Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica. Hello and welcome. Dr. Stephen Mulholland here in Toronto, Canada On Plastic Surgery Talk with our latest installment of our podcast series, Tummy Tuck versus Lipo. What are the differences, how are they integrated, how can they work together, and how do they work separately? There’s a lot of misconception around when is lipo used to contour a tummy and when do you need a tummy tuck? There’s a lot of misinformation, and misunderstanding about what constitutes a tummy tuck and what are the different types, and on the other hand, what kinds of lipo are out there, and what kind of lipo is best for you? In general, a tummy tuck is distinguished by surgically removing and altering the skin, the muscle, and/or the bellybutton. So a classic tummy tuck will be removing loose skin and fat from the lower part of the abdomen, stretching the new skin down to create a tautness, tightening the muscle that may have been loose and separated by weight gain, weight loss or multiple children or multiple parity, and by making a new bellybutton. Those are the three cardinal features of a classic tummy tuck.
Now not all tummy tucks need to include all three of those, so we can start with the least invasive kind of tummy tuck, just a skin pinch. What’s a skin pinch? The skin’s lifted up a little at the bottom, usually very low down, like below a C-section in the pubic area. We lift the skin up, do a little bit of advanced liposuction of the upper abdomen, and then pull a bit of skin to tighten the skin at the lower part of the abdomen, because there’s often there below the belly button, where a lot of loose skin exists. And women don’t need a full tummy tuck, but rather a little, minimal skin pinch. That can often be done under local anesthesia.
The second step up would be a skin pinch tummy tuck with a tightening of the muscle below the bellybutton, or a limited short scar abdominoplasty and leaving the bellybutton alone with doing advanced liposuction techniques above the bellybutton.
The third level of tummy tuck would be your standard tummy tuck. Lift the skin up, tighten the muscle, remove some skin, pull tight and make a new bellybutton.
The last kind of a tummy tuck would be a more extended, the extended tummy tuck. The incisions go around the hip bones and around the back to pull down loose flank tissue as well as tummy tissue.
Under the mini tummy tuck or skin pinch you could add endoscopic or telescopic tummy, where there’s not much loose skin at all, just a bunch of muscle that’s separated and a young woman might have this tight skin, one pregnancy. She’s gotten back in shape, there’s no fat but she has a big bulge that looks like a second trimester pregnancy because the muscles are separated. We don’t have to remove much in the way of skin, There’s really not much lipo to do, and we can simply put a telescope up through a little incision above the pubic hair and tighten the muscles. So there you can see five or six types of tummy tucks that need to be adapted to the particular patient in front of the surgeon.
Liposuction involves no cutting away of tissue. All it involves is using a technique that extracts fat through a very small port. Generally we swell up the fat with some fluid called tumescent fluid which renders that that anesthetic and numb and then separates the fat cells, and then we can either directly remove it with Use of a suction cannula that can be motorized or non-motorized, or more commonly now for the past eight or nine years, we’ll put a device into that fat that’s been swollen with the tumescent fluid and we’ll heat up the fat. We’ll heat the fat to liquefy it, to make extraction easier. We’ll heat up the fat to get contraction of the skin so the skin looks tighter when the fat’s removed and not subject to post-liposuction laxity. Those heating techniques have moved beyond ultrasound which is called Vaser that was done a decade and a half ago to the last 12 years or so, when we’ve used a laser internally that’s called Smart Lipo, or the past six or seven years where the most powerful contraction technology out there, radio frequency, has been used to liquefy fat and tighten skin just before the aspiration, and that is called BodyTite.
BodyTite lipo is the admission of electrical current into the fat to liquefy it, to tighten the skin, and after about five or six minutes of BodyTite, then we remove the fat through traditional cannula techniques, but the difference is that fat is now liquefied. It’s like a mango smoothie, like we’re removing a smoothie gently with very little bruising and swelling. Bruises that techniques you might have seen on shows like Nip/Tuck and Extreme Makeover 20 years ago, those are of historical interest. Generally, modern surgeons will use techniques like BodyTite and SmartLipo, or even Vaser Lipo, to liquefy, soften the fat, tighten the skin, and then remove the fat at the same session towards the end, making a much more gentle procedure, a procedure that has less pain and discomfort and bruising, but most importantly, good contraction for good skin tone.
