Tummy tuck for plus sized clients
What changes the tuck
A tummy tuck for plus sized clients is planned for fat excess and skin redundancy that a routine abdominoplasty does not have to solve to the same degree. Plus sized clients in this range have a BMI of 25 to 35, more generous fat deposits, and skin redundancies. The extra fat and the redundant skin both raise weight, and the higher weight raises BMI. The challenges are the ones not seen in the same way in patients who fall outside that BMI range. Redundant skin changes the abdomen in three ways that make the operation harder than a tummy tuck performed on a routine basis. The lower skin can lean over the pubic region. The lower back and flanks can form prominent love handles. The upper body can look exaggerated because fat and lax skin remain above the lower abdomen. Incision height, how far the tuck extends around the flanks, and whether a second stage is used all follow from those three findings.
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48-year-old female patient tolerated full tummy tuck surgery and liposuction of the flanks to improve her abdominal torso appearance and convert her belly button from a horizontal deformity to a natural appearing oval shape.
The photographs above are one patient at three months, in a frontal view, a left oblique view, and a left view. Three months is the interval this set uses. The incision and staging decisions still follow the fat and the skin on the person being planned.
Pubic fullness and a lower incision
The pubic region is naturally generous in fat. Skin redundancy from the lower abdomen can lean on that region. The lean makes the pubic area look full, and it often makes it sag, so fullness and droop sit together. A traditional incision height leaves that lean in place, because the cut sits too high to move the pubic tissue with the abdominal closure. The correction is a tummy tuck with a lower incision than the one traditionally used. That lower incision lets the pubic region be transposed to a position and a size that fit the repaired abdomen.
Transposition means the pubic tissue itself is moved. Tightening only the skin above it does not change a pubic mound that is already generous in fat and is being pushed downward by redundant lower skin. The lower incision is still the tuck. The cut is set low enough that the pubic region can be raised and reduced as the flap is closed. The fat that belongs to the pubic region stays part of the plan, because that region is naturally generous. The added problem is the skin from above leaning on it, and the lower line is chosen for that lean.
Love handles and an extended tuck
Prominent love handles sit over the lower back and the flanks when excess fat and redundant skin are both present. An extended tummy tuck is what removes that lateral flank and lower back fullness. Those areas are not amenable to liposuction alone. The tissue is very fibrotic, and it is high in connective tissue density. Tissue with that density does not respond well to suction, because liposuction can remove fat and cannot remove collagenous tissue. After the fat is gone, the collagenous framework and the redundant skin still occupy the flank. The extended tuck excises that skin and the fibrous fullness instead of asking suction to clear collagen.
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The service designations for this patient include Tummy Tuck. 48-year-old female patient tolerated full tummy tuck surgery and liposuction of the flanks to improve her abdominal torso appearance and convert her belly button from a horizontal deformity to a natural appearing oval shape.
Love handles in this pattern are a combined problem. Liposuction can remove fat. The flank and lower back described here are fibrotic, so the pinch is not a simple fat cushion. Cutting the redundant flank skin out, as part of the extended tuck, is how that lateral fullness is eliminated during the first operation.
Upper body prominence
The third change is exaggerated upper body prominence. Generous fat in the upper and mid abdomen keeps the upper torso full even when the lower skin has been the main complaint. The laxity pattern is also different from the usual tuck. The usual pattern is not laxity in both the vertical and the horizontal directions. The pattern named here is that infrequent laxity in both vectors. Vertical laxity is the up and down excess a tuck can cut out. Horizontal laxity runs from side to side and can remain as a wide, loose upper contour.
A conventional tuck is built to treat lower abdominal skin redundancy and lower fat excess. It addresses the lower abdomen. It leaves the generous fat of the upper and middle abdomen, and it leaves horizontal skin that is still redundant after the vertical excess is gone. That remaining fullness above the lower abdomen is the upper body prominence this plan stages.
When the tuck is staged
Staging is recommended when clients score 2 to 4 on the HDL body scale, or when BMI is 32 to 36. A tummy tuck for plus sized clients in that band is staged for two reasons. The first is the generous adiposity of the upper and mid abdomen. The second is the infrequent laxity in both the vertical and the horizontal vectors. The descriptive range for plus sized clients remains a BMI of 25 to 35, with more generous fat and skin redundancies. The staging trigger remains a score of 2 to 4 or a BMI of 32 to 36.
