Should I have Liposuction, an Abdominoplasty, or Both?


Dr Bernard Beldholm

Many patients aren’t sure if they need liposuction or a tummy tuck. One removes fat; the other tightens loose skin. Deciding to have liposuction, a tummy tuck, or both depends on how much loose skin and fat you have, age, and your desired result.

This article helps you understand what lipo and tummy tuck surgery can do for you. You’ll learn what each procedure does. Liposuction and tummy tuck pros and cons are explained. We’ll also cover the safety and effectiveness of combining the two procedures in one surgery.

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Liposuction vs tummy tuck surgery

Let’s start by defining liposuction and tummy tuck surgery. Both are body contouring procedures, but they provide different results. This section helps you understand what each procedure is for.

What is liposuction?

Liposuction provides surgical fat reduction. It is a body conturing procedure that is done to reduce body fat. Liposuction works well to remove a small pocket or bulge of fat. Many people have stubborn fat rolls on the abdomen, even after reaching a stable weight.

Lipo gets rid of fat by suction. It suctions away the fat using a cannula. A cannula is a hollow needle. The fat is injected with a solution to make it swollen and firm first. This makes it easier to target fat cells, without disrupting tissue nearby.

Doctor Bernard prefers VASER liposuction. It uses ultrasound energy to liquefy fat first. This makes it easier to remove the fat with suction. It lowers the risk of blood vessel and nerve injury, compared to traditional lipo. This results in less bleeding, bruising and pain.

Liposuction can be done on nearly any body part. Many patients seek abdominal liposuction, since most people store excess fat on the tummy. Note that lipo is not a weight loss procedure. It is also not a substitute for diet and exercise. Patients should reach a healthy weight before having liposuction to remove stubborn fat pockets. Lipo puts the finishing touches on your body. It provides a more shapely, contoured figure by removing small fat bulges.

What is a tummy tuck?

A tummy tuck (abdominoplasty) is a skin removal surgery. It gets rid of extra skin on the abdomen after weight loss or pregnancy. Hanging skin folds make the abdomen look bulky and shapeless in clothes. Abdominal skin reduction fixes this problem. It also helps to fix separated ab muscles that stretched due to obesity or pregnancy.

Skin tightens naturally after weight loss or pregnancy, but only to a degree. No amount of diet or exercise can reduce hanging skin. If you still have loose belly skin one year after pregnancy or weight loss, then it is time to consider a tummy tuck. This procedure tightens abdominal skin. Once the skin folds are gone, you will look much better in clothes. Your abdomen will look more youthful and taut.

Like liposuction, a tummy tuck is not a weight loss procedure. It only removes loose skin. A standard tummy tuck does not reduce fat. A tummy tuck won’t make you skinny. You should reach a stable body weight with diet and exercise before tummy tuck surgery.

Weight loss after pregnancy or obesity often causes loose skin. With the fat gone, your skin may look deflated. That is why people get a tummy tuck. It surgically removes hanging skin that remains after reaching a healthy weight.

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Should I have lipo, a tummy tuck or both?

Liposuction removes fat. A tummy tuck tightens loose skin. If you have loose skin and fat on the abdomen, a tummy tuck with lipo may be the right choice.

Who is a good candidate for liposuction?

Liposuction helps you get rid of a small area of fat. It is great if you have a pinch of fat or fat roll that won’t go away with diet and exercise. Liposuction does not tighten loose skin. If you already have loose skin on your tummy and sides, then abdominal liposuction can make it worse. If you have a small amount of belly fat and you’re not worried about the skin becoming looser, then liposuction may be an option.

Who is a good candidate for a tummy tuck?

A tummy tuck helps you get rid of loose skin on the abdomen. It is ideal for post-weight loss patients that have reached their goal weight. Tummy tucks are also popular after pregnancy. Being obese or pregnant in the past causes saggy skin after you lose the weight. If you grab a roll on your tummy, and it is mostly loose skin (rather than fat), then a tummy tuck is what you need.

