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Tummy tucks and lower body lifts (aka circumferential tummy tuck or belt lipectomy) may seem like a similar operation and in many ways they are. They both address abdominal laxity and excess skin. However, the surgeries address two totally different patient populations and, in my opinion, can give very different cosmetic results.
A tummy tuck typically involves a couple things: lower abdominal skin removal, abdominal muscle repair, repositioning and contouring the belly button, and some degree of liposuction. The goal of this operation is to restore the normal anatomy of the abdomen and improve the waistline. The scar travels low and goes from hip to hip.
A tummy tuck will primarily address the area between the hip bones. When the skin quality is good and has good elasticity, liposuction of the hips and back can help contour and narrow the waist.
But what happens if you have excess skin that extends beyond the hip bone? This is where a lower body lift shines.
The lower body lift will extend the incision around the hips and around the back. It will remove excess skin around the hip and lift the outer thigh and the buttock. For most patients who have lost a considerable amount of weight, this is generally a better procedure. When the skin has lost its elasticity, liposuction alone cannot help correct the hips and back. That is when removing the skin becomes beneficial. The scar is kept low and extends 360 degrees around the hips and back. A lower body lift will also include muscle repair, repositioning and contouring the belly button, and liposuction.
For most patients, we always do a monsplasty or pubic lift. This helps flatten and lift the pubic area so that the front has a good contour.
A lot of people ask questions about the abdominal muscle repair so we’ll delve into that a bit. We all have two long muscles that extend from our rib cage to our pubic bone called the rectus abdominis muscles. These are the “six pack muscles”. While that seems cosmetic, they are actually very important for holding your core stable. Anatomically they are supposed to sit right next to reach other with little space in between.
When there is increased volume inside the abdomen around the organs, these muscles can get stretched apart, called a rectus diastasis. This can be a pregnancy and can also be related to visceral fat or the fat that lives inside the belly. Visceral fat can expand as we gain weight and stretch those muscles apart causing a rectus diastasis. When weight loss occurs, and the visceral fat decreases, the muscles do not go back to normal.
Pregnancy and visceral fat can both cause a rectus diastasis and cause a bulging belly when you stand. Repairing those muscles back together, called a rectus plication, can help flatten the belly, narrow the waistline, and improve function.
A tummy tuck is a great option for patients who have excess skin mostly in the front of their abdomen between the hip bones, muscle separation/laxity, and good skin elasticity in the hips, sides, and back. When the skin elasticity is good, liposuction is a good option to treat those areas. This is a common operation after pregnancy and/or weight loss.
A lower body lift is a great option for patients whose excess skin travels further around the side than the hip, hip rolls, sagging of the sides and the buttock. This is often for patients who have lost a lot of weight with lifestyle changes and/or GLP-1 medications (Ozempic, Wegovy, Mounjaro, Tirzepatide, Zepbound) and/or weight loss surgery. However, even patients who have not lost a considerable amount of weight can be good candidates for this surgery depending on their anatomy.
We offer an individualized approach. These surgeries are not a one size fits all. Just because you have lost a significant amount of weight doesn’t mean you can’t be a good candidate for a tummy tuck and vice versa.
In general, we find that the recovery and post-op journey for both a tummy tuck and lower body lift are about the same.
Sometimes, patients will stay overnight in the hospital. Patients will typically have drains for 2 weeks. Patients will wear surgical compression for about 6 weeks and regular compression for another 6 weeks.
We typically say about 4 weeks back to strenuous activity (activities that elevate your heart rate or break a sweat) and 8 weeks back to heavy lifting (> 25-30 lbs).
One of the most challenging parts of the recovery for these surgeries is initial positioning. Since we are pulling the skin tight in the front, patients need to keep bent at the waist to keep tension off the incision. This means walking in a hunched over position and sleeping in a recliner position. This can be either in a recliner or with a post-surgical wedge pillow. These pillows keep your back elevated and go underneath your knees to keep you bent at the waist but also keep you comfortable.
Thankfully, this positioning only lasts 2 weeks on average.
In summary, tummy tucks primarily address loose skin on the front of the abdomen whereas lower body lifts address loose skin all the way around the waist.
If the skin quality is good on the hips and buttocks, then liposuction can be done with a tummy tuck to address these areas.
If there is more excess skin around the hips and back, then skin removal with a lower body lift may be a better option.
These decisions are very specific to your anatomy. We highly recommend coming to see us in the office to share your concerns, examine those areas, and come up with a customized surgical plan.
You can call us, text us, use our online scheduler, or e-mail us at info@psinj.com.
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