Christopher Chung, M.D.
American Board of Plastic Surgery
Chief Medical Officer
Sono Bello

When a patient is seen in consultation for aesthetic abdominal surgery, there is commonly some confusion as to which procedure will best achieve optimal results: liposuction vs. tummy tuck.

Generally, the two can be separated by the responsible tissues that cause the aesthetic abdominal deformity: skin, fat or muscle.  So as with most procedures, the consult starts with a discussion of what exists (often times, it’s a combination of the three but with varying expressivity).  Once this is identified, a tailored treatment plan can be established to achieve the patient’s goal.

When a surgeon examines an abdomen in prep for a recommendation of how to proceed with the body sculpting project, he/she sees evidence of massive weight loss (bypass or band), number of pregnancies, multiple pregnancy (twins), hernias, loss of skin elasticity (stretch marks), in addition to the compartmentalized deposition of fat in the upper abdomen, lower abdomen, waist, pubis. This is what we call the Aesthetic Diagnosis.

Once these features are documented they should be aligned with the patient’s aspirations, aka, expectations. That can sometimes be a difficult process, however, it is best accomplished by distilling the project down to the issues that are creating the less than desired abdominal contour. Once patients understand this process, they start to truly understand the advantages and limitations of liposuction vs tummy tuck procedures.

Tummy Tuck (Abdominoplasty):

Abdominoplasty is a two-dimensional procedure where the skin is removed from the lower abdomen, a wide incision is made in the lower abdominal crease from hip to hip and around the umbilicus to allow for the advancement of the skin of the abdomen toward the umbilicus, the removal of the excess SKIN and the tightening of the entire abdomen in one dimension, vertical.

• Anesthesia:  a full abdominoplasty as described above requires general anesthesia
• Complications:  infection, hematoma, skin necrosis, serum Scar hypertrophy or keloid.

Liposuction (Lipocontouring):

Since we are truly contouring all features of the Abdominal aesthetic unit in a three-dimensional approach to the shape of the abdomen and leaving the skin to follow the lead of the new and improved contour other in those cases that demonstrate too much excess skin. Most patients who are not happy about their abdomens have contour and not skin issues.  This fact explains the fact the lipocontouring is the second most common aesthetic surgical procedure in the US. Sono Bello is the premier center for the delivery of the state of the art techniques in lipocontouring.  The meticulous medical oversight and the sheer number of cases have made Sono Bello the go. Patients seeking lipocontouring are in all age groups.  Abdominoplasty patients are limited generally to the baby makeover, massive weight loss, of intense cardio weight loss groups.

Abdominal lipocontouring is rewarding in:

• Men who work out and cannot get rid of circumumbilical fat.
• Women who cannot get rid of lower abdominal fat after having babies but with young resilient skin that does not need to be excised to achieve contour improvements.
• Post-menopausal women who cannot selectively de-fat their abdomens due to “middle age” hormone distribution of fat
• Patients with surgical scars where fat deposits in bulging patterns around the scars
• Patients that due to their genetics deposit out of their fat in their abdomens despite diet and exercise programs

Abdominal Lipocontouring:

• Rare complications:  seroma, hematoma, infection but eat of less significance than in an abdominoplasty since a large flap is not created
• Insignificant well-placed Scars*
• Three-dimensional improvement and contouring
• Removes fat cell populations that will not selectively store fat in these areas thus actually defying genetics/gender propensity of fat deposition: for instance, the 40-year-old woman who has contouring will NOT develop the typical shape in the abdomen of the 60-year-old woman since we have proactively removed fat cells to preclude selective deposition later.

Local Anesthesia:

• Rapid recovery
• Thus, the artistic opportunity for the plastic surgeon is global with lipocontouring and one dimensional for the abdominoplasty. Abdominoplasty is actually the operation of choice when skin is the only issue.
• LipoContouring is used to contour the entire abdominal aesthetic unit from rib cage to pubis and sometimes beyond into the waist and pubis is necessary to create optimal shape.