46-year-old female patient following a tummy tuck and lower body lift. Note the elimination of the FUPA.
What is a FUPA? FUPA, or a Fatty Upper Pubic Area, is amongst the most commonly sought after reasons for cosmetic surgery. As the acronym describes, a FUPA is a collection of adipose tissue, or simply put, fat, that is located between the hip bones, located in the pubic region. Childbirth, aging, rapid weight loss, and genetics may contribute to the formation of a FUPA. FUPA can affect both males and females and is often a big point on contention.
In females, the FUPA often times becomes more apparent after a Caesarean section. This is due to a low set incision, commonly known as a Pfannenstiel incision, which anchors the skin and subcutaneous tissues down to the underlying muscle with scar tissue. This, in turn, creates a prominence of underlying fatty tissue in the pubic area. In males, this often happens simply due to the excess of fatty tissue that resides in the pubic area. Either male or female, the FUPA sticks out of clothes and is quite unsightly for some.
The common misconception is that the only issue at hand is fat, when in fact, it can involve excess fat, skin, or both! There are several non-surgical approaches to soften the overall appearance of the FUPA. These include riding, doing crunches, leg raises, rollups, superman pose, burpees, pelvic tilt, and classic Pilates moves, such as The Hundred- all of which address both the fat and skin. One should not minimize the importance of a healthy lifestyle to lose lower abdominal fatty tissue! Create a cardio routine, be mindful of what you eat, de-stress with yoga and meditation.
Surgical Correction of FUPA
The goal of surgical correction of this is to create a gentle rather than a prominent convexity. The key to correction of a FUPA is to prevent an overdone appearance, such as a concavity. These goals are achieved by understanding whether the issue at hand is related to skin redundancy or excess fat. Excess fat may be addressed with liposuction of the FUPA while redundant skin may be addressed with an excision of the skin. FUPA skin excision is performed through a lower tummy tuck incision. An incision allows for resetting of the height of the pubic area, providing a pubic lift, and enhancing the overall appearance of the pubis. Ideal pubic height ratios are based on the evaluation of super models; these distances extend from the inframammary crease to the belly button, the belly button to the upper groin, and upper groin to the bottom of the genitals, as 44%, 38%, and 18% respectively. From a technical standpoint, the key to a great result is acknowledging these ideal aesthetic height proportions, the underlying anatomy, and how to improve these proportions. Liposuction of the pubic region should be performed conservatively to prevent the formation of a concave or overdone appearance. In addition, care should be taken to avoid injury to the pudendal nerve which is responsible for erotic sensations. Addressing the FUPA in males enhances the overall appearance of male genitalia as it minimizes the surrounding tissue and showcases the male anatomy. Similarly, in females, addressing it will reduce the surrounding clutter and showcase the female anatomy in an aesthetic manner!
In summary, trying to reduce the size of your FUPA can be frustrating despite exercise. But, at least there is peace of mind that if exercise and lifestyle changes don’t get you to where you need to be, there is always the Cosmetic Plastic Surgery Institute!