Patient before and six weeks after a no-drain tummy tuck with rectus muscle repair.

“I hate my tummy! What to do?”

We hear this lament often. Problems with tummies occur from pregnancies, being overweight (and after weight loss), sun damage, and age.

Pregnancies stretch skin as well as separate the rectus muscles (the six-pack muscles), causing a protuberant abdomen and-or wrinkled skin. Stretched skin can hang over the lower abdomen. If there is excess weight gain during the pregnancy, the sagging will be worse.

Treatments can include liposuction, abdominoplasty (tummy tuck), mini-tummy tuck, reverse tummy tuck; minimal surgical treatments are liposuction with skin-tightening Renuvion, or Renuvion alone.

Fatty abdomens must be treated according to the amount of excess fat, loose skin, and if the problem extends around into the back area. Problems and treatments must be treated according to each individual’s problems.

Liposuction only removes fat with minimal skin tightening. Liposuction can be used virtually anywhere from the ankles to the chin. However, the skin may need to be tightened as well.

Tummy tucks remove excess fat and skin and tighten the rectus muscles as well, and are usually accompanied with a liposuction of abdomen, sides and back.

If sagging skin and fat extend around the body, a procedure called a “belt” or “circumferential lipectomy” can be done. This extends around the patient and tightens the abdomen as well as the outer thighs and buttocks. Results are usually dramatic.

Tummy tucks leave scars across the lower abdomen, usually covered with a bathing suit, and a scar around the belly button. There should never be “stitch marks.”

The latest tummy tuck technique eliminates the need for drains. This technique requires special suturing called progressive tension sutures. The recovery time is much less, as is the discomfort.

A reverse tummy tuck is for a patient with loose skin and wrinkles only in the upper abdomen. The scar is placed in the creases under the breasts. The skin is pulled upwards and excess skin is removed, tightening the skin.

Basically, tummy tuck options require elevation of the skin to be removed, performing whatever needs to be done while the skin is elevated, and then excising the extra tissue.

The latest minimal surgical technique for a loose abdomen is the Renuvion. This involves inserting a probe under the skin using either local or general anesthesia and tightening the skin with heat from a combination of radiofrequency and helium. This causes instant shrinkage of the fibers that connect the skin to the underlying muscles, which both shrinks and elevates the skin.

The Renuvion can also be used to tighten skin on the back, arms, neck, breasts and thighs.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton.