Is a tummy tuck the answer to your unwanted belly fat? Find out what you need to know about abdominoplasty.

References to “belly fat” are everywhere: magazine cover lines, infomercials, diet supplement packaging and gym advertisements all promise they can tackle your unwanted belly fat. Regular exercise and a healthy diet that’s low in fat can certainly make a huge difference in the shape of your middle—and it’s the all-important first step if you do have a large amount of belly fat.

But there may come a point where belly fat is unresponsive—especially when you are otherwise lean. And even more unresponsive than the fat is the excess skin around the belly, which is most commonly caused by lost skin elasticity after having children. It’s usually only after much frustration and thousands of crunches that a woman begins to think about surgical alternatives, like abdominoplasty, commonly known as a tummy tuck.

Who Needs a Tummy Tuck?

A tummy tuck can remove the excess skin and fat and reattach separated muscles that have been stretched. “Most patients who opt for a tummy tuck are looking for an improvement in their body shape and contour. They’re often very active. They’re not obese, but are unable to get rid of their belly despite determined effort with diet and exercise,” says Brannon Claytor, MD, a board-certified plastic surgeon with Atlantic Plastic Surgery Center in Portland, Maine. They’re usually finished having children, he says, and are often in their mid-thirties. Women considering abdominoplasty want to improve their appearance in clothes because they’re self-conscious about wearing anything tight fitting. Sometimes, they’re after a streamlined profile in a bikini as well—but only if they are comfortable with a scar.

In fact, Dr. Claytor has found that at his practice, about 40 percent of tummy tuck patients have already had a C-section or some other type of abdominal surgery. “They’re comfortable with having a scar already,” he says. They’re also more likely to have some sort of contour deformity from their C-section scar (because the abdomen is very stretched out when the gynecological surgeon is trying to close the incision).

Tummy Tuck vs. Liposuction

Is a tummy tuck the answer for all unwanted belly fat that is diet- and exercise-resistant? Claytor says no. Liposuction—where excess fat is sucked out of the belly through a tiny incision—cannot do anything about excess skin and stretch marks. If you have a bulge of hanging, loose skin that you can grab in your hand, liposuction alone won’t fix it. However, if loose belly skin is only minimal and you’re just trying to get rid of the deposits of fat around the belly, you don’t need a tummy tuck. Liposuction will probably provide the results you want.

Sometimes patients need both, Claytor says. Not all surgeons will perform both at the same time because it increases surgery risks when you combine procedures. Ask your surgeon if he has experience with multiple procedures at the same time.

The Tummy Tuck Procedure

A tummy tuck incision extends from hip to hip and is usually right above the pubic hairline. Through this incision, your surgeon can remove the excess skin and fat and stitch the loosened ab muscles back together again. Depending on how much fat and tissue you need removed, you may need a second smaller incision up higher (around the belly button).

After surgery, it’s crucial that you follow all of the post-op instructions your surgeon gives you. You’ll get medications for discomfort, and your surgeon will also give you instructions for caring for your incision. Remember, abdominoplasty does leave a scar (although your tummy tuck scar can be well-concealed since it’s low). You may have drains after surgery (Ask your surgeon: at Claytor’s practice, they perform tummy tucks that don’t require drains). The tummy tuck healing process is quick, Claytor says. “You can usually go back to work within one or two weeks, but you’ll want to avoid heavy activity until four weeks after surgery.” As with all plastic surgery procedures, it’s very important that you don’t smoke because it makes it harder to heal and can lead to other complications.

Tummy Tuck Risks

The most common tummy tuck surgery risks are widened scars and bulges at the flanks.