Who is a good candidate for a tummy tuck with lipo?

Many patients have loose skin and fat at the same time. You can have a tummy tuck with lipo if both are present on the abdomen. Combined procedures such as a tummy tuck with liposuction improves your body in two ways — all in one surgery.

Pros and cons: Liposuction vs tummy tuck

Let’s discuss the pros and cons of each procedure before you make a decision.

Liposuction pros

Liposuction shapes the abdomen by removing fat. It gets rid of fat that won’t go away with diet and exercise alone.

Compared to tummy tuck surgery, there is far less downtime. The risk of liposuction complications is lower than a major surgery, such as a tummy tuck. Lipo also costs less than abdominoplasty cost. However, lipo only removes fat. It won’t tighten skin much.

Liposuction cons

Liposuction only reduces fat. If you have hanging skin on the abdomen or stretch marks from pregnancy, lipo won’t help If you have torn abdominal muscles from pregnancy, liposuction does nothing to fix it.

Lipo also does not tighten loose skin. If you already have loose skin, it can make it look worse. Once the fat is removed, your skin may appear looser. The biggest problem with liposuction is that it relies on your own skin to tighten around the new body shape. If you’re young (20s or early 30s) with good skin elasticity, that is usually not a problem — unless you have loose skin from pregnancy. Youthful, elastic skin tightens around the new shape with ease.

Think of it like emptying a balloon

Age and skin elasticity may affect liposuction results. Patients aged 35 and older need to be cautious if they are removing a large amount of fat with lipo. Doctor Bernard says older patients should think of the body like a balloon. Instead of a balloon filled with air, let’s say it is filled with fat. When the balloon is full, the skin looks nice and tight. Lipo is like emptying a balloon. When you empty the balloon, it deflates. It gets wrinkly and loose. It looses tightness. So that’s what happens if an older person with poor skin elasticity has a lot of fat removed with lipo. It is not a good cosmetic result. A tummy tuck with lipo is a better choice.

Tummy tuck pros

There are many tummy tuck benefits. Mainly, it gets rid of excess skin. Your tummy looks tight after the procedure. It also repairs separated ab muscles — a common side effect of pregnancy or past obesity. When excess skin is removed, some stretch marks are removed as well.

Tummy tuck cons

A tummy tuck may be appropriate if you have excess abdominal skin. However, there are some factors to keep in mind. It is a major surgery. It takes a long time to recover. There will be a tummy tuck scar on your lower belly. The scar is hidden in clothes and swimwear. Scar fading takes time. Scar treatments and Laser Genesis help scars look better, but the scar will never totally disappear.

Liposuction has a faster recovery time, costs less, and lipo scars are smaller. However, lipo only reduces fat; It won’t fix hanging skin on the abdomen. Nor will it fix ab muscles. Lipo does not get rid of stretch marks, either.

What if you have loose skin and fat?

If you have excess skin and abdominal fat, you’ll need a combined procedure. A tummy tuck with liposuction provides two great results in one surgery.

Can I have a tummy tuck and lipo at the same time?

Yes. It is safe and effective. A tummy tuck with lipo achieves better fat reduction and skin tightening than either procedure alone.(1,2,3)

Is it safe to have a tummy tuck with lipo

Yes, according to current medical research. In the past, it was not considered safe to have a tummy tuck and lipo together. This thinking is outdated, according to Doctor Bernard. New research shows that a tummy tuck with liposuction may lower the risk of tummy tuck complications and tissue trauma. (1,2,3) Most experts agree it is safe. For patients with loose skin and fat on the abdomen, it is common practice to have a tummy tuck and liposuction at the same time these days.

In the past, tummy tucks did not include lipo

Old tummy tuck methods only removed skin folds. Loose skin was tightened, but liposuction was not included in the surgery. Surgeons just removed loose skin and repaired separated abs, but the belly fat remained.

