Abdominoplasty, or tummy tuck, is one of the most frequently performed cosmetic procedures, not only affecting the aesthetic appearance of the abdominal area but also restoring its structural support. In addition to aesthetic benefits such as improved abdominal wall contours and a more natural-looking navel, it also helps to bring the abdominal wall muscles and layers closer to their normal anatomy.

First performed in 1899, abdominoplasty has seen the development of many different techniques, and existing techniques have been improved and improved. The most common cause of abdominal wall deformities is pregnancy, because the skin, muscles, and connective tissue structures are subjected to a tensile force exceeding their stretching capacity. This results in thinning of the skin, loss of elasticity, stretch marks, and separation of the abdominal muscles. Post-pregnancy weight loss also worsens the condition due to the limited tightening ability of the skin. Excessive weight loss after dieting or bariatric surgery (gastric bypass, gastric reduction) also creates a similar effect to pregnancy, manifesting as excess skin, subcutaneous tissue, and laxity in the abdominal wall muscles.

Before deciding to perform abdominoplasty, a detailed evaluation and examination are necessary. The patient’s medical history, amount of weight loss, body mass index, weight changes and fluctuations, nutritional problems, treatments received, previous abdominal surgeries, frequency of exercise, and heart and lung diseases are all investigated. Patients with a body mass index above 30 or those expected to have more than 1.5 kg of tissue removed have a significantly higher risk of postoperative complications. Therefore, surgery is not recommended for such patients. During the examination, skin quality, fat tissue thickness, location of folds, muscle status, and previous scars are noted, and necessary measurements are taken.

The necessary preoperative drawings are made while the patient is standing. A marking is made 1-2 cm below the abdominal fold, in the bikini line area, with the middle section parallel to the ground and the sides extending slightly upwards. This is the entry point for the surgery and also the location of the postoperative scar. The excess skin is grasped by hand, the upper limit of the tissue to be removed is marked, and completed into an ellipse. Although various methods have been used, the most frequently used method in our clinic is lipoabdominoplasty. In this method, we first perform liposuction on specific areas of the abdominal wall; considering that lifting the entire abdominal skin from the anterior abdominal wall increases the risk of postoperative circulatory problems, we only separate the necessary portion from the abdominal wall and free the rest using liposuction cannulas. After the liposuction is completed, we make an entry into the abdominal wall from the preoperatively marked area and separate only the middle section of the abdominal skin. In this area, we bring the separated abdominal muscles closer together by suturing them, starting from the lower end of the sternum and extending to the lower abdominal border. During this part of the surgery, we mostly use an endoscope because we have to work in a narrow tunnel. Then, during the operation, we put the patient in a semi-sitting position and cut away the maximum amount of tissue we can remove without excessive tension. We create an opening in the stretched abdominal skin around the navel, which we had previously circled, to make this area painless. After all the stitches are finished, we complete the procedure with the application of a corset. In this method, liposuction prevents potential circulatory problems, and therefore risks such as wound problems and tissue loss, as well as minimizing postoperative pain by reducing bleeding, and since it also thins the remaining abdominal wall, the aesthetic results are much more satisfying.