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Tummy Tuck Articles 5

Subgroups of Tummy Tuck Patients

Patients anatomically can be grouped into types I, II, III, IV. A type I patient has good skin elasticity, good muscle tone, no diastasis, and isolated lipodystrophy. A type II patient has mild lower abdominal laxity, diastasis recti, and infraumbilical lipodystrophy is mild to moderate. A type III patient has moderate lower abdominal laxity, diastasis recti, and more prominent lipodystrophy (with significant striae after multiple pregnancies). A type IV patient has severe upper and lower flaccidity of skin and muscle with excess fat throughout.

Type I Patients

  • can usually be treated with liposuction alone — No repair of the musculoaponeurotic layer is needed
  • Liposuction alone uses several small access incisions in the umbilicus, at the top of the pubic hairline, and laterally within the bikini or underwear line
  • This technique allows abdominal contouring with the least amount of visible scarring

Type II Patients

  • conservative liposuction with resection of the lower abdominal skin

  • exposure of the midline below the umbilicus allows tightening of infraumbilical muscle laxity

  • the umbilical stalk is not transposed

Type III and Type IV Patients

  • The modified abdominoplasty involves elevation of a skin flap from the pubis to the subcostal margin
  • The umbilicus is transposed
  • The redundant lower skin margin is resected
  • Fat resection is performed sharply rather than by liposuction
  • The fascial midline is tightened to address muscle laxity both above and below the umbilicus
  • Closed suction drains and compressive dressings are used

Type IV Subtypes

In patients who have undergone bariatric surgery, the midline scar can be used to make a vertical midline incision to tighten the upper waist and flanks in the horizontal direction. During the consultation, Dr. Hughes will help you make the decision for circumferential body lift if needed to address posterior redundancy as well as need for concomitant thigh improvement.