Our skin’s ability to extend without leaving stretch marks when we gain weight and stretch without sagging when we lose weight depends essentially on structural and genetic factors. While excessive weight gain and loss and pregnancy causes skin loosening on the entire body, most commonly deformed areas are breasts and the abdominal area. Excess skin, sagging and stretch marks of the abdominal area are not affected by diet and exercise. While diet and exercise are favorable to the reduction of excess fat tissue accumulation in this area, the only effective and long-lasting method to remove excess skin is abdominoplasty (tummy tuck) surgery. Men and women with otherwise regular body contours who have abdominal skin loosening are candidates for this operation. Abdominoplasty is particularly effective on women who gave birth several times, whose abdominal area has stretch marks, skin loosening, and weakened abdominal muscles. Abdominoplasty is a surgical procedure aiming to remove excess fat and loose skin of the abdominal area by tightening the muscles of the abdomen; it is not a weight reduction surgery. Overweight patients should lose as much weight as they can before this operation.The appearance of prominent tummy and abdomen will dramatically improve, however the scar is permanent. There are many abdominoplasty techniques used by plastic surgeons. Abdominoplasty may be done with surgeries aiming to re-sculpt the body contour (breast enhancement surgeries, liposuction etc.) or other surgeries (such as tubal ligation, surgeries of the uterus, ovaries, etc.) In the event the patient cannot lose much weight and if the fat tissue accumulated underneath the excess skin in the abdomen is limiting the body movements, this surgery can be planned for functional reasons in addition to aesthetic purposes. An abdominoplasty surgery will improve your appearance and your self-esteem. Before deciding on the operation, you should carefully evaluate your expectations and discuss them with your surgeon.BEFORE THE OPERATIONYour surgeon will have some requests during this period. Especially if you are a smoker, you should consider quitting 4 weeks before and 2 weeks after the operation. During the same period, too much sun exposure should also be avoided. You should avoid taking vitamin E and aspirin if you usually do, and heavy diets. During your first consultation, your surgeon will determine your general health status, fat volume and distribution in the abdomen, excess volume and loosening of the abdominal skin and the skin quality. During this consultation, you should inform your doctor about your past illnesses, current health issues (diabetes, etc.), habits (smoking, drinking etc.) and any medication (aspirin, tranquilizers etc.) in a correct and detailed manner. Other subjects to discuss with your doctor are the reasons why you want this surgery and your expectations. Do not hesitate to discuss these subjects openly. You may be a candidate for a full or mini-abdominoplasty alone, accompanied by liposuction, or only a liposuction surgery may be sufficient for you.OPERATIONThe operation is performed under general anesthesia, in a hospital environment. Abdominoplasty takes 2 – 2.5 hours depending on the extent of the surgery. It often requires an incision that extends from one thigh bone to the other however concealable underneath a bathing suit or a bikini, and a second, round incision around the belly. If the patient has an existing C-section scar, this scar is generally extended on both sides. During the operation, the skin of the abdomen is loosened from the inguinal area to the rib level by the muscles underneath. Any weakness of the abdominal muscles, or hernias is consolidated, excess skin and the fat tissue underneath is removed with incisions. Following the operation, the area is closed with hidden (intradermal) sutures and is covered with a dressing. To evacuate excess fluid that may accumulate in the area, one or two tubes called drains are placed under the skin. A special corset that the patient is required to use for 3 weeks is put on at the end of the operation. The drains are usually taken out the next day, or the patient is discharged after a 1 night stay.POST-OPERATIVE PERIOD During the first few days following the operation, swelling and pain (manageable with painkillers) may occur in the abdominal area. Compared to a C-section, most of the patients state that the abdominoplasty is much less painful. This is correct; although the scars are longer, this surgery does not involve the abdomen, nor internal organs such as the peritoneum or the uterus. It may take several months before you feel like you used to. You may go back to work a week – 10 days later. The scar may seem to get worse during the first 3 to 6 months however it is normal, the flattening and discoloration of the scars may take 9 months to a year. Although the scars cannot disappear completely, they may be concealed under a bikini bottom. The abdominoplasty procedure yields perfect results in patients who have abdominal muscle weakness or loosened skin. Most of the patients can keep the result of the operation for years with regular exercise and diet.WHAT ARE THE RISKS?Hundreds of abdominoplasty surgeries are performed each year. The results of this operation, when performed by a plastic surgeon specialized in body contouring, are generally satisfactory. Every surgical procedure has a certain amount of risks and the most important point is for you to understand the ones related to abdominoplasty. When accepting the surgical procedure, it is crucial for the individual to consider the benefits and the risks of the surgery. Although many women or men do not encounter the complications below, you should discuss the possible complications and their consequences with your plastic surgeon until you are certain you understand them. With a correct preoperative examination and evaluation, when performed in an appropriate hospital environment by a plastic surgeon, complications such as infection and bleeding are rarely observed. Delay in healing, or bad healing may occur, and may result in scars. A small secondary surgery may then be necessary. Skin loss and scarring complications are observed more often in smokers. In conclusion, I suggest this surgery to potential candidates when their general health status is favorable to the operation, considering that hormonal changes, including age and menopause, cause fat increase around the abdominal area and this situation becomes particularly noticeable and uncomfortable when combined with excess skin.