Abdominoplasty or liposuction: what decides is not the fat

Plenty of people arrive asking for abdominal liposuction and leave with an indication for an abdominoplasty, or the other way round. They are very different operations — in length, recovery, scar and price — and what decides between them is usually not the amount of fat.

The three problems of the abdomen

An abdomen you dislike can have up to three different things, and each is corrected differently:

• Fat. You can pinch it, it is soft, it sits between skin and muscle. It is the only thing a liposuction resolves.
• Excess skin. It stretched beyond its capacity to retract and no longer returns. It hangs, it has stretch marks and it usually forms a fold over the caesarean scar. No liposuction removes it; taking fat out from under skin like that leaves it worse.
• Diastasis. The rectus muscles, running vertically down the centre of the abdomen, separated during pregnancy and did not come back together. The wall is left soft and bulges, especially at the end of the day.

Fat can be lost. Stretched skin and diastasis are not corrected by any exercise, and that is the point that causes most frustration: there are women doing abdominal work for years against a problem that is not muscular but a separation between muscles.

The ten-second test

Lie on your back with your knees bent. Lift your head and shoulders as if starting a sit-up and, with your other hand, feel the midline of the abdomen just above and below the navel.

If you feel a soft channel between two firm cords, that is the diastasis, and the width of that channel gives an idea of its size. A separation of more than two fingers is already significant.

If there is a diastasis, a liposuction will refine the contour and leave the wall bulging just the same. The abdomen will still push out at the end of the day.

What each one corrects

Liposuction works when the skin is of good quality and retracts, there is no diastasis and what is left over is localised fat. It is a day case or one night, back on your feet within days.

Abdominoplasty removes the excess skin and rejoins the muscles along the midline. It is major surgery and that is worth saying without dressing it up: three to four hours, one or two nights in hospital, twenty-one to thirty days to normal life and a long, permanent scar across the lower abdomen. In exchange, it is one of the operations with the highest satisfaction, because it gives back something the person had written off.

And they are often combined: abdominoplasty with liposuction of the flanks in the same session, which is what gives the complete shape.

The scar is the part you have to accept

There is no abdominoplasty without a scar. It runs from side to side across the lower abdomen, it is planned to sit below the underwear line and it fades over the months, but it is permanent. Anyone unwilling to trade hanging skin for a long scar should not have the operation, and that is a legitimate decision.

Two things before deciding

Your weight has to be stable, and close to what you can sustain: operating in the middle of weight loss means repeating. And if you are thinking of having more children, it is worth waiting: a later pregnancy separates again what was repaired.

Neither is urgent. What is worth doing is knowing which is your case before paying for the other.