The female form is very distinct from that of the male. This is most obvious in the breasts and buttocks, but it is also evident in more subtle but very important ways in the waist. The waist is the region between the rib cage and the pelvic bones. In women, it narrows in its horizontal dimensions, creating an hourglass silhouette. In men, the waist has a relatively constant dimension from top to bottom. The waist consists of the abdomen in the front, the flanks on the sides, and the lower back posteriorly. Thus, the appearance of the abdomen, the belly region, plays a significant role in the appearance of the waist. The abdomens of women should have relatively smooth contours with tight skin and the absence of bulges or excess fat. Some muscular definition, in the form of a “six pack,” is considered attractive sometimes in women, but this is more a matter of taste than an absolute criteria. An additional feature that contributes to the distinct attractiveness of the female abdomen is a slight convexity, or subtle bowing outward (but not a bulge), due to increased lordosis (inward curvature) of the lower back in women. Furthermore, the umbilicus should be surrounded by a slight depression or concavity that exists in the aforementioned convexity.
With age and especially with following child bearing, the female abdomen can lose many of its distinctive and attractive characteristics. The fascia, the strong covering that holds the muscles in place, becomes weaker and stretches. Thus, the muscles spread apart at the midline allowing the abdomen to bulge forward. Excess fat is collected, especially in the lower abdomen, creating an additional pooch. Furthermore, the skin loosens, which does not support the fat well and contributes to the pooch. Stretch-marks (striae) are also generally present in the lower abdomen of women who have been pregnant. One final thing to point out is that as the muscles weaken, the shape of the entire waste changes as the flanks bulge out as well. Additional fat collected on the flanks with their new dimensions leads to the loss of the very important and very feminine hourglass silhouette. Finally, fat collects in the lower back as well, further deteriorating the feminine nature of the waste. Thus, many of the changes that occur in the anterior abdomen are also seen at the flanks and back.
Traditional Full Abdominoplasty – The main procedure to address the waist and restore a youthful and feminine form is the abdominoplasty. This procedure is designed to reverse and correct many of the negative changes experienced by women in the region between their rib cage and pubic bone. An abdominoplasty is designed to flatten the anterior abdominal region and narrow and shape the flanks. This is accomplished by a combination of removing excess skin and fat in the lower abdomen below the belly button, tightening and repositioning the abdominal muscles located beneath the skin, tightening the overlying skin, and liposuction to shape and contour the remaining tissue especially in the flanks region.
Most women require and benefit from a full abdominoplasty. This procedure, as described above focuses on the entire abdomen and flanks between the lower park of the rib cage and the upper pubic bone. As described above, this procedure employs the skin and fat removal, skin and muscle tightening, and liposuction. There are variations on this procedure that may suit some women better, which are discussed below.
Lipoabdominoplasty – Lipoabdominoplasty is an exciting procedure that is a relatively new addition to the abdominoplasty options that I present to patients interested in body contouring procedures of the abdomen. A traditional full abdominoplasty does involve some liposuction of the flanks (the sides) but generally does not involve liposuction of the anterior or front tissues of the abdomen. Lipoabdominoplasty is a variation of a full abdominoplasty that involves a significant amount liposuction to the front part of the abdomen. This procedure is especially helpful for women with a fuller figures who are interested in abdominoplasty, as it helps reduce some of the abdominal tissue bulk that might not otherwise be addressed with a traditional full abdominoplasty.
Mini-abdominoplasty – A mini-abdominoplasty involves some of the features and some of the benefits of a traditional full abdominoplasty. This particular procedure focusses on the lower abdomen, the area between the umbilicus (belly button) and the pubic bone only. This is a contrast to a full abdominoplasty which focusses on this region and the areas above it between the ribs and the umbilicus. Due to the mini-abdominoplasty’s limited focus, the results can be limited as well. There is less tightening of the muscles and less skin removed. It has been my opinion and my experience that there are very few true or good candidates for a mini-abdominoplasty. Most women want and need the wide range of changes and benefits of a full abdominoplasty; they just don’t know it until they receive a full education about the difference between the two procedures.
The recovery from an abdominoplasty can be a little more extensive than some other procedures. This is due to the reorientation and tightening of the muscles and the repositioning of the abdominal skin. It should be noted that, due to the significant benefits, I have never interacted with a patient who regretted having an abdominoplasty or complained about the recovery. Most abdominoplasties are performed in an out-patient setting, but recovering one night in a hospital setting is a possibility for those who prefer that option. Some patients require drains to remove excess fluid for the first several days. Although, this is not universally true, and I often use a technique that eliminates the need for drains. Women should plan on positioning themselves bent at the waist for about one week. This creates the need for special positioning in bed, including placing a number of pillows or a reading wedge behind the back and a number of pillows beneath the knees. Patients should plan to take up to two weeks off from work, but often patients can return to work responsibilities earlier, depending on the nature of their work. Return to driving occurs at about the same time frame. Women should be prepared for having a scar located on their lower abdomen. This scar is present no matter how the abdominoplasty is performed or which surgeon performs it.
One important issue that should be considered in all patients undergoing abdominoplasty is the potential for blood clots. Although this is a serious issue, the occurrence is relatively rare. There are special precautions including medical devices and medications that can be utilized to significantly reduce the risk of blood clots. I discuss these options with and employ them in almost all of my patients as long as there is not a contraindication to doing so. Patients learn more about these precautions when they meet with me during their consultation.
The obvious benefits of abdominoplasty have been discussed above. There are also some benefits that are a little less obvious. Many women report that they experience better posture after an abdominoplasty due to repositioning the abdominal muscles (the “core” muscles) to their natural anatomic position and relationship to one another and other muscles. Abdominoplasty can also represent an opportunity to reduce unattractive C-section or hysterectomy scars. It should also be mentioned that many women report enhanced enjoyment and satisfaction from sexual activity following an abdominoplasty. This requires special attention to reducing pubic mound bulk/fullness and lifting the pubic tissues to reverse the sag that occurs with age and pregnancy. I discuss this benefit with my patients.
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