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Plastic surgery patients frequently seek help to improve the contour of the abdominal area. Common concerns voiced by patients include protuberant (protruding) stomach, loose skin, poorly fitting clothes, limitations to activity, and skin rashes.

There is no single body contouring procedure that is best for every patient. Plastic surgeons customize the procedure to fit the particular anatomy of each patient. Although patients have similar problems related to abdominal anatomy, there is large variation in anatomy. The anatomy and fat distribution is also very different in men and women.

A common question asked by patients seeking improvement is, “Do I need a tummy tuck or liposuction?” In other words, there is a difference in the two procedures, and there are advantages and disadvantages with both procedures. In the simplest terms, liposuction removes only fat, and tummy tuck surgery (abdominoplasty) removes fat and skin. Many different variations and hybrids of these procedures have been described in order to provide the best “fit” for individual patient needs.

In general terms, patients seeking improvement of the abdomen fall into three categories. First is the patient that is a good candidate for liposuction. This group of patients typically have minimal or no redundant (extra) skin, good to excellent skin texture, good muscle tone, and good to excellent fascia (muscle covering). They typically have normal or near normal body weight (not obese). This group of patients are usually nulliparous (have never had children). These patients are usually not good candidates for abdominoplasty.

The second is the patient that is a good candidate for a tummy tuck. This group of patients have redundant fat and skin. They typically have compromised skin tone, compromised muscle tone, and compromised fascia tone. They may or may not be overweight. Patients that have had children commonly have this body type. These patients are not good candidates for liposuction alone of the abdomen.

The third category of patients falls into a “gray area,” meaning that the patient is a reasonable candidate for liposuction and a reasonable candidate for tummy tuck surgery but is not a great candidate for either procedure. This type of patient has some extra fat and some extra skin.

In this category of patient, choosing either procedure is reasonable depending upon the goals of the patient. For example, a patient may be averse to the scarring associated with abdominoplasty and will therefore choose liposuction over a tummy tuck. Another patient may want to have excess skin removed and will choose a tummy tuck over liposuction even though the tummy tuck creates a larger scar. In this category of patients, either procedure may be appropriate, and at the same time, neither is ideal. For this group of patients, when either procedure is reasonable, the decision as to which one to choose is made after the consultation.

Some patients may be candidates for abdominoplasty and liposuction during the same procedure. In this circumstance, the tummy tuck improves the abdomen, and the liposuction improves the flanks. The procedures are customized to fit the needs of each patient, and the procedures are determined based on the individual anatomy of each patient. No procedure is perfect, but significant improvement can be obtained in most patients. In general, the best results are obtained in the best candidates.