An abdominoplasty, commonly called a tummy tuck, involves removing excess skin and fat from the abdomen, tightening the underlying muscles, and repositioning the belly button to create a flatter, firmer midsection. The average surgeon’s fee is $8,174 according to the American Society of Plastic Surgeons, though that doesn’t include anesthesia, facility fees, or other related costs. Here’s what the procedure actually looks like from start to finish.
Who Is a Good Candidate
The best candidates are people who are at or near a stable goal weight, ideally within about 15 pounds of where they want to be. A BMI in the healthy range of 18.5 to 24.9 is considered ideal, though patients with a BMI up to 29.9 may still be eligible. Being at a stable weight matters more than hitting a specific number, because significant weight changes after surgery can compromise your results.
Surgeons also look for patients who are done having children, since pregnancy stretches the abdominal wall and would undo the muscle repair. Nonsmokers heal better and face fewer complications. If you smoke, you’ll typically be asked to quit well before your surgery date.
Types of Abdominoplasty
Not every tummy tuck is the same procedure. There are three main variations, and which one fits depends on how much correction you need.
- Mini tummy tuck: Uses a single short horizontal incision above the pubic area. It only addresses the lower abdomen, tightening loose skin and muscle below the belly button. The scar is shorter, and recovery is generally faster.
- Traditional (full) tummy tuck: The most common version. It requires two incisions: one across the lower abdomen between the hips and another around the belly button. This approach addresses both the upper and lower abdomen, allowing for full muscle repair and significant skin removal.
- Extended tummy tuck: A more extensive procedure where the horizontal incision stretches around the hips to remove skin and fat from the flanks as well. It may involve two or three incisions, sometimes including a vertical one between the pubic area and belly button when a large amount of skin needs to come off.
What Happens During Surgery
A full abdominoplasty typically takes two to five hours under general anesthesia. Some surgeons begin with the patient face-down for liposuction of the flanks and waistline, then reposition to face-up for the main procedure. Liposuction is commonly used to refine areas that won’t be directly cut away, particularly along the midline and sides of the abdomen.
Once liposuction is complete, the surgeon makes the lower abdominal incision and lifts the skin and fat layer (called the abdominal flap) upward, separating it from the muscle wall all the way up to the ribcage. This step exposes the abdominal muscles underneath. The flap is split down the midline to the belly button opening to make the dissection easier.
With the muscles exposed, the surgeon repairs any separation between the left and right abdominal muscles. This separation, called diastasis, is extremely common after pregnancy or significant weight changes. The repair involves stitching the muscles back together along the midline, running from the breastbone down to the pubic bone. Many surgeons perform a double-layer closure for added strength, and the stitching can be done vertically, horizontally, or at an angle depending on what’s needed. For patients with very wide separations (greater than 5 centimeters), the tissue may be too stretched to hold stitches alone, and a mesh reinforcement can be placed behind the muscles.
After the muscle repair, the operating table is angled to about 30 degrees so the skin can be pulled down under gentle tension. The surgeon marks where the excess skin falls, checks for symmetry, and trims away the extra tissue. The belly button, which has been left attached to the muscle wall on its stalk, gets a new opening cut in the repositioned skin. It’s then stitched to the underlying tissue with anchoring sutures that create a natural inward contour. The wound is closed with absorbable stitches, and drains are often placed to prevent fluid buildup.
Managing Pain After Surgery
The muscle repair is the most painful part of an abdominoplasty, and the tightness it creates can make the first several days uncomfortable. Prescription pain medication is standard for the initial recovery period. Many surgeons also use nerve blocks during the procedure itself, injecting local anesthetic into the abdominal wall to reduce pain signals. Research has found these blocks significantly reduce the amount of pain medication patients need afterward, and they can shorten time in the recovery room and get patients moving sooner.
Some numbness or a pulling sensation in the abdominal area is normal and can last weeks or even months. This typically fades gradually as nerves heal.
Recovery Timeline
For the first few days, you’ll need to rest at a reclined angle, not flat on your back, and you won’t be able to stand fully upright. Walking short distances early on is encouraged to prevent blood clots, but bending, lifting, and prolonged standing will be off the table for weeks.
Driving, cooking, and light errands usually become manageable after one to two weeks. If you have young children, plan for someone else to handle the lifting and physical caregiving during the first several weeks. Most people take about a month off work. If your job involves physical labor, you may need even longer.
Exercise is restricted during the first month to protect the muscle repair. Your surgeon will clear you for gradually increasing activity, typically starting with walking and progressing to more demanding workouts over six to eight weeks.
Potential Complications
Abdominoplasty is a major surgery, and complications do occur. Rates vary depending on the patient population. In a study of post-weight-loss patients (who tend to have higher complication rates than average cosmetic patients), the most common issues were fluid collection under the skin at 36%, wound separation with delayed healing at 16%, and blood pooling at 12%. These numbers are on the higher end; complication rates in patients who haven’t had massive weight loss are generally lower, but seromas (fluid pockets) remain the single most common issue across all groups.
Drains placed during surgery help reduce the risk of fluid collection. Most minor complications resolve with additional office visits, drainage, or conservative treatment rather than a return to the operating room.
Long-Term Results
The results of a tummy tuck are considered permanent in the sense that the removed skin and fat don’t grow back, and the muscle repair holds as long as you don’t become pregnant or gain a significant amount of weight. Interestingly, research published through the American Society of Plastic Surgeons found that about 60% of patients actually continue losing weight after the procedure. On average, patients lost five to six pounds in the first three to six months, and by five years post-surgery, the average weight loss reached nearly ten pounds with more than a 5% decrease in BMI.
Patients with a higher starting BMI tended to lose the most weight over time. Researchers described a “near constant negative change in body weight” that persisted for years, suggesting the procedure may reinforce healthier habits or change how the body regulates weight. The final scar, while permanent, fades considerably over one to two years and sits low enough to be hidden by underwear or a swimsuit.