Your Questions

Q: Dr. Eppley, I am interested in a mini tummy tuck. My main concern is the recovery. I exercise daily, Pilates and tabata a few times a week. I just think of the time away from that and I cringe. Recovery time is a concern also because I travel a lot and if I’m going to do this I want to do it soon before our next scheduled trip in June. I have attached a picture. I know with the stretch marks I’m going to be scarred anyway but losing the excess skin would be fantastic.

A: Thank you for sending your picture and expressing your concerns about the procedure.  Between the picture and your concerns, the reality is that the mini tummy tuck is probably the not best procedure for you. In addition your recovery concerns are not going to be surmounted by having a ‘smaller’ tummy tuck operation. You have so much loose lower abdominal skin that a mini tummy tuck is going to produce a very subpar result. Even with a mini tummy tuck when you bend over there is still going to be loose skin that hangs between your belly button and the lower scar line. To really get rid of the maximum amount of loose lower abdominal skin a full tummy tuck pattern is needed in your case. While there is nothing wrong with choosing a mini tummy tuck for a smaller and lower scar, it is important to understand and accept that its improvement will be far less than you may expect.

The amount of abdominal skin to be excised aside, it is a significant misconception that the recovery time for a mini tummy tuck is really smaller than a full one. The stark reality is that regardless of the tummy tuck operation chosen you will need a minimum of three weeks away from such strenuous activities that you love.  The biggest risk and complication that every tummy tuck patient faces is that of developing a fluid collection (seroma) due to early and excessive physical activity. Once a seroma develops it will set back recovery a month and will result in the need for weekly aspiration of fluid and the risk of lower abdominal skin contracture/deformty. It really doesn’t matter whether it is a mini- or full tummy tuck this risk is the same. In fact it is a higher risk in mini- tummy tucks because the patient often thinks it is ‘less’ of an operation and they can go back to full activity as soon as they feel like it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have loose skin around my belly button after having several children. I went to a plastic surgery consult and was given the option of a mini tummy tuck and moving the belly button lower from the ‘inside’.  I have some concern about the tummy tuck option for my belly. My only hesitation is the aesthetics of having my belly button one inch lower.  Most of my pants/jeans/swimsuits sit just below my bellybutton which, other than the puffy ring around my bellybutton, looks good (generally speaking). I attached a few pics with jeans and swimsuit bottom. I am thinking that it will look “odd” after a mini tummy tuck, such that the bellybutton will no longer be visible with these clothes on and my overall appearance will look “strange”.  Where my belly button sits is between my waist and hip; it seems that the belly button would be moved down around my hip which might appear “not quite right”. Are there any other alternatives for a better appearance of this area?

A: Unfortunately there are no other effective solutions for the excess skin around your belly button other than the mini tummy tuck approach. Unless one puts a horizontal scar across the belly button area (which would obviously be unacceptable) the only way to work out the extra skin is to translocate the belly button lower through a mini-tummy tuck approach

Like just about everything in aesthetic surgery, it is all about the tradeoffs…you usually tradeoff one problem for another. You just have to decide which problem you can live with the best…the skin the way it is around the belly button or less skin around a belly button which is positioned lower. There are no ideal solutions for your problem that don’t have their own drawbacks.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in liposuction or a tummy tuck, preferably liposuction though. I have had two pregnancies, seven years apart with the last one being five years ago. This has left me with loose skin and fat around my mid section. I am 38 years old and weigh 140 lbs and have a 34″ waistline measurement. I feel great, I just can’t get rid of the skin and fat around and under the naval area. I have had two abdominal surgeries in the past and skin hangs over the suprapubic scar. If I just have liposuction will I be left with flabby skin?

A: As a general rule, if one has significant loose skin on their abdomen before liposuction they will still be loose skin afterwards. While many forms of liposuction have been touted about their ability to tighten skin, the amount of skin tightening obtained is almost always far less than what patients desire. As I always tell patients, liposuction can tighten skin in the range of millimeters, however, patients are interested and need skin tightening in the range of centimeters most of the time. With loose skin around the belly button and overhanging a suprapubic scar, you would be better served by having a mini tummy tuck which would incorporate liposuction with it. Given that you already have a suprapubic scar you might as well take advantage and use the entire scar for a mini tummy tuck. It does not add that much more scar length and its ability to remove skin make it more than a worthwhile trade-off.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I lost 90 lbs over the last 2 years. I have been body building during that time and cannot seem to get rid of my stubborn belly skin/fat. I have some abdominal definition but too much skin underneath my navel. Of course, I am very concerned about cost and surprised at myself for even inquiring about the procedure, but I am almost to the conclusion that a mini TT is the only way I can get rid of the extra skin. I would love your expert opinion and recommendations! Thanks for taking a look at my pictures for me.

