When considering surgical options to achieve a flatter stomach several things are taking into consideration.
If the problem is simply some excess fat and there are no stretch marks present, liposuction alone will often give a very satisfactory outcome.
Sometimes liposuction is combined with removal of excess skin below the belly button. This combination of liposuction and limited skin removal is called a mini abdominoplasty. In the mini abdominoplasty, no incision is made around the belly button and there is no tightening of the excess skin above the belly button. Additionally, no tightening of the muscle layer is performed.
In patients who have more excess skin and stretch marks are present, a full abdominoplasty is usually recommended in order to achieve the best outcome.
In a full abdominoplasty, the lower abdominal incision is made in the bikini line from one hip to the other. The skin and fat layer is elevated off of the underlying muscle layer up to the belly button. An incision is then made around the belly button to allow continued elevation of the skin and fat layer off of the muscle layer up to the rib cage. Once this is performed the muscle layer is tightened from the rib cage down to the pubic bone. The skin and fat layer is then pulled tightly downward and the belly button is brought out through a new opening at the same level it was pre-operatively. The excess skin and fat is then removed and the wounds are closed. Very typically two suction drains are placed and often remain for up to 2-3 weeks.
The recovery from a full abdominoplasty is longer than liposuction alone or mini abdominoplasty. Usually the patient is instructed to stay home for 2 weeks post-operatively and ease back into all other activities over the course of 6 weeks. It is very important not to perform core strengthening exercises for up to 12 weeks.
Liposuction alone is the quickest recovery. There is minimal restriction of activities. In general patients are instructed not to do anything that is painful or uncomfortable.
A mini abdominoplasty has a slightly shorter recovery when compared to a full abdominoplasty. Usually the patient remains home for up to 10 days. Because no surgical tightening of the muscle layer is performed, restrictions regarding core exercises is minimal.