skin may widen and hyperpigment more than skin with less pigment. This is the risk of an abdominoplasty scar in one of Hispanic origin. Always remember that a tummy tuck is a trade-off, getting rid of that loose skin and fat with a better waistline for a scar. A scar is still an imperfection but, hopefully, one that is more tolerable.
Dr. Barry Eppley
Q : I have a stomach pouch that I just can’t stand. After my third child, I just could not get rid of this loose skin and fat that hangs below my belly button. Despite really watching what I eat and trying to exercise more, it won’t come off. It hasn’t budged at all in the past year. I think I may need some type of a tummy tuck. What is the difference between a mini- and a full tummy tuck?
A: Any form of a tummy tuck, also known as an abdominoplasty, removes skin and fat as well as tightens the rectus muscles. The removal of skin and the muscle tightening is what separates it from a liposuction procedure.
Most types of tummy tucks are horizontal full-thickness excisions of skin and fat down to the abdominal muscle wall. The difference between a mini- and a full tummy tuck is in the amount and location of this cut out. A mini-tummy tuck performs it below the belly button while a full tummy tuck goes above the belly button. As a result, the full tummy tuck has a longer final scar as well as a circumferential scar around the ‘new’ belly button. The mini-tummy tuck just has a less long low horizontal scar only.
A patient’s decision between a mini- and full tummy tuck must consider a variety of factors. How long a scar can one tolerate? How much loose skin and fat does one have? Is there loose and creapy skin around the belly button? Are there any rolls of skin above the belly button? How flat does one want the stomach area to be?
The simplistic answer to deciding between a mini- and full tummy tuck is what the stomach looks like above the belly button. Only a full tummy tuck can smooth out loose skin and fat above that central abdominal marker.
Dr. Barry Eppley