Different people have different nicknames for their belly pooch. Some call it “donut” or “apron belly” or “Karen,” but in the anatomy books is has a real name – panniculus. This is the term doctors use to describe the thick layer of fat tissue in the lower abdominal area. The belly pooch can occur due to unwise lifestyle choices (such as sedentarism, unbalanced diet), and after pregnancy, childbirth and bariatric surgery. Genetics can also play an important role. If the belly pooch runs in the family, the chances are you might have a predisposition towards it. 

When diets, exercise routines, and prayers fail to deliver results, there is one more thing you can do to get rid of the belly pooch. It is a rather invasive plastic surgery intervention called the tummy tuck or, in medical terms – abdominoplasty




The American Society for Aesthetic Plastic Surgery (ASAPS) started counting the tummy tucks performed in 1997. In 2000, there were over 62,000 patients getting tummy tucks. With a whopping 97% increase in the number of tummy tucks performed, it got to 130,000 in 2019 (1). There is no doubt about it – the abdominoplasty is one of the most popular invasive plastic surgery procedures that people are getting nowadays. 

The brochures advertising the intervention claim that a tummy tuck can considerably improve quality of life. By removing the pooch belly, the patient can get a better-defined body with good muscular tonus. The patient has more freedom to move, looks better, and has more self-esteem. As a result, lots of things can change (for the better) in terms of social relations and even intimate affairs. 




While the tummy tuck is definitely a big hit in the 21st century, it all started two centuries ago when the earliest versions of tummy tuck were performed. But no, people were not overly concerned with the aesthetics of the abdominal area at that time, so the procedure was mostly performed to use the excess skin to cover up wounds. 

Officially, the first tummy tuck ever was performed in 1890 by Dr. Demars and Dr. Marx in France (2). However, it was a gynecologist in Baltimore, Maryland performing what we now call an abdominoplasty no later than 1899. But the 19th century was not so great for tummy tucks as they had no means to save the belly button, so it was all gone when the surgery was over. No belly button – imagine. 



In the 20th century (1905), other doctors from France managed to perform a tummy tuck, preserving the belly button. But the incisions were large, both vertical and horizontal, and didn’t look great afterward. 

Versions of the tummy tuck procedure were used to treat wounded soldiers during World Wars I and II, and, as a result, the techniques have been much refined. 


The tummy tuck is the plastic surgery procedure performed to remove the excess skin and fat layer at the lower abdominal area. The patient’s eligibility for the procedure is evaluated during the initial consultation with the plastic surgeon. This is also the time when the patient finds out which one of the four different types of tummy tuck is recommended for his or her particular case.

The classic or the traditional tummy tuck is the most popular one and implies two incisions (one around the belly button and another one in the lower abdominal area). This procedure is often performed in association with liposuction to better contour the body



But it is the mini tummy tuck that is the most wanted procedure by patients seeking this intervention. And for a good reason. This procedure entails just one, much shorter incision compared to the traditional abdominoplasty, and the recovery is faster.

These next two types of tummy tucks are recommended for people with excessive skin sagginess, but not only at the level of the abdominal area, but also the flanks and even the back. So, we have the extended abdominoplasty - the incisions go beyond the hip bone mark to the sides of the body – and the circumferential tummy tuck – the incision goes around the waist and allows the removal of excess skin from the level of the abdomen, hips, buttocks and even the thighs. This procedure is also known as a lower body lift, and it is usually a good solution for people who had bariatric surgery. 




The procedure is performed with the patient under general anesthesia as the duration of the intervention can be anything between 1.5 and more than 5 hours. 

After the patient is asleep, the plastic surgeon will make the incisions (3). As we’ve seen before, usually we are talking about a long incision at the suprapubic area (traveling from one hip bone to the other) and another one around the belly button (needed to reposition the belly button). After the incisions are made, the plastic surgeon lifts the skin and associated fat layer up to the level of the rib cage to gain access to the abdominal muscles. 

The next step of the procedure is strengthening the abdominal muscles and correcting a potential umbilical hernia or diastasis recti. The muscles are sutured on the median line to create that flat, firm tummy aspect. Once this is done, the excess skin is excised, and the incisions are sutured. If there are stretch marks on the skin flap that is removed, the patient could get rid of them forever (4). However, the stretch marks on the upper part of the abdomen are often left behind.



