Tummy tuck (abdominoplasty)

A tummy tuck (abdominoplasty) addresses excess abdominal skin, fat tissue, and laxity in the abdominal wall. You may be researching this option for changes caused by pregnancy, weight fluctuations, or structural factors. During the examination, we listen to which changes concern you and explain the extent of skin removal, bringing the muscles closer together, and fat removal.

Lower abdominal skin folding over underwear, laxity around the navel, and a broad appearance of the front abdominal wall are different reasons for seeking a consultation. These findings can coexist, or one may be more noticeable than the others. The tummy tuck plan depends on how much of the concern comes from excess skin, subcutaneous fat, or laxity in the abdominal wall.

Skin, fat tissue, and abdominal muscles

We remove sagging skin and fat from the lower abdomen and bring abdominal muscles that have separated to either side closer together at the midline. In the upper abdomen and waist, we use liposuction (fat removal) to thin the fat layer and shape the waist’s inward curve. Each of these procedures addresses a different tissue in the abdominal region.

The skin, subcutaneous fat, and deeper muscles and connective tissue all contribute to abdominal appearance. Loose skin and separated muscles are different findings. Identifying which layer has changed during the examination helps determine the area for skin removal and whether muscle repair is needed.

Rectus diastasis, separation of the right and left muscle groups at the front of the abdomen, is associated with widening of the connective tissue between them. This can cause the front abdominal wall to project forward. During repair, the fascia, the supporting connective tissue layer covering the muscles, is tightened with sutures to bring the muscles closer together at the midline.

Suitability for a tummy tuck

A tummy tuck may be considered for people whose weight is stable, whose general health is suitable for surgery, and who have abdominal excess skin that can be removed. If substantial weight loss is intended, the surgical plan is based on the tissues remaining once weight has stabilized. Alongside body weight, the distribution of sagging skin and the abdominal wall structure affect the choice.

Pregnancy can stretch the abdominal skin and the connective tissue between the muscles again. If you are considering a future pregnancy, you can mention this during the tummy tuck consultation. Surgical timing is considered in relation to this anticipated change in the abdominal wall.

Cosmetic tummy tuck surgery is not performed during pregnancy. If an uncontrolled systemic illness or a general health condition prevents surgery, suitability is reassessed after that condition has been addressed. The operation works on excess abdominal skin and the accompanying fat. For people seeking overall weight loss, the current stage of weight management treatment also contributes to the suitability decision.

Some abdominal fat lies beneath the skin, and some lies inside the abdominal cavity around the organs. A tummy tuck and liposuction do not remove fat from inside the abdominal cavity. If this deeper fat contributes substantially to abdominal projection, not all the visible volume falls within the scope of these operations.

What do we assess during the examination?

The examination assesses whether excess skin is concentrated below the navel and how far it extends above the navel and toward the sides. Separation between the abdominal muscles and fat in the upper abdomen and waist are also examined. The location of excess skin determines the extent of tissue removal, while muscle separation determines the need for repair.

If you have had a cesarean section or another abdominal operation, you can share the incision locations and surgical details. Previous procedures may have changed the abdominal tissues and skin mobility. The relationship between an old incision and the area of skin considered for removal forms part of the new markings.

The navel’s position, mobility of the skin above it, and the extent of the lower abdominal fold toward the sides guide incision design. Moving the skin by hand in different directions shows where the excess is concentrated. A side view, as well as a front view, helps distinguish abdominal wall projection from sagging skin.

A broad fold of skin and fat hanging from the lower abdomen may be called a skin apron. Removing this fold does not mean the skin above the navel or the abdominal wall is also repaired in the same way. A tummy tuck plan may include adjustment around the navel and repair of the supporting layer covering the muscles, alongside removal of the apron. Which tissue will be removed and which layer will be repaired are separate topics during the consultation.

The abdomen may fold differently when standing and sitting. A fold around the navel when sitting is not the same finding as excess skin that also hangs downward when standing. Moving the skin by hand during the examination shows how the upper abdominal skin may shift toward the lower abdominal incision line. This mobility helps explain whether the skin above the navel will be included in the surgical plan.

Full, mini, and extended tummy tuck

A full tummy tuck is an option for abdomens with skin laxity both below and above the navel. Excess skin and accompanying fat are removed through a horizontal incision in the lower abdomen. The upper abdominal skin is repositioned downward, and the opening through which the navel emerges is prepared according to this new skin arrangement.

A mini tummy tuck addresses cases where excess skin is mainly below the navel. The incision lies in the lower abdomen, and the procedure focuses on this limited lower abdominal area. A separate incision around the navel is usually unnecessary. Pronounced laxity extending above the navel may lie beyond this limited working area.

In an extended tummy tuck, the horizontal incision also includes the portion of excess lower abdominal skin that extends to the sides of the waist. This option may be considered when sagging at the front of the abdomen is accompanied by excess skin at the sides. The term extended describes the lateral extent of tissue removal. Where the sagging ends determines the incision boundaries.

The location of excess skin is as influential as its amount when choosing a technique. Laxity extending above the navel and a fold concentrated in the lower abdomen create different working areas. The level of muscle wall separation is recorded separately from excess skin. This allows an explanation of which procedures the terms mini, full, or extended tummy tuck include.

Diastasis repair and navel position

Rectus diastasis is also called diastasis. Separation of the muscles at the midline may occur above the navel, below it, or in both areas. In someone having skin removed from the lower abdomen, the need to bring the muscles closer together may extend above the navel. The skin incision and the boundaries of the repair beneath it are therefore marked separately.