A: You are to be congratulated on making such a body change. Not many people can lose nearly 100 lbs and end up with a fairly well sculpted body. But you are correct in that you have done all you can do and the lower abdominal skin will only respond to surgical removal. The good news is that it is tremendously successful and will put the final touches to your body transformation. This mini-tummy tuck is what most men actually need as their abdominal skin shrinks much better than women because of retained skin elasticity. (never having gotten pregnant) Also male tummy tucks do not require manipulation of the rectus muscles (muscle sewing) for the same reason. This makes everything about the male tummy tuck a little easier than that of many women. The biggest problem in men is to control their activity level afterwards for three weeks to avoid a postoperative fluid collection. (seroma)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I can’t figure out whether I need a full or a mini-tummy tuck. After having two children what bothers me most about my stomach is the little bit of loose skin and the stretch marks between my belly button and my mons. Interestingly, there is no loose skin when I am standing straight but it appears when I am bending over. I am 32 years old and in very good physical shape at 5’ 2” and 106 lbs. My abdominal muscles feel very taut and I don’t think they are separated at all.  I also have a hole on the upper part of my belly button from a prior piercing that I would like removed.

A:  Your description of your abdominal concerns is a common one and you are what I call a plastic surgery ‘tweener’. This means one is stuck between two procedures and can go either way. Either type of tummy tuck can be done on you.l Understanding which way to go requires an understanding of the trade-offs of making either choice. A full tummy tuck, removing an ellipse of skin from above the belly button down to the pubis, will eliminate all loose skin and will avoid the sag you now see when you bend over. But the final scar will be horizontally long and will end up high, about halfway between the new belly button and the pubic region. A mini-tummy tuck will result in a smaller scar that can be kept down quite low but will result in less skin removed and there will remain some small sag when you bend over. The decision comes down to whether you value the most amount of skin tightening or the best scar location and size.  

Dr.  Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had two children, the last one being two years ago. As a result of my pregnancies, I have some loose skin and stretch marks which are greatest right around my belly button. I would like to get rid of how my belly button area looks as I just hate it paticularly when I bend over or sit down. I know because I am very small and thin that I don’t have enough loose skin to do a full tummy tuck. But I want to have a completely flat stomach with no loose skin. I am thinking that if I have the skin cut out from around my belly button, rather than low like done in a traditional tummy tuck, that I will get the tightest result. I know this will leave me without a bellybutton but that would not bother me. Have you ever done a high tummy tuck like this?

A:  It is very common that many of the stretch marks and loose skin that results from pregnancies is around the belly button. This is because this is the region of the stomach that undergoes the greatest amount of skin expansion. After delivery, wrinkling and belly button deformities are common. While the type of ‘high’ tummy tuck that you are describing can certainly be done, I would advise against it. Regardless of how flat and tight the abdominal skin would be, having a horizontal scar across the center of your stomach without a bellybutton would create a secondary cosmetic deformity of its own that would not be very natural looking. You would be better served by having a mini tummy tuck with an umbilical float technique. This would create a very low horizontal scar just about the pubic hairline and keep a belly button that is positioned lower with less wrinkled skin around it. While this may not create the supertight abdominal skin that you desire, you would have substantial improvement but having a more natural look.

Dr.  Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I need advice as to whether I should have a mini- or full tummy tuck. I have attached some pictures of my stomach so you can see. I have been to two plastic surgeons and have gotten two different opinions. In listening to them, both make sense for what they want to do so I am confused.

