Abdominal Contouring

Options for Flattening Your Tummy

The abdomen is one of the toughest spots to maintain, especially after having children, gaining or losing weight, and getting older.

  • MYTH: if you only do enough sit-ups, you can fix a sagging, poochy belly.
  • TRUTH: extra sagging skin will never be reduced with diet or exercise.


This 26 year had completed her family and disliked the bulging of her central abdomen. She was fit, and worked out several times per week. She disliked having people ask her when her baby was due. After 2 years of dieting and intense exercise, she realized that she could not fix this problem without help.


Patient’s Individualized Solution:

This patient had a long waist and did not want a foreshortened look that can accompany traditional tummy tucks where skin and fat is removed from below the belly button. Her belly button is quite high; so her long torso would be significantly shortened by removing that much skin. Instead, she requested an endoscopic tummy tuck, which leaves very little scarring.

The separated rectus muscles are repaired through an umbilical incision, and a small amount of skin was removed at the Cesarean section scar. The biggest improvement was correction of the front to back protrusion. With the muscle separation corrected, the weak spot in the middle that allowed abdominal contents to “poke out” was eliminated. This is a lifelong correction, with many patients looking great 12-20 years after their tummy tuck.

Things to consider when planning your own abdominal contouring:

This solution is not a good one for everyone. Candidates for this type of surgery cannot have much extra skin or fat. Loose skin is the main reason most women have abdominoplasties.
Flab, or loose skin, that hangs over the front of jeans will not be corrected with this short scar solution. The outcome really depends on the level of fitness the patient is in before she has surgery.
Abdominal Contouring

Radio Frequency Assisted Liposuction (RFAL)

Many women do not want to have a tummy tuck since they have heard that it is extremely painful and the skin is numb afterwards. The long scar is also a disadvantage. However, traditional liposuction is notorious for leaving behind a lumpy, irregular skin surface. Skin that was loose before surgery can be even more flabby after surgery.

  • MYTH: regular liposuction is all you’ll need to flatten your tummy after having kids.
  • TRUTH: it is very rare for liposuction alone to work. The reason: excess skin that hangs over has poor tone and has frequently been damaged. It will not “snap back” with traditional liposuction. Even laser assisted liposuction (“Smart Lipo”) has been shown to only increase the natural elasticity of abdominal skin by 3-4%.


This 20 year old had an odd fat deposit in her lower abdomen. The skin was stretched out because of it; she was worried the traditional liposuction would leave a little “apron” of hanging skin.
Abdominal Contouring image

Patient Individualized Solution:

RFAL (“Rafael”) is a radiofrequency device that heats the skin and undersurface before liposuction. The device, officially known as BodyTite by Invasix, is in phase III of clinical trials by the FDA. As a clinical investigator for Invasix, Dr. Duncan is licensed to use this device under IRB guidelines.

This patient has a remarkable result with RFAL; no residual loose skin is seen, and the surface is very smooth. Note the improvement of her stretch marks as well.

Things to consider when planning your abdominal contouring:

This solution works best on patients with mild skin laxity and no true overhang. This patient has not had children, so no bulging due to muscle weakness was present. This type of surgery takes longer to heal than traditional surgery, but it does continue to improve over a year.