Reshaping the abdomen by treating skin excess, abdominal contour and—where required—the abdominal wall.
Pregnancy, weight change and individual anatomy can leave changes that exercise or further weight loss cannot fully correct.
An abdominoplasty is planned around the particular components contributing to the abdomen rather than treating every patient with the same operation.
The operative plan begins by identifying what is creating the contour.
Loose or redundant skin is removed and the remaining abdominal skin redraped to create a smoother envelope.
Pregnancy can separate the rectus muscles and stretch the central abdominal wall. Where clinically relevant, this can be repaired during surgery.
The central abdomen needs to be considered with the waist, flanks and mons so that the result transitions naturally into surrounding areas.
A separation between the rectus muscles is common after pregnancy. It may contribute to central abdominal prominence even in someone who is otherwise lean.
Not every patient requires abdominal-wall tightening; the decision is based on examination and the anatomy present.
Where a meaningful diastasis is present, the central abdominal wall can be tightened as part of the abdominoplasty.
The aim is restoration of appropriate support and contour—not indiscriminate tightening of a normal abdominal wall.
Two relatively small areas can have a disproportionate effect on whether an abdomen looks natural and balanced.
In a full abdominoplasty, the umbilicus usually remains attached to the abdominal wall while the surrounding skin is redraped. Its final opening and position need to sit naturally within the new abdominal contour.
Lower abdominal skin excess can coexist with descent or fullness of the mons. This should be assessed during planning so the lower abdomen and pubic region remain in proportion after surgery.
I use liposuction selectively where localised fat contributes to the contour of the abdomen, waist or flanks.
It can be useful for refining transitions and improving proportion, but it does not replace removal of genuine loose skin.
The extent and location of liposuction are planned together with the skin excision so that both parts of the operation serve the same contour objective.
Timing is part of good surgical planning.
It is generally preferable for weight to be relatively stable before abdominoplasty. Further pregnancy can stretch the abdominal wall and skin again, so future pregnancy plans are also relevant to timing.
Smoking, nutrition, medical fitness, previous abdominal surgery and individual risk factors are considered before proceeding. Sometimes the appropriate decision is to defer surgery until those factors are optimised.
Abdominoplasty is a substantial operation and recovery should be planned accordingly.
Swelling, tightness and reduced mobility are expected. Walking is encouraged early, but patients often remain slightly flexed initially while the abdominal tissues begin to settle.
Mobility and comfort progressively improve. Activity is increased in stages, with heavier lifting and strenuous exercise restricted during healing.
Swelling continues to resolve over time and the scar matures over many months. Final contour is therefore judged after the tissues have had time to settle.
The risks relevant to the proposed operation and individual patient are discussed carefully during consultation and informed consent.
Consultation allows us to separate skin excess from abdominal-wall change, localised tissue fullness and the contribution of neighbouring areas. From there, I can explain which components of surgery are worthwhile, where the scars would sit and what degree of contour change can reasonably be achieved.
Arrange a consultation →Written and reviewed by Dr Constant van Schalkwyk, Specialist Plastic Surgeon ·