Drain tubes are positioned on each side of the incision to help avoid fluid or blood accumulation at the surgery site. And from now on, it’s only up to the patient to have a fast and successful recovery (and there is a long list of dos and don’ts!). 


Massive weight loss that occurs suddenly as a result of bariatric surgery or a weight loss program is a big deal and a considerable achievement. As a result, the health condition can improve; the patient feels better and is easier able to perform certain activities. However, this doesn’t mean that self-image is improved too. Usually, after sudden weight loss, patients are left with impressive amounts of sagging skin – skin folds on the tummy covering partly or entirely the pubic area, on the arms, the legs, and so on. 

After weight loss, the skin is rarely (if ever) able to retract on the new contours of the body. More than this, the saggy skin on the tummy can cause issues with finding the right clothes, can affect mobility, not to mention the potential dermatological issues that can occur as a result of poor oxygenation at the level of the skin folds. And the main thing – the nagging sensation that all the efforts put into weight loss were for nothing as the aspect of the body hasn’t improved to reflect them. This is why bariatric surgeons can recommend patients to consider a tummy tuck surgery once the weight loss has occurred and a normal weight has been achieved (5). 




Childbearing is a unique and spectacular experience. However, it can leave marks on the body that are difficult to get rid of. Some women learn to love their stripes (stretch marks), and their curves (excess fat at the level of the tummy and flanks) while others can’t wait to get back to their pre-pregnancy bodies. 

The changes in the body during pregnancy, especially the ones to accommodate the growing baby in the uterus, tend to relax and stretch the abdominal muscles. One of the reasons why mothers can’t enjoy a flat tummy after childbirth is the gap that can occur between the right and left abdominal muscles. In medical terms, we call it diastasis recti and it can be just as bad as it seems, even if there is no pain involved. To help women get their pre-pregnancy bodies, plastic surgeons have created a package of procedures called the Mommy Makeover. Usually, it consists of a tummy tuck, more often associated with liposuction, and also a procedure targeting the breasts (breast lift or breast augmentation). 



While the tummy tuck can’t help you lose the baby weight you might still be carrying, the procedure can refine the aspect of the body and eliminate some of the unwanted pregnancy marks. The tummy tuck surgery should be scheduled when the patient doesn’t plan another pregnancy in the future (7). Otherwise, the results of the surgery can be compromised. 


We’ve discussed bariatric surgery, pregnancy, and it might seem like it’s all about weight loss here. But is it? A responsible plastic surgeon will mention that it is better to have a normal, stable weight to be eligible for the procedure (7). This is not a weight-loss method, but a body contouring technique

Good candidates for tummy tuck surgery are men and women with a normal weight, generally good health, and reasonable expectations. The only weight you lose when you have a tummy tuck is the volume of the flaps that are excised. If it was not much, then the weight loss might be insignificant. To get rid of some excess fat tissue in the surrounding areas, you might need to get liposuction with the tummy tuck surgery too. 


The abdominoplasty is not a hit and run procedure that you can have in your lunch break. It’s an invasive procedure, and the downtime can be in between 2 and 4 weeks, depending from case to case. Complications can occur if you’re not following the surgeon’s recommendations, and they can be rather severe. 



If you are interested in the procedure, you should know that there are some loops and hoops you need to go through before enjoying a flat, firm tummy. One of them is walking with the back slightly bent forward and sleeping with the knees bent for about two weeks or until the incisions are healed (8). Yes, the recovery period is not sexy at all. This sounds like a lot of effort, and it is. But it’s necessary to avoid putting unnecessary pressure on the incisions that might cause the sutures to rupture. For the same reason, the patient is advised to avoid laughing, coughing, sneezing, and other things that can cause a sudden contracture of the abdominal muscles (constipation is one of these things!). 

Tummy tuck surgery can be the last resort for people who tried everything to improve the contours of the abdominal area and failed. Abdominoplasty is a complex intervention, and the recovery time is lengthy. But for eligible candidates is a fast and reasonably safe method to say goodbye to the pooch belly (call it Karen, if you prefer) forever. 





July 24, 2020