Abdominal liposuction and tummy tuck: what is the difference?

What do the two procedures address?

The reason a belly sticks out differs from person to person. It may be because there is a lot of fat under the skin, because loose skin folds over, or because the abdominal muscles have separated. Liposuction is surgery in which a thin tube (cannula) is inserted through a small incision to remove fat under the skin, and no skin is cut away. Abdominoplasty usually removes excess skin and fat and tightens the abdominal muscles, and it is said to be commonly requested by people who want to regain their pre-pregnancy appearance or maintain a youthful figure ^[1].

According to a 2020 review, abdominoplasty became widespread in 1967 as a procedure performed without liposuction, and after liposuction was introduced in 1983, liposuction became the central tool among the various procedures used to refine the contours of the front and sides of the abdomen ^[3]. At first, liposuction was used together with a limited tummy tuck (mini-abdominoplasty) to refine the contours, and later a method of safely combining a full abdominoplasty with liposuction (lipoabdominoplasty) was developed ^[3].

How is the right procedure chosen?

A 2014 review introduced an approach in which patients are classified through examination according to the layers that need treatment (skin, fat, and muscle) and a matching level of treatment is then chosen ^[2]. A 2020 review also described how the use of skin elevation (undermining), excision, and liposuction has been systematized, with each selected according to the degree of skin laxity and of musculofascial diastasis, the separation of the muscles and their fascia ^[3]. Changes to the abdominal wall after childbirth were described as usually being addressed most thoroughly with abdominoplasty ^[2].

In general, if the skin has kept its elasticity and the problem is mainly fat, liposuction is considered. If the skin has stretched and sags, or the muscles have separated, liposuction alone can do little to correct this, so skin excision or surgery to tighten the muscles is discussed as well. However, most of the research summaries used for this article are reviews of abdominoplasty, and they include no data giving figures on the effects and complications of liposuction performed on its own in typical cosmetic patients. Even at the same weight, the assessment differs depending on the condition of the skin and muscles, so an examination comes first.

Does separation of the abdominal muscles after childbirth always need surgery?

Rectus diastasis is a condition in which the two rectus abdominis muscles, which run vertically down the middle of the abdomen, have moved apart. A 2014 systematic review identified 437 studies in its search and included 28 of them, covering 3725 patients, but only 1 was a randomized controlled trial, and most were case studies without statistical analysis ^[4]. Rectus diastasis was common in women who had given birth, and it was reported that physical activity before childbirth may help prevent it and that exercise may improve symptoms after childbirth ^[4].

The same review stated that rectus diastasis is not in itself a true hernia, so it is not associated with the risk of the bowel becoming trapped and strangulated, and that surgery for it is mostly performed for cosmetic reasons ^[4]. It stated that rectus diastasis does not always require surgery, that conservative management can also be an alternative, and that if surgery is performed, the decision should be based on how much the abdomen protrudes rather than on the width of the gap between the muscles itself ^[4]. Surgery was performed during abdominoplasty or laparoscopically, and patient satisfaction was high; long-term recurrence was reported in 1 study, and no recurrence was seen in 5 studies ^[4].

After major weight loss, and in men

A 2016 review cited the growing number of patients who have lost a large amount of weight (massive weight loss) and the arrival of new fat reduction technologies as the background to the great advances in body contouring surgery over the past 10 years ^[5]. Body contouring in men is also increasing, and with the rise in weight loss (bariatric) surgery, more men are said to be seeking excisional surgery after losing a large amount of weight ^[6].

In people who have lost a lot of weight, there is often a large amount of loose skin, so excisional surgery tends to be the focus, and the surgical plan and risks also differ from those of abdominal surgery for typical cosmetic purposes. Findings about this group should therefore not be applied directly to abdominal liposuction in people whose weight has not changed much. The reviews used here are based on international literature, so it also cannot be said for certain that the same results would be seen in the body types and skin of Korean patients.

Recovery and complications

Abdominoplasty involves lifting and removing a wide area of skin, so wound-healing problems and seroma (a buildup of fluid at the surgical site) are major concerns. A 2020 review explained that methods of elevating the skin selectively, only as far as needed, and preserving the perforating blood vessels of the abdominal wall were developed to reduce wound-healing problems and seroma in abdominoplasty combined with liposuction ^[3]. In the systematic review of surgery for rectus diastasis, major complications were also few, and minor complications were mainly seroma and wound problems ^[4].

Liposuction can also cause swelling, bruising, changes in sensation, and uneven contours. A 2012 review covered the complications that can occur with each body contouring procedure, the pitfalls to avoid, and care after surgery ^[7]. The recovery period, how long to wear a compression garment, and when you can return to daily life vary depending on the extent of surgery and the individual, so it is best to confirm a specific plan before surgery.

What to check during your consultation

Planning before surgery is described as needing to include a review of the patient's medical history, a physical examination, and a frank conversation with the patient ^[7]. A 2016 review treated patient selection and safety, an understanding of anatomy, and planning whether to stage several procedures or combine them as the basic principles of body contouring ^[5]. Evidence-based reviews summarizing preoperative evaluation, surgical and anesthetic techniques, and patient safety and outcomes also continue to be updated ^[8].

• Whether the problem lies in the fat, the skin, or the muscles
• The difference between liposuction alone and liposuction combined with skin excision
• If skin is removed, where the scar will be and how long it will be
• Whether you have rectus diastasis and whether it needs surgery
• The recovery period and possible complications