Trim and Tuck

Get rid of 'the roll'

Liposuction patients come in all shapes and sizes. Dr. Mark Foglietti, director of The Cosmetic Surgery Institute in Beachwood, has seen women triathletes and men who hit the gym daily. He’s seen mothers, bariatric surgery patients and runners. He sees “normal” people, and few of them bring in magazine pictures when they request liposuction or abdominoplasty (tummy tuck) procedures.

“Some people could never achieve the appearance of a model in Vogue if they had a personal trainer, a dietician and a plastic surgeon,” Foglietti says, pointing to the extreme before-and-afters that reality television shows present. “I think Midwestern people are more realistic,” he remarks.

In fact, if a 50-year-old woman asks for the tummy of a 20-year-old girl, Foglietti raises the red flag. “It happens occasionally,” he says. “We’ll see a 19-year-old girl who has not had children and wants a six-pack abdomen without the effort and the exercise.”

These cases are unusual, he adds. Most men and women who want to tighten their abdomens are healthy and exercise — and still complain of skin that sags. For women who have had multiple pregnancies, skin stretches out like a rubber band; then it loses its snap. Extreme weight loss also can leave people with a “roll” they can’t remove.

Still, role models in Sports Illustrated swimsuit issues set the precedent for some patients, says Dr. Gregory Fedele. Jessica Alba and Heidi Klum have that “toned stomach, nice shape and a waistline that is smaller,” he describes.

Can a tummy tuck or liposuction — or both — produce this look?

That depends on your skin’s ability to bounce back once stretched and what lies beneath. Liposuction is ideal for patients with relatively firm skin, but localized areas of fat that won’t budge despite diet and exercise, Fedele says.

During this procedure, a surgeon injects a mixture of saline and medication into the target area, which decreases postoperative bruising and reduces pain. Fat is removed through a cannula, which is a high-pressure suction device about the size of a radio antenna. Foglietti won’t guarantee how much body fat liposuction will remove, but patients usually go down one or two clothing sizes, he says.

A tummy tuck produces more dramatic results and helps get rid of the roll. “The goal is to give a patient a flat, tight stomach after surgery,” Foglietti says.

Fedele describes an abdominoplasty, in which abdominal muscles are tightened, but not cut. An incision is made below the bikini line; skin and fat is pulled down, “tucked” underneath, and secured with absorbable sutures.

Foglietti adds that many patients opt for both surgeries. “They will have liposuction of regions other than the stomach area to give the body a better contour,” he says. “An example is a woman has a tummy tuck and liposuction of hip folds to give her trunk a slimmer appearance.”

Often, the procedures renew patients’ commitment to exercise, Foglietti adds. “Abdominoplasty can be such an improvement to self image that the patient is motivated to exercise and eat better because there was a time and monetary commitment to the procedure.”

[Patients who get liposuction won't see results when they step on the scale.  because fat is lighter than water, the procedure results in lost inches, not pounds (Dr. Mark Foglietti, The Cosmetic Surgery Institute, Beachwood, Ohio).]

Procedure Pointers:
Target zones —
Liposuction should not replace diet and exercise, but stubborn areas can be “treated” with the procedure, Foglietti says. Saddlebags, inner thighs, knees and back folds are common trouble spots for women. Men choose liposuction for love handles and to flatten the chest. Both camps complain of a “waddle” under the chin.

No Yo-Yos — Foglietti performs both abdominal procedures only on individuals with a stable body weight. “I don’t like yo-yo dieting,” he says, though he doesn’t expect patients to be at their “ideal body weight.”

Foglietti prefers consistency. “If a woman comes in who usually weighs 12 pounds less, I’d like to see her with that weight shaved off,” he says. “However, if for the past few years she’s been stable at this weight, that makes her a candidate for liposuction.”

Recovery — With any plastic surgery procedure, you can expect a trade-off, Fedele says. “You trade in a stomach that is loose and bulging in the lower stomach for a nice, tight, muscular layer … with a scar,” he says of the tummy tuck procedure.

Fedele says patients can return to work at their desk jobs in 10 to 14 days. Patients with occupations that require heavy lifting or strenuous work require more recovery time. And, he notes that women who have had C-sections generally recover better than those who have not. “They already have a good idea of what it’s like to recover from a surgery that causes stomach discomfort,” Fedele points out.

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