Over the past decade tummy tucks (abdominoplasty) have increased in popularity in comparison to just about any other cosmetic surgery procedure. Whether it’s part of a “mommy makeover” or just for loose skin after pregnancies or larger weight loss, abdominoplasty is considered when exercise and diet don’t do enough. A trade-off is the scar, which of course no one wants even though patients who have a tummy tuck usually feel that it was worth it. But not everyone needs a full tummy tuck, and so variations such as the mini-abdominoplasty and the reverse abdominoplasty sometimes suffice. (Combining the 2 is a “bidirectional abdominoplasty”.)
Tighten Loose Skin with the Standard Tummy Tuck
First it is important to acknowledge that liposuction won’t tighten loose skin, especially when there are stretch marks. When the lax skin involves most of the abdomen, the standard tummy tuck is best. This removes an area of skin and fat from the belly button to the pubic area, and the skin of the upper abdomen is pulled down to cover where the skin was removed. This results in a bikini line scar from hip to hip, and the belly button is brought out through the skin flap so there is a scar there.
The Advantage of Good Skin Tone
When there is good skin tone in the upper abdomen, a mini-abdominoplasty may be considered. This removes less skin and often results in a shorter scar, which is also placed low so as to be concealable in a swimsuit. The upper abdomen is not involved (except for perhaps some liposuction) so there is no scar around the belly button. A variation of the mini uses a technique called an “umbilical float” which detaches the belly button from underneath and re-attaches it an inch or so lower. This may provide the surgeon with access to the upper abdomen for muscle repair if needed, and slight improvement in skin tone just above the belly button. It can only be done when the natural location of the belly button is a bit high. Only about one in ten patients are a good candidate for a mini-abdominoplasty, and fewer still for the umbi float.
Shedding the Upper Abdomen Fat
An even more uncommon procedure is the reverse tummy tuck. It might best be called an upside-down abdominoplasty, because it is like a mini for the upper abdomen. The scar in this case is along the bottom crease of the breasts, and usually across the midline. That is a bit more of a noticeable location for a scar, but in patients who have had a breast lift or reduction there would be a scar under the breasts anyway. Not many patients have skin laxity in the upper abdomen but not the lower, so the reverse tummy tuck is more of a rarity.