Making your bed

Tummy Tuck, Lipo or Coolsculpting?

Pregnancy can be devastating to the abdominal region. I often use the ‘making your bed’ analogy to describe the surgical options. When you wake up in the morning your bed sheets are messy. How do you make your bed ? Do you pat the bed down and just quickly straighten it out ? Or do you separate all the sheets and lay them down one layer at a time ? I would guess that the if you separate all the layers and make your bed properly, it looks the best. Simply patting down the bed sheets leaves lumps and bumps and often does not look as good. This is often the case with coolsculpting or liposuctioning of the abdomen that has gone through previous pregnancy

A surgeon has to recognize 3 post pregnancy issues when it comes to the abdominal wall. The muscle stretch (diastasis recti), the skin stretch (loss of skin elasticity), and change in the distribution of fat in the abdominal wall. Everyone understands the first two, but the third issue is just as important to keep in consideration. Because there is a change in the fat distribution, liposuction alone may not be the best option and often is the worst option. The skin often times does not redrape on the abdominal wall as nicely. Failure to recognize this leads to poor outcome from liposuction. This is equivalent to patting down the bed sheets.

The photos attached illustrates this issue.  The patient shown underwent liposuction alone as a first procedure years before seeing us.  It left her with ‘lumpy’ contour of her abdomen, for which she was unhappy.  Based on this, this patient was likely NOT a good candidate for liposuction alone.   The second photo shows her after a tummy tuck.  Clearly there is improved contour and the irregularities have been addressed.

The change in fat distribution after pregnancy makes the outcome from liposuction less predictable. This is something that we surgeons try to recognize at the time of the consultation.  In some cases, patients who are not ready for tummy tuck, I often tell them they are better off with the poorly distributed fat.  When patients come to the consultation, I review all these options with them.