A: When considering the type of tummy tuck one may need, it is important to look at the components of the excess tissue problem. The most important consideration in choosing between a mini- vs a full tummy tuck is how much skin is present. While you don’t have a large amount above your belly button, there is enough there that a mini-tummy tuck will not fully get rid of it.  The other tissue consideration is the amount of muscle laxity or protrusion. You appear to have a protuberance of your abdomen starts way above your belly button.  Like the skin excess, this muscle protrusion indicates that you will get a much better result from a full tummy tuck. One issue to consider in doing a fully tummy tuck is the vertical level of the horizontal scar. If the belly button cut out in the skin needs to stretch down to meet the lower incision, the horizontal scar will likely end up a little high. Therefpre, I would recommend that you end up with a small vertical scar in the lower part of your abdomen.  That way the scar can stay low and the belly button hole can be closed vertically. I think this would be better given how jeans and underwear are cut and designed today for women.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, what I would like to know is would liposuction and laser treatment to tighten abdomen area help with my problem area?  I seem to have small area over belly button that has always been there even when I lose and get almost too skinny for frame.  My skin on lower abdomen seems to be fine its tight when I stand but when I sit it gets kind of mushy with the rest of stomach.  I just have a hard time fathoming the fact that I would need a tummy tuck it’s not huge like some peoples I have seen.  I have had two pregnancies but no C-sections. Thank you so much!

A: In looking at our pictures, I can appreciate the slight quandry you have being uncertain whether liposuction alone or a mini-tummy tuck is needed. As a general rule, when you see a roll of skin above the bellybutton that is a sign of skin excess that can really only be flattened by a mini-tummy tuck. Since a mini-tummy tuck loosens and repositions the belly button from underneath, the roll of skin above is stretched out and moved lower which is how it gets ‘removed’. However, when your lower abdomen is in good shape (no excess skin) and the roll of tissue above the bellybutton is as much fat as skin, then liposuction alone is a viable treatment. In your case, I would have laser liposuction alone accepting that the postoperative flatness will be much improved even if it is not ‘washboard’ tight.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I read your comment on floating belly button.  I saw a plastic surgeon recently who said it would be best for me to repair my abdominal muscles all the way to top, float the belly button and then reattach it right where it was as I have almost no loose abdominal skin. (mini-tummy tuck)  It sounds good in terms of a lower and smaller scar but the “cutting the cord” idea really bothers me and worse since I saw it on Youtube!  Since the belly button is sort of the center of connection for mothers, I just want to know if it is ok and safe and if it can really be reattached?  Thank you.

A: While I can appreciate your concern, you have nothing to fear. The umbilicus, or belly button, is really nothing more than a band of scar that runs from the midline of the union of the rectus abdominal muscles to the overlying skin. While it is a remnant or scar from the original umbilical cord, it serves no useful purpose other than its aesthetics….and that it would look weird if someone didn’t have one. In a mini-tummy tuck it is very common to release it from its attachment to the fascia of the muscles so it is out of the way for a complete vertical repair of the loose rectus muscles. It is easily sutured back down either to its original location or lower depending upon how much abdominal skin is removed. This is a perfectly safe procedure and I have never seen it to be a problem afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I need to do something with my stomach to make me feel better about myself. I have had two children and the last one really did my stomach in. I didn’t have any stretch marks or loose skin after my first child. But I gained 45 lbs with my second and obviously my skin didn’t like that and now I am left with some loose skin and stretch marks particularly around my belly button. I did have a plastic surgery consult about six months ago and was told that I needed a mini-tummy tuck with a ‘free floating umbilicus’. I didn’t understand what that was and I was worried that my belly button would move around so I never had the surgery. Can you tell me what that is and should I be concerned about it?

A: The fundamental difference between a full or complete tummy tuck and a mini-tummy tuck is in how much skin and fat is cut out and where this occurs. In a mini-tummy tuck this tissue removal is done below the belly button as opposed to a full tummy tuck where it is done above and includes the skin around the belly button. Thus in a mini-tummy tuck, the underlying attachment of the belly button to the abdominal muscles (technically the fascia covering of the muscles) must be released so the upper abdominal skin can stretch down and close to the lower abdominal incision. Before closure the base of the bellybutton is reattached in a new lower position, usually about an inch or so lower than where it was originally. It is only ‘free floating’ for a very short period of time during surgery and is not an issue after surgery. The term free floating is both an historic and poor name which is why it is better known as umbilical transposition or relocation.  

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am 28 years old and have had 2 kids. I only gained about 25 to 30 lbs with each pregnancy but I still ended up with stretch marks on my lower stomach and loose skin around my belly button. I know that liposuction alone is not the solution for my stretch marks and loose skin. I am at a fairly good weight for me being 5’ 3” and weighing 130 lbs. Which type of tummy tuck do you think would be best for me?

