The skin and muscles of the abdominal wall can be stretched during pregnancy or excessive weight gain or loss. Over time, the skin loses its natural elasticity as it has been stretched beyond the point that it can naturally recover. This leaves loose skin and fat which can cause difficulty with clothing and may look unattractive. The abdominal muscles can become stretched or separated, further adding to a lack of tone. Lower back pain and lack of core strength are commonly associated with this. 


Exercise and diet can help to reverse these changes to some extent but in many people, it is difficult to get back into the shape. In these instances, surgery may be helpful to tighten the muscles and remove the excess skin.


The important thing to remember about abdominoplasty is that it is not about weight loss; it is about altering the skin and muscles to produce a firmer look and feel. 


What is abdominoplasty?

Abdominoplasty, or ‘tummy tuck’, is an aesthetic procedure performed to improve the shape and contour of the abdomen. The operation is undertaken to remove excess skin, stretch marks, and fat, and it can tighten the underlying abdominal wall muscles. It offers improved contouring, core strength and appearance.


Combining the abdominoplasty with liposuction to the waistline can enhance its effectiveness for some patients.


Who is a good candidate for abdominoplasty?

A tummy tuck is a highly individualised procedure. The common reasons for considering a tummy tuck are:


  • Extra skin on the abdomen and abdominal muscle weakness due to ageing, pregnancy, weight fluctuations
  • Sweating and dermatitis under the fold of excess skin
  • Difficulty participating in sport
  • Self-consciousness due to the appearance of the abdomen
  • Weakness of the abdominal wall muscles which creates a bulge when straining or lifting


What are the limitations of abdominoplasty?

  • Obese patients often have excessive fatty tissue within the abdominal cavity, which is behind the abdominal muscles. This cannot be removed by a conventional tummy tuck
  • The scar of a tummy tuck is designed to lie low, so it will be hidden behind underwear. However, the scar may not be perfectly even
  • A tummy tuck cannot correct stretch marks, although these may be removed if they are located on the areas of excess skin that will be excised
  • Internal or external scars from any previous abdominal surgery may also affect the candidacy


Where will the incisions be? 

The incision for a full abdominoplasty usually runs above the pubic hairline, from hipbone to hipbone. The shape and length of the incision is determined based on the amount of correction needed. There may also be an incision around the navel.


Are all abdominoplasty procedures the same? 

There are a variety of different abdominoplasty procedures depending on the age and specific circumstances. These include: 



Typically, liposuction is suitable for patients without stretch marks who have goodquality elastic skin and whose main problem is an excess of fat. Often patients have what might be termed a ‘pot belly’ — a slight excess of fat in the lower tummy. 


Mini abdominoplasty

A mini-tummy tuck is usually recommended for those who have always been in fairly good shape but cannot achieve their aesthetic goals with diet and exercise, who have a slight excess of skin and fat, especially below the belly-button.


Full abdominoplasty

In patients with a greater degree of slackness, excess skin, excess fat and splaying of the muscles, a classic tummy tuck may be required. An incision is made from hip to hip, and around the belly button. 


Some additional areas may be treated with liposuction and the muscles above and below the belly-button are tightened. Although this operation leaves the biggest scar, it provides the greatest degree of improvement in shape. 


Extended abdominoplasty 

In cases of extreme weight loss, it may be more appropriate remove more tissue than is usual in a full abdominoplasty. If the incision extends around the hip to improve the contour of this area, it is termed an extended abdominoplasty.


Reverse abdominoplasty

Instead of having a scar at the bottom of the abdomen, the scar is placed to lie under the breast crease and between the breasts. This operation is usually only performed in particular situations, for example after someone has already had a traditional abdominoplasty but still has a degree of upper abdominal skin and fat excess. 


How long does the effect of abdominoplasty last?

Although the results of a tummy tuck are technically permanent, the positive outcome can be diminished by significant fluctuations in weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone a tummy tuck.


Abdominoplasty will not prevent the effects of normal ageing. Once the skin is tightened, it will get looser with ageing. 


What are the complications of abdominoplasty?

In general, abdominoplasty is safe, and the results are entirely predictable, with an associated high degree of patient satisfaction. Nevertheless, no surgery is without risk. 


Words — Dr. Katarzyna Mackenzie, Plastic Surgeon