How To Get Rid of FUPA

How to get rid of FUPA depends on fat, skin, or both

FUPA means fatty upper pubic area. It is the tissue between the hip bones in the upper pubic region. Patients ask about it because the mound shows in fitted clothing, over a belt, or during intimacy. The first step to get rid of FUPA is to name the tissue, because fat, loose skin, and scar do not respond to the same treatment.

Why the upper pubic area becomes a mound

Childbirth, aging, sudden weight reduction, a cesarean section, and heredity can each produce this mound. It affects men and women equally. In women it is often more obvious in tight clothing such as yoga pants, and some women are uncomfortable with the appearance during intimacy. In men who carry extra weight, the same fat is difficult to hide. It hangs over the belt or sags beneath the belt line, depending on where the belt is worn.

After a cesarean, the mound often looks larger. The low horizontal incision creates scar that distorts the soft tissue so it protrudes over the lower abdominal muscles. Fat behind that scar is what leads many patients from a pregnancy change to a surgical question. A low abdominal scar can hold that bulge forward even when the rest of the weight has come down.

Exercise, and when it does not get rid of FUPA

A common mistake is to treat the mound as fat only. It can be extra fat, extra skin, or both. When the mound is not extensive, muscle work can soften how it looks. Planks, crunches, leg raises, rollups, superman holds, burpees, pelvic tilts, and Pilates tone the area. Better muscle tone supports the connective tissue that runs from the skin to the pubic bone. That support does the most when the mound is modest.

Losing lower-abdominal fat, through diet and general exercise, is the right first plan when the problem is fat that has not been locked in by a scar. It does not correct a hereditary pad, a poorly placed scar, or fat that has not moved with training. Muscle work pulls the tissues in. It does not delete a fold of skin or release a scar that is pushing the pubic soft tissue forward.

How the exam separates fat, skin, and scar

A pinch of the upper pubic area starts the exam. Soft, thick fullness that compresses is fat. Thin, empty skin that folds is redundancy. A ridge that stays fixed when the patient stands, and that follows a cesarean or other low abdominal incision, is scar tether. Many mounds are a mix. Treating every mound as fat is how the wrong operation gets chosen.

Standing and sitting both matter. A mound that flattens when the patient is lying down and returns over the belt when standing is fat and skin under gravity. A mound that stays peaked because scar is holding it will not flatten with more core work. Clothing is part of the complaint. Yoga pants and a belt line show a small volume that a loose shirt hides. The exam treats that visibility as a contour problem, not as a reason to remove every bit of pubic fullness.

Sudden weight reduction belongs in the same exam. Fat can leave faster than the skin can tighten, so a person who has already lost weight may still have a pubic fold made of skin. Heredity can place fat in this spot even when the rest of the abdomen is lean. Aging thins the support of the skin. Childbirth stretches it. Those causes can stack, and the dominant one is what the operation has to treat.

How surgery is chosen to get rid of FUPA

The surgical goal is a natural curve. A scooped concavity is the look to avoid. The exam decides whether the cause is skin redundancy, extra fat, or both. That choice is the same one made for a lower abdominal bulge that may be fat, skin, or both.

• Liposuction to remove excess fat.
• Surgery to remove excess skin.
• Scar revision.

Liposuction is the choice to get rid of FUPA when the mound is fat and the skin can still retract. A cannula takes the fat through small incisions. If the skin is already loose, suction alone leaves a sag, and the mound changes shape without getting flatter in clothing. Liposuction is the right tool only for the fat portion.

The American Society of Plastic Surgeons describes liposuction as removal of fat deposits with a cannula. That description matches the fat-only mound. It does not cover a mound made of spare skin or a mound held out by scar.

46-year-old female patient who had an extended tummy tuck to eliminate her FUPA

What the two operations in the photographs are

The opening photograph is a full tummy tuck with muscle plication and VASER liposuction of the flanks, plus a breast lift. That is a torso operation. The pubic area changes because abdominal skin is removed and the abdominal wall is tightened, not because a pubic mound was suctioned by itself.

The later photograph is an extended tummy tuck done to eliminate the mound. The incision is longer when the skin excess is wider than a short central ellipse. It is still skin removal. That is a different operation from liposuction of a fat mound whose skin can still retract.

Neither photograph is a picture of planks, Pilates, or diet alone. They show the surgical side of the choice, used when skin, scar, or a large fat deposit is what remains after the non-surgical plan has done what it can.

A lower tummy tuck incision is the choice to get rid of FUPA when skin has to be cut out. Through that incision the surgeon resets the height of the pubic area and can improve the overall appearance of the pubis. A pubic lift is the incision plan used to get rid of FUPA skin and to set that height, rather than a lift that simply pulls the skin as high as it will go. The tummy tuck incision is the access for that skin removal.

Scar revision is used to get rid of FUPA when a low horizontal scar is pushing the soft tissue forward. Releasing that scar lets the mound sit back instead of folding over the lower abdominal muscles. Scar work is sometimes combined with fat removal or with skin removal when more than one of those problems is present.

The trunk proportions used to set pubic height

The proportions used for this closure come from supermodel evaluations. They divide the front of the trunk into three distances, and a surgeon matching proportion uses these distances when setting the new pubic height.

• 44 percent from the inframammary fold to the belly button.
• 38 percent from the belly button to the upper groin.
• 18 percent from the upper groin to the bottom of the genitals.

Those height ratios guide the closure after the decision to get rid of FUPA is made. Pulling the pubic skin higher than these proportions creates a short pubic segment and a conspicuous, operated look. Leaving it longer than these proportions leaves the mound looking low in clothing.

Keeping a curve instead of a hollow

The pubic area is supposed to meet the lower abdomen in a gentle curve. Taking too much fat, or setting the skin higher than the 44, 38, and 18 percent distances, leaves a concavity. That hollow reads as operated, especially in fitted clothing. The endpoint is a small, even mound in the lower 18 percent of the trunk, not a flat or scooped pubis.

Liposuction stops when the remaining fat is a thin, even layer and the skin still has a surface to settle against. Skin excision stops when the closure lands on those trunk proportions. Scar revision stops when the soft tissue is no longer tented over the lower abdominal muscles. Going past that point, in order to make the pubis perfectly flat, is how a concavity is made.

The American Society of Plastic Surgeons describes a tummy tuck as removal of extra abdominal skin and fat, with tightening of the abdominal muscles when the wall has been stretched. The patient in the opening photograph had that fuller operation: a full tummy tuck with muscle plication, VASER liposuction of the flanks, and a breast lift for breast size and shape. A mound that is only pubic fat or pubic skin does not automatically include muscle plication or a breast procedure. Tummy tuck surgery and high-definition liposuction are separate decisions from a pubic-mound plan, and the pubic mound itself is planned from fat, skin, and scar.