In a national database study, cosmetic abdominoplasty was grouped with procedures that remove excess skin and soft tissue below the navel[1]. By contrast, a retrospective study of liposuction patients describes residual sagging and contour irregularities as remaining limitations of liposuction[2]. When the two are combined as lipoabdominoplasty, a meta-analysis of seventeen trials enrolling 14,061 adult patients found no evidence that the combined operation was associated with higher complication rates than traditional abdominoplasty[3].
So, if the fat were gone, would loose skin or muscle separation still remain? Why not ask a board-certified surgeon to help you answer that question during an examination?
This article was researched and written with AI assistance from peer-reviewed sources, and automatically fact-checked against those sources. It has not been reviewed by a physician. It is educational, not medical advice. Please consult a board-certified surgeon about your situation. How we write.
Liposuction is widely performed for body contouring, but residual sagging and contour irregularities remain concerns with the technique, according to a retrospective study of liposuction patients[2]. In a retrospective cohort of patients evaluated for abdominal contouring, the 20 who had abdominal liposuction only had an overall complication rate of 5 percent[4].
In that same abdominal contouring cohort, two of the 20 liposuction-only patients (10 percent) were dissatisfied and underwent further revision with full abdominoplasties[4].
In a retrospective study of 113 patients treated by a single surgeon, the 40 who had liposuction followed by helium plasma radiofrequency, a heat-emitting energy treatment intended to stimulate skin contraction, had a lower abdominoplasty rate than the 73 who had conventional liposuction (30% versus 67.1%)[2]. Complication rates in that study were similar between the two groups (2.5% versus 2.7%)[2].
A systematic review comparing laser-assisted with traditional liposuction included seven studies and reported better skin retraction with laser-assisted liposuction among the main outcomes of three studies, but the reviewers found high risks of bias that impede a more reliable conclusion[5].
If you are weighing liposuction on its own, see our guide Am I a liposuction candidate?
The national database study of cosmetic abdominoplasty covered 11,137 patients who underwent excision of excessive infraumbilical abdominal skin between 2015 and 2019, including 4,740 who had cosmetic abdominoplasty and 6,397 who had functional panniculectomy[1].
A meta-analysis comparing lipoabdominoplasty with abdominoplasty describes lipoabdominoplasty as an operation to improve body contouring and remove excess skin caused by massive weight loss[3].
One series reports that high-tension lateral abdominoplasty inadequately addresses laxity and fullness in the flank and lateral thigh, and that excess flank soft tissue often persists despite adjunct liposuction[6]. That series of 72 consecutive patients used an extended lipoabdominoplasty, called a cosmetic body lift, for patients who had not had massive weight loss[6].
For more background, see our FAQ about tummy tucks.
A continuing-education review of abdominoplasty lists rectus diastasis correction by rectus sheath plication among its learning objectives[7].
In one retrospective series of 146 patients, high definition lipoabdominoplasty was described as a technique for treating abdominal flaccidity and lipodystrophy, with correction of muscle diastasis[8]. In that series, combined surgeries were performed in 76 cases (52%)[8].
In a UK series of 286 consecutive patients who had drainless lipoabdominoplasty, the abdominoplasty included multilayer rectus plication[9].
A series of 24 male patients combined transverse plication of the abdominal wall with high-definition lipoabdominoplasty[10]. The authors of that male series note that rectus abdominis diastases are less common in men than in women, with pregnancy as the most determining factor in their development[10].
In a single-surgeon cohort comparing biplanar and standard lipoabdominoplasty, the authors postulate that patients with weakening of the abdominal wall and some fullness of the hip line would benefit most from the biplanar technique[11]. That same cohort found no statistically significant differences in complication rates, length of procedure or aesthetic outcomes between the two techniques[11].
Do you have a bulge that stays when you tense your stomach muscles? Is that something to show a board-certified surgeon during the examination?
Lipoabdominoplasty combines two traditional techniques, abdominoplasty and liposuction, according to a review of the technique[12]. That review states that traditional abdominal plastic surgery results in a high rate of morbidity because of the need for a large undermining of the flap, and that the lipoabdominoplasty approach introduced in 2001 standardized a selective undermining, corresponding to 30% of the traditional undermining, between the medial borders of the rectus abdominal muscles[12].
A literature review reports that lipoabdominoplasty has not gained widespread use because concerns exist about increased complications related to wound healing and thromboembolism[13].
A randomized clinical trial assigned abdominoplasty patients to lipoabdominoplasty, traditional abdominoplasty, or a combined technique with wide undermining and liposuction of the abdominal flap[14]. That trial found no statistically significant differences in complication rates between the groups, and liposuction, with or without wide undermining, was more effective in reducing epigastric pinch thickness and enhancing aesthetic outcomes[14].
Our article Liposuction and tummy tuck surgery offers further reading on the pairing.
