Robert Langdon, MD
The Langdon Center for Laser and Cosmetic Surgery
In the great majority of cases liposuction should be done before abdominoplasty (tummy tuck) is considered. In most cases, properly performed liposuction of the abdomen will provide satisfactory results such that abdominoplasty is not necessary.
In the abdomen, subcutaneous fat tends to be most prominent in the lower abdomen but in most cases is also significant in the upper abdomen. If thorough liposuction is performed in the lower abdomen, there will be significant post-operative contraction of the skin. Skin that has developed stretch marks may require laser-assisted liposuction (such as ProLipo laser or SlimLipo laser) to further enhance post-operative skin contraction; the laser procedure is performed at the same time as liposuction.
Even when abdominoplasty is a consideration, in nearly all cases liposuction is also necessary. Although properly performed tumescent liposuction is nearly 100% safe and free of serious complications, abdominoplasty carries much more significant risks, especially when done using general anesthesia. Even more hazardous is combining abdominoplasty with liposuction. This combination has accounted for most of the serious complications that have occurred following liposuction. Because liposuction is very likely to provide satisfactory improvement all by itself, it is a smart choice to first undergo liposuction before even considering abdominoplasty.
Another major disadvantage of abdominoplasty is the significant scarring that results from this procedure. Unlike areas such as the face where incisions for a facelift can be obscured and are not noticeable to onlookers, abdominoplasty nearly always produces significant and unsightly scarring. The skin in the lower abdomen is very prone to scars that spread or develop an uneven contour or color. Almost all patients who undergo abdominal surgery (such as removal of an appendix or gallbladder, or a hysterectomy), will develop significant and obvious scarring. This type of scarring is routine after abdominoplasty and is generally not acceptable for a purely cosmetic procedure. In contrast, liposuction performed with micro-cannulas produces virtually no visible scarring.
Because properly performed liposuction is very likely to provide satisfactory results in patients with excess fat (especially in the lower abdomen), and even in those with loose overlying skin, it makes sense always to proceed first with liposuction. In all likelihood a tummy tuck will not even be necessary and the patient will avoid the unsightly scarring that results from abdominoplasty.
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