Typically, the requestor is a woman (which doesn't surprise us, and as female plastic surgeons, we totally feel it ourselves and sympathize wholly). There are basically two camps of patients: folks who have lost a bit of weight (either through diet and exercise or with medical/surgical assistance - like lap-bands or gastric bypass) and moms who are done having babies.
People who come to us at Duet for a tummy tuck consultation aren't conceding defeat to fat. Believe me, these patients are in great shape, highly motivated, with super-active careers. They may still be hanging on to that pesky extra five or ten pounds, but they are not fat. They have come to our office because they finally realize that no matter how many crunches or how healthy their diets, the little (or big) pooch that hangs beneath their belly button is not going away.
Exhibit A:
This is what prevents us from wearing the size of skinny jeans we truly are. This is what morphs into the dreaded "muffin top". This is where the bulk of those ugly stretch marks live. But why?
Like the saggy upper arms and brachioplasty discussed last week, it's mostly a skin problem. Those blessed with youth and good genes can get rely on our skin's inherent elasticity; the rest of us suffer with skin that doesn't go back to the way it was before the pregnancy or weight gain. The severity is exaggerated in many of our gastric-bypass patients, who have lost weight so quickly that their skin couldn't keep up, resulting in unflattering sharpei-like folds.
Luckily (hmmph?) for us women, we can blame one more culprit for the loss of our figures: pregnancy. As the uterus expands to accommodate the growing bundle of joy, the belly stretches out as well - not just the skin, but everything underneath as well:
Top to bottom, outside in: the skin of your belly stretches (epidermis and dermis; when the latter tears, we get stretch marks), as do the underlying fat and abdominal wall. Unfortunately, that abdominal wall (the six-pack of rectus muscles plus the enveloping fascia) doesn't have a lot of resiliency, resulting in this problem:
See how the belly goes from softly rounded in the relaxed photo on the left to sort of pointy in the photo on the right (taken while flexing in a sit-up)? That, ladies and gentlemen, is the abdominal diastasis.
Not quite a hernia (where your bowels are seeking to escape through an actual opening in the abdominal wall), but close - your abdominal contents bulge at an area of weakness. This particular area of weakness associated with pregnancy is the space created by your six-pack muscles moving farther apart to accommodate the growing fetus.
Exhibit B:
Don't get me wrong. This is great for the baby, but once mom's ready to move on, the fascia is too stretched out, the muscles don't return to their original position, and mom gets a poochy, flabby waist that contributes to the thick appearance of the belly.
So we've got a skin problem, a muscle/abdominal wall problem, and maybe a teeny little fat problem. What's a girl (or guy) to do?
Stay tuned for next week's Friday Figure Fix: all about abdominoplasty.