Now, can you combine a tummy tuck and lipo? Absolutely. So a lot of the mini or limited versions of a tummy talk allow you to do extensive BodyTite lipo on the upper tummy, on the flanks and on the hips, or the bra line so you can get a circumferential improvement, tightening skin on the bottom, reducing fat on the top and the sides and the back to get a three-dimensional 3-D circumferential improvement in contour and shape as well as tightening of the abdominal skin that might that might be lax. So combining liposuction and tummy tuck is frequently done.
There is a slight increased risk in combining liposuction and tummy tuck, and these two procedures themselves are reasonably invasive, so you want to make sure you see a well trained, certified plastic surgeon who works out of a certified surgery center, that the right amount of fluid resuscitation, blood thinning, perioperative and postoperative care is followed to make yours a very, very safe journey. You can make an astounding difference in a mommy makeover that combines a little bit of a tummy tuck, some lipo, and a breast augment that’s going to be done safely and effectively to ensure that you can thrive to enjoy that outcome and have a procedure that you can confidently say is going to be safe and effective at delivering your aesthetic goals without providing excessive risk on your wellness and safety. Choose your plastic surgeon, choose your center, and then pick the right combination of skin removal, muscle tightening, fat contouring, and bellybutton shaping, to give you the best possible post-mommy makeover.
So tummy tuck, lipo, we have a better sense of what’s involved, what’s about pricing? In general, liposuction is charged depending on the surgeon’s experience, the kind of technology they have, high-tech, BodyTite, Smart Lipo, Vaser, or basic lipo. The city that you live in, the competitive prices in that city, and the surgeon’s perception in the marketplace. So in general, most surgeons charge by the area. In Canada and the United States, you’ll find most single site lipo, SmartLipo, BodyTite lipo, is going to be somewhere between $4000 and $8000 for the first zone. And then there’s a sliding scale, depending how big you are and how much fat. There’s going to be less and less for the second, third, fourth, and fifth zone.
What are the legal limits that you should be safe about when doing liposuction? In general, most jurisdictions in Canada and the United States have a loose or a fixed regulation of five liters of combined aspirant. That’s the combined infernatant and supernatant. So it’s the fat plus the tumescent fluid and serum or blood that you get back. So combined aspirant five liters. Usually it works out to about 3 liters of fat to 3 1/2 liters of fat and 1 to 1 1/2 liters of tumescent fluid that you’re aspirating back. Some states, for example New York State, very regulated on our patient ambulatory lipo. You can’t take any more than 500 cc’s of fat in a patient under local that’s going to be leaving your office. Check the regulations where you live and where the surgery is performed, but in Canada, for most provinces, 5 liters of combined aspirant is the legal limit.
In my practice, if I’m taking anything more than 2 liters of combined aspirate, I make people stay overnight in a 24-hour stay fully monitored environment where fluid resuscitation, replacement, and blood thinning are standard practices to minimize the risk of pulmonary emboli, DVT, things that could be serious following liposuction and generally extremely rare if postoperative care is followed appropriately.
Tummy tuck is not generally priced by the zone because it’s working only on the tummy, the bellybutton and the muscle, but by the amount of work needed to be done. Is it a skin pinch, is it a standard tummy tuck, is it an extended tummy tuck? So most tummy tuck ranges, depending on the type of tummy tuck will be somewhere between 4000 and 5000, and upwards of 14,000 or 15,000 depending on how much tissue, how much muscle, and how much work needs to be done on your bellybutton in order to accomplish a good aesthetic outcome. So thank you for joining me, Dr. Stephen Mulholland here, Toronto, Canada on Plastic Surgery Talk, where our podcast today was on the differences between liposuction and tummy tuck, sometimes a confusing question for let’s say, the novice or first-time plastic surgery patient. If you found this to be educational or informative, please share this on your social media channels, have fun, be safe, and we’ll see you back on our next installment of Plastic Surgery Talk podcast series.