A meta-analysis found fewer complications in the lipoabdominoplasty group than in the traditional abdominoplasty group (RR = 0.85; 95% CI 0.74-0.97)[3]. In subgroup analysis, the lipoabdominoplasty group had a lower incidence of hematoma (RR = 0.56) and seroma (RR = 0.69)[3].
Across all 14,061 patients in that meta-analysis, 577 (4.1%) developed seroma, 113 (0.8%) experienced hematoma, and 35 (0.2%) developed deep venous thrombosis[3]. In the same pooled group, 783 patients (5.6%) experienced wound infection, dehiscence, or fat necrosis[3].
In a chart review of 161 patients, lipoabdominoplasty had a perfusion-related complication rate of 4.30 percent compared with 11.76 percent for traditional abdominoplasty, a difference that was not statistically significant (p = 0.126)[15]. Revision surgery was needed by 10.75 percent of lipoabdominoplasty patients and 20.58 percent of traditional abdominoplasty patients in that review (p = 0.116)[15].
That chart review also found no statistically significant difference in perfusion-related complications among high-risk patients, who were active smokers or had significant scars above the navel from previous abdominal surgery[15].
In the abdominal contouring cohort of 114 patients, the 31 who had combined liposuction plus abdominoplasty had complication, dissatisfaction and revision rates of 9, 3 and 3 percent[4]. In the same cohort, the traditional W-pattern abdominoplasty group had a complication rate of 42 percent, a dissatisfaction rate of 42 percent and a revision rate of 39 percent[4].
Seroma figures differ even within one source: a literature review counted seroma in 21 of 1,316 lipoabdominoplasty patients (1.6%), while the same authors' own case series recorded seroma in 20 of 85 patients[13].
The UK series of 286 patients reported a seroma rate of 3.1%, with 16.0% of patients requiring revision under general anesthesia and 6.6% under a local anesthetic[9]. In that UK series, one-third of patients had local complications, and there was no significant relationship between lipoaspirate volume and any of the four primary outcome measures[9].
In the cosmetic body lift series of 72 patients, complications included seroma in 2.8 percent, infection in 4.2 percent, necrosis or ischemia in 4.2 percent and revision in 18.1 percent[6].
In a retrospective review of 118 consecutive abdominoplasty patients, overweight or obese patients developed seromas more often than normal-weight patients (31 of 81, or 38 percent, versus 7 of 37, or 19 percent)[16].
In a single-surgeon chart review of 83 abdominoplasty patients, 21 obese and 62 nonobese patients showed no significant differences in seroma, wound dehiscence, hematoma or surgical-site infection[17].
Adding flank liposuction did not appear to raise seroma risk in the review of 118 patients, with seromas in 15 of 39 patients (38 percent) after abdominoplasty alone and 23 of 79 patients (29 percent) after abdominoplasty with flank liposuction[16]. A separate study of 232 abdominoplasty patients concluded that small volume liposuction distant to the abdominal flap does not increase the incidence of seroma formation[18].
In the national database study, postoperative pulmonary embolism risk was independently associated with cosmetic abdominoplasty, elevated body mass index, preoperative recent weight loss and concurrent hernia repair[1]. Most pulmonary embolism events in that study occurred outpatient after discharge (87.2%), at an average of 10.5 ± 6.7 days after surgery[1].
The authors of that database study suggest it may be advisable to delay abdominal excisional body contouring until weight has plateaued[1]. You can read more in our page on liposuction, thrombosis and embolism.
If you develop chest pain, shortness of breath or a swollen, painful leg after surgery, contact your surgeon or emergency services right away.
In a small prospective cohort study of 31 normoglycemic Hispanic women without obesity, the 18 who had combined liposuction and abdominoplasty showed significantly reduced HOMA-IR values, a measure of insulin resistance, 60 days after surgery, while the 13 who had liposuction only did not[19]. The authors suggest that liposuction combined with abdominoplasty improves insulin resistance in healthy Hispanic females, and state that more studies are warranted[19].
Bring the headline question to your consultation, and ask a board-certified surgeon to examine you before you decide.
A study of liposuction patients describes residual sagging as a remaining limitation of liposuction[2]. A systematic review reported better skin retraction with laser-assisted liposuction in some studies, but found high risks of bias that impede a reliable conclusion[5].
A meta-analysis of seventeen trials found no evidence that lipoabdominoplasty was associated with higher complication rates than traditional abdominoplasty[3]. A chart review of 161 patients found no statistically significant increase in perfusion-related complications with lipoabdominoplasty[15].
Some series include muscle repair: one retrospective series of 146 patients described high definition lipoabdominoplasty with correction of muscle diastasis[8]. A UK lipoabdominoplasty series included multilayer rectus plication[9]. Ask a board-certified surgeon whether plication is part of the plan for you.
In a review of 118 abdominoplasty patients, flank liposuction did not appear to increase the risk of seroma formation[16]. A meta-analysis found a lower incidence of seroma in the lipoabdominoplasty group than in the traditional abdominoplasty group[3].