The abdomen is one of the areas of concern that most of my patients interested in body contouring ask me about. For the purposes of this article, the abdomen is the area extending between the ribs, pubic bone, and hip bones laterally. Next to the hipbones is the love handle or flank region that melds with, and bridges the abdomen with the back area.
The most commonly presented complaints are:
- Shape of the abdomen- rotund/not flat
- Stretch marks/scars
- Excess skin and fat.
All of my patients seek correction with a technique that minimizes scars, reduces recovery, minimizes risk, and of course, is cost effective. These are most certainly my goals. And patient safety is always my number one concern.
Choosing the Correct Body Contouring Treatment
To better understand the unique structure and properties of the abdomen, think of an onion and its layers. In the case of the abdomen, the layers are skin, fat, and abdominal strength/muscle layers. You must consider all three layers before choosing an appropriate treatment.
Layer 1 – The Skin
The skin condition is a crucial factor in considering body contouring. If the skin is thick, has no stretch marks, is youthful in appearance, and is not redundant, — e.g., no flap or skin/ fat apron — you can expect the skin to shrink if you were to perform liposuction. On the other hand, you may actually make poorly elastic, thin, and redundant skin that hangs over the belt worse with liposuction if you do not remove the excess skin.
Layer 2 – The Fat Pad
The thickness of the fat pad over the abdomen is a second, very important contributor to the abdomen’s appearance. If the fat pad is moderately thick, the patient may be an excellent candidate for liposuction alone. However, some fat must be left to ensure the skin can glide over the muscle layer and provide enough padding. For optimal results, the skin quality must be good — i.e., the skin should be able to shrink to its smaller contour — and you must not excessively stretch the abdominal strength layer.
Layer 3 – The Strength Layer
Perhaps the least understood and most important contributors to the overall shape of the abdomen is the strength layer. This layer envelops the abdominal muscles. Also called the Fascia, this layer is strong, but inelastic. Once stretched, the fascia may not return to its original shape and size.
The fascia acts like an internal girdle and foundation of the abdomen. It acts like a girdle by shaping the abdomen and flank region. It also serves as a foundation supporting and shaping the superficial fat and skin layers above.
When the strength layer stretches — e.g., from weight gain, or pregnancy — the internal girdle effect weakens. The strength layer then becomes rounded, which causes the fat and skin layers to also become rounded. It’s common for physically fit women with little abdominal fat to still have a “pooch” caused by a stretched fascia.
In Part II, we will begin to discuss body contouring options starting with liposuction.