For patients with loose skin and abdominal fat, the results were good…but not great. Things are different today. A Lipo-abdominoplasty to remove loose skin and fat at the same time. The procedure involves cutting off extra skin and shaping the abdomen with liposuction fat removal.

The Lipo-abdominoplasty (tummy tuck with lipo)

This is the way Doctor Bernard performs the Lipo-abdominoplasty. An incision is placed on the lower abdomen. First, he removes belly fat with liposuction. Fat removal is done on the tummy, love handles, and sides, depending on where you need it. He spends nearly two hours on liposuction.

Doctor Bernard uses the latest VASER lipo technology. Skin is dissected up to the ribs. Ab muscles are tightened by stitching them together. Next, he pulls the skin down, toward the pubic area. Excess skin is cut away. Any stretch marks that happen to be on the loose skin are removed as well. The incision is closed with sutures.

I can’t decide if I need a tummy tuck, lipo or both

It’s a big decision. Many patients go back and forth. You may feel unsure whether a body contouring procedure is right for your needs. Doctor Bernard is here to guide you every step of the way so you can make an educated decision.

Quick guide to body contouring

If you have trouble deciding which procedure is right for you, ask yourself the following:

  • Do you have stubborn fat rolls on the abdomen? (LIPO)
  • Are you bothered by loose abdominal skin? (TUMMY TUCK)
  • If you pinch your abdomen, is there loose skin, fat, or both? (EITHER)
  • Is your skin youthful and firm? (LIPO)
  • Is your skin sagging and inelastic? (TUMMY TUCK)
  • Does your skin snap back into place quickly after you pinch it? (LIPO)
  • Were you pregnant or obese in the past? (TUMMY TUCK)
  • Do you have stretch marks on the lower abdomen? (TUMMY TUCK)
  • Have you been diagnosed with diastasis recti? (ab muscle separation) (TUMMY TUCK)
  • If not, do you see a gap between the ab muscles? (TUMMY TUCK)
  • Do you still look pregnant, years after giving birth? (TUMMY TUCK)
  • Do you want to get rid of fat rolls and loose abdomen skin? (TUMMY TUCK WITH LIPO)

I still need help choosing

Doctor Bernard can help you choose the right procedure at your consultation. A consultation allows him to perform a physical exam of the abdomen. The amount of loose skin and fat is assessed. You’ll have a chance to voice your cosmetic concerns at the consultation. Doctor Bernard is a compassionate surgeon and skilled listener.

What else should I consider?

Your cosmetic goals are always considered. In addition to the results you hope to achieve with body contouring, your budget and downtime preferences are also discussed at the consultation. Doctor Bernard answers all your questions. If you are a candidate, he will design a treatment plan just for you.


Deciding to have liposuction, a tummy tuck, or a combined procedure depends on whether you have loose skin, fat or both. Your age, skin elasticity, budget and downtime are also factors that Doctor Bernard considers when creating a treatment plan just for you. No matter which procedure you choose, it is his goal to deliver a great cosmetic result.


  1. Smith, Lane F., and Lane F. Smith. “Safely Combining Abdominoplasty with Aggressive Abdominal Liposuction Based on Perforator Vessels.” Plastic and Reconstructive Surgery, vol. 135, no. 5, 2015, pp. 1357–1366., doi:10.1097/prs.0000000000001200.
  2. Sozer, Sadri Ozan, et al. “Abdominoplasty with Circumferential Liposuction.” Plastic and Reconstructive Surgery, vol. 142, no. 4, 2018, pp. 891–901., doi:10.1097/prs.0000000000004819.
  3. Vieira, Brittany L., et al. “Is There a Limit? A Risk Assessment Model of Liposuction and Lipoaspirate Volume on Complications in Abdominoplasty.” Plastic and Reconstructive Surgery, vol. 141, no. 4, 2018, pp. 892–901., doi:10.1097/prs.0000000000004212.
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