Abdominoplasty
or liposuction?

The two operations solve different problems, yet they are constantly confused. Here is a simple test to help you work out which one applies to you.

These are commonly confused operations in plastic surgery, and the confusion is costly. Liposuction for a problem that calls for abdominoplasty gives a disappointing result — and sometimes an abdomen that looks worse than before.

The difference in one sentence: liposuction removes fat; abdominoplasty removes skin and tightens the abdominal wall.

The pinch test

This test is only a rough guide: it gives you an idea, but it does not replace an examination and cannot by itself decide whether you need liposuction or abdominoplasty. Stand in front of a mirror and take hold of the skin below your navel between your thumb and index finger.

• If there is a thick, firm fold between your fingers and the skin springs back as soon as you let go, this is fat: liposuction
• If the fold is thin and loose and the skin stays wrinkled, this is excess skin: abdominoplasty
• If you have both: a combination of the two

Now do the same lying on your back. If your abdomen flattens when you lie down but bulges when you stand, you probably have diastasis.

Diastasis — the third factor

The rectus abdominis muscles run vertically on either side of the midline. During pregnancy or significant weight gain they move apart, and the connective tissue between them stretches.

The result is an abdomen that bulges forward despite a normal weight and regular exercise. The abdominal wall simply no longer holds the internal organs in.

When liposuction is sufficient

• A stable weight close to normal
• Good skin elasticity
• Localised fat deposits resistant to diet and exercise
• No significant excess skin or diastasis

Recovery is considerably easier — back to work in three to seven days, incisions of a few millimetres and no long scar.

When abdominoplasty is needed

• Loose skin after pregnancy or major weight loss
• Diastasis
• Stretch marks on the lower abdomen
• A fold of skin that hangs over your waistband

Recovery is more demanding — two to three weeks before you can return to office work, drains, a compression binder and a long horizontal scar that is permanent.

Combining the two

In practice, the two are often performed together. Liposuction of the flanks and hips complements abdominoplasty and gives a cleaner overall contour than either operation can achieve on its own.

Combining them requires care: both procedures affect the blood supply to the skin, so the same area is never treated aggressively with both.

A word of caution

Neither is a way to lose weight, and neither is a substitute for a stable weight.

If you are planning to lose a significant amount of weight, surgery is postponed. After losing twenty kilograms the skin looks completely different, and the plan has to be made afresh.