Q&A: After four children, is there a way to tighten the loose skin without scarring?

Ask A Doctor Question: 

My wife is 5'4 and weighs about 125 lbs.  After having four children she has a moderate fat deposit below the umbilicus and loose skin above it.  The fat should respond well to liposuction.  Is there a way to tighten the loose skin without leaving a noticable scar?

- Stefan


Roger Friedenthal, MD -

Your wife is trim and has some loose skin above her umbilicus from tissue stretching after multiple pregnancies. While liposuction may take care of the lower abdominal fat, there is no reliable way to tighten loose skin above the umbilicus without a scar of some kind. There is a mini-abdominoplasty using what is referred to an an "umbilical float," where the umbilicus can be lowered about an inch or so through a low horizontal abdominal incision at the pubic hair line. This could be nicely combined with a small liposuction and might give the result you desire. One can also tighten the skin below the umbilicus at the same time. It is, of course, not possible to know whether this is the right procedure without at least a picture, but it could be a reasonable option. This sort of procedure is only useful when there is a good distance from the umbilicus to the pubic hair line, so that the distance can be shortened and not cause a problem. As always, there is nothing like a personal consultation with a qualified plastic and reconstructive surgeon.
Good luck.

--Roger Friedenthal, MD
San Francisco, CA


Dean Kane, MD -

Dear Stefan:
Congratulations on your expanding family!
There have been many generations of skin tightening and fat reduction devices (ie, no surgery) using laser light, ultrasound and radio-frequency. The current state-of-the-art has led to mild if any improvement which lasts 3-6 months if at all. It is based on the use of heat transfer across the epidermis (top layer of skin) to the dermis which contains the collagen fibers and inflammatory cells which produce them to contract the skin and produce more collagen. A different non-surgical option called CoolSculpting by Zeltiq has shown promising results and freezes the fat between 2 cooling plates. While it is NOT guaranteed, we have seen some firming of the skin when the CoolSculpting is multiply stacked.
To date, the long term effects of heat transfer fat reduction and skin tightening are disappointing. The future holds other combined technologies to produce this effect from above and below the surface of the skin. Ultimately, the skin will re-stretch and the procedure will need to be performed every 3-4 months for optimal effect.
The best, most long lasting procedures are surgical at this time. Depending on the laxity and draping of the skin:
A mini-tummy tuck will remove skin excess with a short “bikini” line scar. It is limited in effect. A skin-only tummy tuck will stretch the skin from the lower rib margin and re-locate the umbilicus without tightening the muscle/fascial corset typically stretched out with aging, child bearing or weight gain. A traditional tummy tuck will care for the above. Surgical procedures as you perceive have a longer recovery period, and other limitations to consider.
A consultation with a well versed, experienced board certified plastic surgeon is your best bet for a diagnosis and management plan.
I wish you and your wife the best.

--Dean Kane, MD
Baltimore, MD


Glenn Lyle, M.D. -

This is always a tricky problem. The degree of laxity above the umbilicus usually determines whether or not a tummy tuck is necessary. There are very few modalities that help improve the laxity of the skin after 4 children. Technologies such as Titan, Fraxel, Cellulaze, sometimes SmartLipo etc may help but unless the laxity is minimal- may give you disappointing results. Hard to tell without a formal evaluation.
Liposuction can always remove the fat- how the skin looks afterward determines how successful it has been.

--Glenn Lyle, M.D.
Raleigh, NC


A. Roy Heron, M.D., Owner -

Yes, your wife would benefit by having Smart-Lipo. The laser destroys the fat calls and gives one significant skin tightening.

--A. Roy Heron, M.D., Owner
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