A tummy tuck for plus sized clients at a BMI of 25 to 35 is the group described here, and that description is separate from the staging trigger. Someone at a BMI of 28 can fit the description and still sit outside a staging band that starts at 32. Someone at a BMI of 36 meets the staging trigger and sits just above the top of the descriptive range. The BMI of 25 to 35 describes the group. The score of 2 to 4, or a BMI of 32 to 36, is when the upper and middle abdomen are left for a later operation.
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From this angle, the Tummy Tuck result is easier to follow. 48-year-old female patient tolerated full tummy tuck surgery and liposuction of the flanks to improve her abdominal torso appearance and convert her belly button from a horizontal deformity to a natural appearing oval shape.
The conventional tummy tuck addresses lower abdominal skin redundancy and fat excess. Without extensive undermining, it is not amenable to liposuction of the upper and middle abdomen at the same time. The staged plan waits instead of adding that undermining during the tuck. Patients wait three to six months for the abdominal skin flap to heal. After the flap has healed, they may undergo liposuction of the upper and middle abdomen. Vertical redundancy is eliminated at the initial tuck. The later liposuction is for the fat that remains in the upper and middle abdomen.
After the flap has healed
Clients with generous skin redundancy have the vertical redundancy removed at the initial tuck. Residual horizontal skin redundancy can remain once the flap has healed. An upper body lift can eliminate that residual horizontal skin. It is considered after the tummy tuck has healed. The lower incision still does the pubic transposition. The extended closure still takes the fibrotic love handles when they are present. The upper body lift is the operation named for horizontal skin that is still redundant after healing, and it is not asked to replace either of those steps.
The sequence is the tuck first. That tuck includes the lower incision for the pubic lean and the flank extension when love handles are present. Three to six months are allowed for the abdominal skin flap to heal. Liposuction of the upper and middle abdomen follows that interval. If horizontal skin is still redundant after healing, the upper body lift is the added operation.
How the plan differs from a routine tuck
A tummy tuck for plus sized clients is different from the conventional tummy tuck because these clients have more generous skin redundancy and fat excess. The traditional procedure is modified to reduce a more generous pubic region and to eliminate love handles. A staged procedure is often advocated for the generous upper and middle fat, and for residual horizontal skin laxity, when those findings cannot be corrected during the original operation. Cities where this abdominal surgery is offered are listed with the tummy tuck locations.
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#342 is shown here in a closer clinical frame. 48-year-old female patient tolerated full tummy tuck surgery and liposuction of the flanks to improve her abdominal torso appearance and convert her belly button from a horizontal deformity to a natural appearing oval shape.
The American Society of Plastic Surgeons publishes a procedure overview of tummy tuck surgery. Incision height, the extended flank closure, an HDL body scale score of 2 to 4, BMI figures of 25 to 35 and 32 to 36, and a wait of three to six months are the planning figures used for this tuck.
Frequently Asked Questions
Plus sized clients are described as having a BMI of 25 to 35, with more generous fat deposits and skin redundancies. Both the fat and the redundant skin raise weight, and that higher weight raises BMI. Staging uses a different trigger: an HDL body scale score of 2 to 4, or a BMI of 32 to 36.
The pubic region is naturally generous in fat, and redundant lower abdominal skin can lean on it, causing fullness and sagging. A tummy tuck for plus sized clients uses a lower incision than a traditional tuck so the pubic region can be transposed to a better position and size.
The lower back and flanks in this pattern carry excess fat and redundant skin, and the tissue is very fibrotic with a high connective tissue density. Liposuction removes fat and does not remove collagenous tissue, so an extended tummy tuck is used to eliminate that lateral fullness.
Staging is recommended for an HDL body scale score of 2 to 4 or a BMI of 32 to 36. The reasons are generous fat in the upper and mid abdomen, and laxity in both the vertical and the horizontal directions, which is not the usual pattern. Without extensive undermining, liposuction of the upper and middle abdomen is not done in the same operation as the conventional lower tuck.
Patients wait three to six months for the abdominal skin flap to heal. A tummy tuck for plus sized clients removes the lower skin redundancy at the first operation and, when love handles are present, the extended flank and lower back skin. Liposuction of the upper and middle abdomen comes after the flap has healed.
An upper body lift can remove residual horizontal skin redundancy after the tummy tuck has healed. Vertical redundancy is already eliminated at the initial tuck. The upper body lift is considered for the horizontal skin that remains, after that healing.
Tummy TuckBefore & After
Tummy Tuck Before & After
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