Both are common and both have solutions.   In our image-conscious culture, we are constantly being exposed to models, movie stars and clothing that show images of firm, flat abs and “six packs.” We respond by either frustrating ourselves into trying to achieve the unrealistic or in just giving up and going to the other extreme of becoming “dunlaps.” For those of you who do not know a dunlap is: when that midriff spills over the waistline of pants, resulting in a “dun lapped over” or a “dunlap.”  Of course there are others who have gone to the next stage growing as my mother calls it a “belly roast”- that is when you sit down and you have a lap full of belly. The problem with these words is that they make light of a very serious trend in America – that of obesity. Current statistics show that over 65% of American adults are overweight while 31% of that number are considered morbidly obese. Of even greater concern is the fact that children are not immune to these statistical trends and as of 2004 over 30% of all American children are obese. This current generation of children is the first generation in modern times whose life expectancy is less than their parents!!!

So while we read about the latest celebrity who is anorexic or bulimic, we seem to give little attention to the danger for the “fat” kid across the street. We strive to be sensitive to the overweight and obese and we certainly do not want to hurt someone’s feelings.  But since this is a matter of life or death, wouldn’t it better to just speak the truth. I am amazed about how many people come in for a consultation, wanting to have something surgically done about the appearance of their abdomen yet have not even considered their role in the improvement.  A “tummy tuck” is not a weight loss tool. It serves to reshape and redrape the skin with some recontouring. The more volume of fat attached to that body blanket the harder it is to redrape the skin. Think how easy it is to make up your bed with a thin summer cover versus when you try to make up the bed with a heavy winter blanket.  If the goal is weight loss, then either nonsurgical lifestyle change or surgical intervention by gastric bypass or lap band are the best techniques. Once the appropriate amount of fat has been lost then surgical reshaping procedures become the mainstay of treatment. 

Now let me speak to those of you who say, “I have worked and worked and it just doesn’t go away, it folds up like an accordion in my clothes.”  We will call that type of abdomen a “baby belly.” The abdomen is made up of three external layers that are evaluated. Those layers are muscle, fat and skin.  Often after a pregnancy or after massive weight loss, the skin is stretched beyond its recoil ability resulting in accordions of excess skin. Of course each person is unique and that is why the consultation is a personalized process.  In this situation, the muscles can also get stretched and then not return to their prior alignment. It is the in-between layer – the fat- which the most variable. The surgical term abdominoplasty, aka “tummy tuck,” is a term used to describe many different techniques.  The purpose of each technique is to remove the excess skin and redrape it over the underlying muscle that may have been tightened. Often isolated fat deposits can be contoured at that time, but in general the thinner the body blanket, the tighter the tummy can be made. New techniques in abdominoplasty are emerging.  Some like Belt lipectomy “around the world” follow the growing trend of bariatric surgeries and the increasing number of people who have converted their Buddha belly into a baby belly. In these situations, the accordion like folds of skin travel all the way around a person’s trunk necessitating a more extensive surgery in order to achieve maximum reshaping.  For those people who have more limited needs, new techniques allow for limited incisions and faster recoveries. 

Recovery time depends on the length and extent of surgery, on average plan on being away from work for 2 weeks.  It is always easier to go back early than to get additional time off. In general, insurance does not pay for a cosmetic tummy tuck even one done after massive weight loss.  Occasionally insurance will cover a “panniculectomy” which is an amputation of the overhanging abdominal apron. This is a very basic procedure with no cosmetic frills. This coverage is also becoming rare, as insurance regulations increase and insurance coverage is less.

A frequent question is what is done with the removed tissue?  While currently the tissue is discarded, developing technology can harvest stem cells from the fat to be used in other areas. But more on that in an upcoming article….

So in closing, there are surgeries that can help you attain a more attractive abdomen and new innovations can help make the surgeries less invasive and safer.  To get the best result it is important to prepare yourself for the surgery by being in your best shape. That means stop smoking, make sure you are exercising and eating a healthy, balanced diet prior to surgery.  These preparations will help ensure that your surgical results meet your expectations so that you can trade in your Buddha belly and baby belly for a better belly!