In diastasis, the connective tissue between the muscles widens; in a hernia, there is an opening in the abdominal wall. These findings are distinguished during the examination, with imaging used when needed. If a hernia is identified, its abdominal wall repair is planned separately.

In a full tummy tuck, the navel’s attachment to the abdominal wall is preserved while the surrounding skin is moved downward. The navel is brought through an opening prepared in this skin. Repositioning the navel refers to this adjustment between the skin envelope and the navel’s underlying attachment.

Incision locations and fleur-de-lis

The horizontal incision is designed in the lower abdomen with attention to its relationship to the underwear line. How far it extends toward the sides depends on the strip of skin to be removed. In a full tummy tuck, an incision around the navel is added. Incision patterns in mini and extended techniques differ according to the excess skin in the relevant area.

Fleur-de-lis is a technique that adds a vertical incision along the abdominal midline to the horizontal incision in the lower abdomen. It may be an option, particularly after substantial weight loss, when skin is excessive both from top to bottom and from the sides toward the center. The vertically removed strip addresses laxity across the width of the abdomen, and this technique also leaves an incision line along the abdominal midline.

The midline incision in a fleur-de-lis technique describes where excess skin will be removed. In diastasis repair, the work at the midline targets the connective tissue layer beneath the skin. Muscle separation therefore does not necessarily mean a vertical skin incision is required. Abdominal wall repair can also be performed in a tummy tuck planned with a horizontal incision.

Abdominal stretch marks are removed with the tissue only if they lie on the piece of skin being removed. Stretch marks on skin left on the abdomen lie outside the operation’s tissue removal area. Their distribution above or below the navel is therefore recorded during the examination.

Tummy tuck and fat removal

Liposuction reduces the fat layer beneath the skin, while removing sagging skin is a separate stage of a tummy tuck. Excess skin and localized fat can be present in the same person.

During a tummy tuck, we remove sagging lower abdominal skin and its accompanying fat while performing fat removal in the upper abdomen and waist. We select the areas for fat removal as part of the abdomen as a whole to shape the waist’s inward curve. If fullness at the sides of your waist also concerns you, we can show you during the examination how this area relates to the tummy tuck markings.

General anesthesia is used for tummy tuck surgery. The area for skin removal, the abdominal wall repair area, and planned waist fat removal are specified during anesthesia preparation. Alongside knowing whether the procedure is a mini or full tummy tuck, understanding what will be done beneath the skin helps clarify the surgical scope.

Planning with other body procedures

After pregnancy or weight loss, abdominal skin laxity may be accompanied by breast sagging. A breast lift and tummy tuck may be included in the same surgical plan to address these separate tissue changes. If excess abdominal skin extends around to the back of the waist, circumferential body lift options are considered separately. Upper back folds form a different working area.

When procedures are considered for more than one region, the amount of skin in each area, fat distribution, and general health determine the surgical scope. For example, abdominal muscle repair and fat removal at the waist are different procedures. Tissue needs guide which procedures are performed together or in separate operations.

What should you pay attention to after a tummy tuck?

Nutrition, weight, and smoking

After surgery, we recommend drinking 2-3 liters of water a day to prevent edema and following a protein-based diet. We ask you to avoid gaining weight and, if possible, maintain your ideal weight through your diet.

If possible, we recommend reducing or even quitting smoking one month before surgery. We also advise against smoking after surgery to help wound healing proceed without problems and reduce the possibility of bleeding. In nonsmokers, the surgical process and outcomes involve 30-50% less risk and are trouble-free compared with smokers.

Posture, sleep, and corset use

Because of the stitches in your abdomen, we recommend that you do not walk fully upright after surgery. For 1 week, we ask you to walk leaning slightly forward, avoid lying completely flat, and sleep with at least two pillows under your head.

We recommend wearing your corset for 4-6 weeks from the day of surgery. You can remove it briefly for activities such as showering and using the toilet.

Drains, dressings, and showering

When you come out of surgery, the incision on your abdomen is covered with waterproof tapes and a dressing. Our nurse changes your dressing and provides your care the next morning. We ask you to leave the brown tapes on the wound for a total of 15 days. As these tapes are waterproof, you can shower with them in place 24 hours after your drains are removed.

You will have 2-4 drains, depending on the areas operated on. Our nurses empty the drains when needed and measure the fluid collected. The drains are removed when Dr. Hakan Bulam considers it appropriate; this may take 1-5 days, depending on the person.

After you leave the hospital, we ask you to empty your drains when they are full, record the amount of fluid, and share it with our nurse. If you prefer, you can photograph the drain before emptying it and send the picture to our nurse.

We use dissolvable stitches in the small liposuction incisions and the tummy tuck area. These stitches do not need to be removed, and no additional dressings are needed in these areas.

Massage, exercise, and swimming

We consider lymphatic drainage massage necessary for an easier and faster recovery. You can start immediately after surgery and have a total of 8-10 sessions. Early edema, swelling, and localized firmness decrease over time, and your tissues regain their natural consistency within 3-6 months.

You can start walking from the 2nd week after surgery and other activities after the 4th week. You can swim in the sea or a pool from the 4th week.

You can message our clinic coordinator on WhatsApp with any questions.

These timeframes may vary depending on the person and the extent of surgery. Dr. Hakan Bulam will clarify them for you at your follow-up appointments.