One of the main concerns of almost all extreme weight loss patients is the extra skin and fat that hangs around the waistline. While weight loss can occur differently around the body, the abdominal and waistline deformity occurs most commonly. Unlike the typical woman undergoing a traditional cosmetic tummy tuck, the abdominal operations in the extreme weight loss patient are frequently different as the skin excess is more extensive. There is an extra dimensions of skin that not only create vertical excess but also potentially circumferential as well. This creates a total of five different types of tummy ruck procedures.
The traditional tummy tuck may still apply to some weight loss patients if the skin excess is not that great. In the standard full tummy tuck (abdominoplasty), skin and fat is removed horizontally…like a large ellipse removing skin from the pubis up to above the bellybutton. A full tummy tuck also includes tightening of the abdominal muscles and may involve liposuction around the sides of the waist.
An extended tummy tuck is simply a full tummy tuck that goes further back around the waistline. More skin and fat is removed around the sides of the waistline due to more loose hanging skin. The scar goes further back around the waist but stops short of the middle of the back. Many extreme weight loss patients need this form of tummy tuck as is the most common in my experience.
Some patient’s skin is so loose that a horizontal cutout of skin still does not give a great result. This skin excess lies above the belly button and has folds in the vertical dimension. When this exists, a combined horizontal and vertical cutout is needed and does a much better job of bringing in the sides of the waistline. This type of tummy tuck is known as the anchor or fleur-de-lis. It creates a vertical scar down the middle of the abdomen as well as a low horizontal one. In bariatric patients in the past, this extra scarring was not usually a concern as a midline scar may have already existed from an open bariatric procedure. Today, almost all bariatric surgeries are done laparoscopically so this vertical scar may be more of a concern.
The most extensive tummy tuck is the circumferential body lift. This is really a combination of two operations, a frontal tummy tuck and a back buttock lift. The frontal tummy tuck in the body lift is a standard horizontal one.
The last, and rarely used , type of abdominal contouring procedure is the reverse tummy tuck. In this procedure the abdominal cutout is done high above the belly button. Rather than pulling excess skin down, skin is pulled up in the opposite direction. The resulting scar will be horizontal and high along the breast folds in a women or in the chest crease in a man. This procedure is usually reserved for those patients who have already had a lower tummy tuck but still has residual skin excess up high that remains bothersome.
Dr. Barry Eppley
Indianapolis, Indiana