I Want a Flat Stomach. What are my Options?

Should I do liposuction or a tummy tuck? What about Coolsculpting? When people come to my office asking how to get a flat stomach, I believe it is critical to give a thorough consultation. This means a review of options, how it’s done, recovery, and risks. Too many cosmetic surgery doctors leave out the options part of the consultation and discussion. If you want to learn about your choices and which operation or procedure is best for you, the options are a big part of the learning process. I wrote this educational writing at the request of a patient from Glen Mills, PA.


I can’t tell you how many times I’ve seen patients come to the office after an operation by another plastic surgeon, and they aren’t happy. I ask them, “Why did you do that operation, and why didn’t you do the one that was most likely the better choice?” They respond frequently, “It wasn’t discussed. I didn’t know that was an option.” If you don’t hear about all your choices, you can’t make an educated decision. A thorough review of options is critical for all cosmetic desires. If you want a flat stomach, it’s time to learn your choices.

The main choices are Coolsculpting, liposuction, mini tummy tuck, or a full or classic tummy tuck. There are advantages and disadvantages to the choices, and this is part of the learning process. If you are a twenty year old woman with excess stomach fat, you will need a different operation (liposuction most likely) compared to a 40 year old woman who has had three pregnancies. The development of loose skin or weak muscles from having babies is a major factor to determine the best procedure (tummy tuck probably) for you. Weight changes can also loosen skin, and this will be a factor in determining what is the best operation for you.

Liposuction is part of all tummy tucks, whether mini or full. When I describe liposuction, it means liposuction by itself and no other procedure. When I describe tummy tucks, it means liposuction is also performed. The big difference is that tummy tucks remove loose skin and liposuction by itself does not.


This is a non invasive machine to remove fat by freezing the fat cells. Non invasive means it’s not surgical. In the future, plastic surgery may very well have machines that shrink our fat and make surgery no longer necessary. Unfortunately, Coolsculpting is NOT this devise. Its benefits are minor, and its expense high. The vast majority of plastic surgeons don’t recommend it. Why? Because of the limited benefit and high cost. You can spend thousands of dollars for a result that is practically imperceptible. Coolsculpting has very limited application or use, because liposuction works so much better and is similar in price. All you have to do is Google Coolsculpting and the word unhappy to find too many reviews of unhappy patients. It’s important to learn about this technology, but it doesn’t work as described. I strongly caution you to save your money. I’ve personally had a hundred patients tell me how it was a waste of time and money.


Liposuction involves surgically sucking out excess and unwanted fat from a given area. The stomach or abdomen is one of the most commonly treated areas. Many people will get results that include a flatter and more sculpted abdomen. It might be a result that they only dreamed about. The procedure is relatively easy. It’s done on an outpatient basis, and most will find the recovery is easy with minimal pain. Return to work can be the next day. Full resumption of exercise is in as little as 7-10 days.

It’s important to have good skin elasticity without skin excess to get the best results. Young people without pregnancies are the best candidates. The excess fat is removed, and the youthful skin has the elasticity and rebound in it to maintain a smooth and flat appearance. Old and stretched out skin can hang, have ripples, or have depressions that can give a poor result. This is called a contour abnormality. Patients with youthful and healthy skin are excellent candidates for liposuction. Loose and damaged skin from age and pregnancies are going to be better treated with a tummy tuck. This is critical to understand.

Mini Tummy Tuck

Mini tummy tucks are smaller operations than a classic or full tuck. Incisions can be smaller and muscles might not be repaired. Liposuction is part of this operation to sculpture the fat and to get the best results. The mini tummy tuck is a bigger operation than just liposuction. It has more similarities to a full tuck and with a longer recovery, than just a liposuction operation. Mini tucks are often advertised and sold by some cosmetic surgeons as a simple and quick operation. This I believe is very misleading. Most tummy tucks, whether mini or full, take 4-6 weeks to recover. This is in contrast to the recovery of liposuction which typically is in days. This is an important distinction.

Mini tummy tucks remove loose and excess skin. But not as much as a full tuck. One of the biggest things to understand is that mini tucks do not necessarily remove all the loose skin. Full tucks do this. Mini tucks remove loose skin mainly in the lower abdomen, below the navel area. If you have too much loose skin, you can be disappointed with the results of a mini tuck. I will tell my patients this, “The biggest risk of a mini tuck is wishing you had done a full tummy tuck!”

I will describe a few more important points to learn. If you have too much loose skin or loose skin above the navel, than the full tummy tuck is your best choice, or you could be disappointed by residual excess skin after surgery. A professor of plastic surgery at the University of California, where I trained, once said, “The best candidate for a mini tuck looks like she doesn’t need a tummy tuck.” This was said because mini tucks don’t remove all loose skin. Many people will end up disappointed if they don’t learn this important point.

Full or Classic Tummy Tuck

Full tummy tucks or abdominoplasty operations have incisions that typically run from hip bone to hip bone. It is this incision that allows for the removal of extra and loose skin. The removal of the maximal amount of loose skin is one of the reasons that full tummy tucks deliver results and give high satisfaction. In addition to removal of skin, muscles are tightened, and fat is sculpted with liposuction. Full tummy tucks need significant time for recovery. It takes about 4-6 weeks and is similar in length to a mini tuck. It is substantially longer than just liposuction operations.

Full tummy tucks are often the best choice to get a flat stomach. For woman who have had babies or people who have had weight loss, the full tummy tuck is usually the best decision. It might be the harder operation to recover from and the more expensive one, but it’s typically the correct answer. You don’t want to spent a lot of money on the wrong procedures and then end up unhappy. Full tummy tucks tend to deliver, and they have excellent results and high satisfaction. See additional before and after photos.

“In between” Patients

It’s not always so black and white, however. Patients don’t always fall into the category of the twenty year old who is an obvious liposuction candidate versus the older patient with multiple babies who needs a tummy tuck. People can be in between. They might have a bit of skin looseness and not a lot. They might want the ease and lower expense of liposuction. Others might want to get the more dramatic results of the tummy tuck. There is no set answer on this patient who is in between. The consultation I give you includes a thorough examination. I can help guide you as to which option is best for you.