Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Not all fat is created or treated equal.

Seattle Plastic Surgeon blogs about the importance of distinguishing belly fat a.k.a. visceral fat from subcutaneous fat.  Pull up a chair.  This is going to be a long one.

Abdominoplasty a.k.a. tummy tuck is a BIG operation and it is in every ones best interest to do everything possible to make sure that the surgery is safe and effective.  Careful patient selection is the key.

Abdominoplasty does several things:

  • Tightens the muscle layer by pulling the two rectus muscles together in the midline.
  • Removes the excess skin of the abdomen.
  • Removes the excess fat between the skin and the muscle.
  • Fixes a ventral or umbilical hernia (if present).

One really important thing that abdominoplasty does not do:

  • Remove the excess fat inside the abdominal cavity, so called visceral or belly fat.

Take a look at this before and after photo.  Depressing, huh?  BTW – this is NOT my patient!

My guess is that this patient is not very satisfied with her result.

This patient had mostly visceral fat and this fat resides inside the abdomen.  It surrounds the intestines, infiltrates the liver and collects in a structure called the omentum.  The only way to reach this fat is to go inside the abdomen.

Even if the surgeon were really, really aggressive and went inside the abdomen, it still would not be possible to remove this fat.  The structures that collect the fat are either vital organs or carry the blood vessels to vital organs.

So how does one get rid of belly fat?  Not with surgery but rather with weight loss.  As a patient loses weight, the belly fat melts away and the abdomen becomes flatter and flatter.  If there is a lot of excess and loose skin left after the weight loss, then the patient likely is a  candidate for abdominoplasty.  Here’s a patient of mine that shows it very well.

In the first photo, most of this patient’s fat is visceral fat.  She wanted an abdominoplasty and I told her that she would have a lousy result and needed to loose weight first.  (This is NEVER what a patient wants to hear but it is what they need to hear from a doctor.)  She worked very,very hard to change her lifestyle and came back a year later having lost almost all of her excess weight.  She looked and felt like a million bucks.  I could not have wiped the smile off her face.  She was now the perfect patient and I did an abdominoplasty and a breast lift on her and she got a really, really nice result.  We were both thrilled.  She is a great success story and has kept her weight off.  She really has a whole new life.

I can take credit for about 10% of her new life.  She did 90% through diet, exercise and changing her whole lifestyle.  She not only looks so much better, she feels better and is in much better health.

So when I say “no”, and believe me, saying “no” is hard to do, it is because I don’t want a patient to go through the expense, time, discomfort and risk for a really, really mediocre result that they will likely be unhappy with.

Thanks for reading.  Dr. Lisa Lynn Sowder.

 

 

Category: body contouring, Obesity, Plastic surgery, Seattle plastic surgery, tummy tuck | Tags: , , , , , , , ,

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