Susie is 43 years old, and used to be fairly fit and thin. Until she had children, she could wear form fitting clothing and felt that she looked pretty good. After her second child—a nine pound boy-her waistline totally disappeared and she had an overhang just above her C-section scar.She hated the “ppoch” that poked out front-looking like she was still pregnant. Pro-fit International offered her a “Mommy Makeover” class, and promised that the tummy bulge, expanded waistline, and skin overhang would respond in just “twelve short weeks” if she took personal training fitness classes three times a week. Jason measured her waist and hips with a tape measure and a skin caliper. She was weighed and BMI’d, body fat was calculated, and she was told that her “near obese state”—with a BMI of 30.6—would respond to a low calorie diet high in protein, and intense workouts.
Four weeks later, after working out five days a week, three with an expensive personal trainer—Susie is frustrated. Her second measurement session shows little improvement—and she can swear Jason is pulling the tape measure tighter in order to demonstrate a reduction in inches. Her skin still hangs over her C-section scar, and her weight has actually increased by two pounds. Jason talks her into adding Zerona laser light therapy to her sessions in order to achieve more of a change.
At twelve weeks, Susie has lost four pounds by sticking to an 800 calorie a day program. Her trouble spots are still there, and while she looks a little better in her clothes, she still has no waistline, her central “pooch” is unchanged, and she has even more lax skin that hangs over and creates a bulge in her swimsuit and underwear.
She feels she has wasted her money, although Jason swears that her BMI is now under 30 and she has lost two inches in her waist. She does not see the results she hoped for, and has given up—all that money and effort with no real change in the things she hated about her tummy!
What happened?
Although exercise and diet can do some amazing things, rehabbing a tummy stretched out by pregnancy is not one of them. It is a rare mom that looks the same after having children. Skin stretches out—a lot—and rarely “snaps back” to its original state. The muscles in the center of the abdomen are pushed apart in order to let the tummy expand—and the tissue between the muscles rarely snaps back completely, either. If a C-section is done, the loose skin tends to overhang the tight scar. No diet or exercise will fix torn, stretched-out, or damaged tissue. Going to the gym can tone muscle, but a 1998 study by the Federal Trade Commission showed that women rarely respond to exercise with fat loss.
While men tend to have intra-abdominal fat, women accumulate fat under the skin.Intra-abdominal fat is more “dietable”. Predictable areas where fat tends to accumulate are the abdomen, inner and outer thighs, flanks, upper arms, and back rolls. Genetic fat distribution patterns are often seen. If your mom or grandmother “carried her weight” in her breasts, tummy, or hips, you may too.
Extreme dieting with portion control and calorie restriction can help reduce these subcutaneous fatty deposits—but that may not be a sustainable practice. “Spot reducing” just does not work—no amount of situps will give you that flat tummy you crave. Sadly, men can do it with diet and exercise much more easily than women can.
So, what is the solution? For many women who have completed their family, a tummy tuck is the only thing that can permanently correct damage from childbirth. This used to be considered “big” surgery, but techniques have evolved and this is commonly done on an outpatient basis by plastic surgeons using certified freestanding surgery centers. The main factor in helping tummy tuck patients stay out of the hospital has been the introduction of the pain pump—two IV type catheters that go under the skin near the rib cage, and have multiple tiny little holes inside that drip long acting local anesthetic. With postoperative pain greatly diminished, and without the disabling side effects of heavy narcotics, abdominoplasty patients can minimize postoperative discomfort and can recover safely at home.
Without an abdominoplasty, which repairs the central muscle damage, removes excess lax skin, and enhances the waistline, the issues tend to worsen with age. Liposuction alone may reduce fat, but then skin laxity is worse. Liposuction will not pull the waist back in or fix that central protrusion—there is no flat tummy in most cases with a lesser procedure.
Many patients worry about the scars, which can extend beyond the hipbone, and are also located around the belly button. Usually these scars fade within a year, and may be difficult to detect. Some people who do not scar well can have more prominent scars. There is some permanent numbness associated with tummy tucks; the numbness is very similar to that of a C-section.
While there are drawbacks with any surgery, the restoration of a flat tummy is a big self-esteem booster. A visit to your board certified plastic surgeon will help you to decide if this procedure will help fix your “loosest” trouble spot.