A: While it is impossible to give an accurate assessment without photos, your description of your abdominal concern do make for a philosphic discussion between the two types of tummy tucks.   The conceptual difference between a mini- and full tummy tuck is that the more limited procedure produces less of a result (around the belly button area) but has a smaller and lower placed horizontal scar. The key question is which trade-off can you live with better…a flatter and more complete abdominal result but with a much longer and higher horizontal scar (full) or a less long lower placed horizontal scar but with some stretch marks and loose skin still left around the belly button area. (mini-) There is also a belly button scar difference as the full tummy tuck will have one and the mini-tummy tuck will not.  It really comes down to which aesthetic trade-off  (scar vs amount of improvement) is more important to you.

Many women will less severe lower abdominal concerns (excess tissue) do opt for a mini-tummy tuck. When combined with liposuction in the upper abdomen and around the sides of the waistline, this more limited tummy tuck approach can provide for good improvement with a very acceptable low-placed scar.

Dr. Barry Eppley

Indianapolis Indiana

Q: I am looking to have what I think is called a Mommy Makeover. I have it on TV shows and read about it on the internet. For the breast implants, I am looking to have saline implants done.  I would like them placed behind the muscle if possible.  I am not sure what my ‘true’ cup size is.  I know it is between an A and B.  I would like to be a full C to a small D.  I do need a slight lift but I am concerned about scarring. I would like the incisions to be as discreet as possible. As for the tummy tuck, I think I only need a mini-tuck.  I have a little bit of fat in my lower stomach that stays and I cannot get rid of it.  I also have a little bit of stretched skin that needs to be removed.  I am looking to have the problem fat suctioned out and the muscles to be sutured back together and the little bit of stretched out belly skin removed.  After looking at pictures and watching animated videos on tummy tuck; I realize that my tummy problem is quite small compared to majority of the pictures I have viewed.  I am a small frame as it is.  I am about 5’2” and weight about 115 pounds.

The issues I have may not seem like anything to someone else; but they are BIG to me.  I look at myself each day and do not see a young beautiful woman.  I wonder each day how in the world is my husband still attracted to me.  I am wanting to do this for my self.  I would love to love myself again! Does this sound like it can be all done in a single operation?

A: Mommy makeovers are typically a combination of breast and abdominal reshaping. Improving the very problems that being a mommy has created. Saline breast implants can be placed from a remote incision high up in the armpit that will never be seen. The most limited incision breast lift is that of the superior crescent mastopexy, also known as a nipple lift. It puts a fine line scar at the top of the nipple only right at the junction of the areola and skin. Given your body frame size, you are describing perfectly what a limited or mini-tummy tuck accomplishes.

Both breast augmentation with a lift and a mini-tummy tuck can be done in a single outpatient procedures. The combination of the two truly makes for a new body for Mommy!

Dr. Barry Eppley

Indianapolis Indiana

Q :  I have a stomach pouch that I just can’t stand. After my third child, I just could not get rid of this loose skin and fat that hangs below my belly button. Despite really watching what I eat and trying to exercise more, it won’t come off. It hasn’t budged at all in the past year. I think I may need some type of a tummy tuck. What is the difference between a mini- and a full tummy tuck?

A: Any form of a tummy tuck, also known as an abdominoplasty, removes skin and fat as well as tightens the rectus muscles. The removal of skin and the muscle tightening is what separates it from a liposuction procedure.

Most types of tummy tucks are horizontal full-thickness excisions of skin and fat down to the abdominal muscle wall. The difference between a mini- and a full tummy tuck is in the amount and location of this cut out. A mini-tummy tuck performs it below the belly button while a full  tummy tuck goes above the belly button. As a result, the full tummy tuck has a longer final scar as well as a circumferential scar around the ‘new’ belly button. The mini-tummy tuck just has a less long low horizontal scar only.

A patient’s decision between a mini- and full tummy tuck must consider a variety of factors. How long a scar can one tolerate? How much loose skin and fat does one have? Is there loose and creapy skin around the belly button? Are there any rolls of skin above the belly button? How flat does one want the stomach area to be?

The simplistic answer to deciding between a mini- and full tummy tuck is what the stomach looks like above the belly button. Only a full tummy tuck can smooth out loose skin and fat above that central abdominal marker.

Dr. Barry Eppley