The Thin-Fat Patient
Distribution of body fat is determined by our genetic makeup. Fat is stored in our bodies, either in the skin or inside body cavities as visceral fat. The types of surgery needed to reduce fat depends on where the fat is. Below is a photo of a patient who came to me for an abdominoplasty. It was difficult to tell where her fat was. Examination showed a thin layer of fat in her abdomen and very loose muscles.
Every so often, I get to see this illustrated beautifully in my patient’s anatomy when I am performing a tummy tuck (abdominoplasty).
The patient I was operating on the other week appeared torose (a fancy word I love which essentially means fat). When I pinched her skin, though, there was not much to her. Barely an inch of fat; yet she looked big!
Her appearing to be fat was caused by two main factors:
- Visceral fat – the fat around her internal organs, intestines, etc.
- Loose muscles of the abdomen – during pregnancy, the muscles had been stretched out so much that they could not hold her abdominal contents in; it was a huge hernia, if you will
In these types of patients, the plan for the abdominoplasty surgery is different from the plan for those patients who carry their weight in their skin fat. With internal (visceral) fat and loose muscles, the muscles must be tightened to push the abdominal contents back into the body. The amount of liposuction is minimal, and most of the surgery involves tightening the muscles and excising skin. That is the thin patient who looks fat.
With patients who have fat in their skin, there is more liposuction and fat removal and less tightening of the muscles required. That is the thin patient who looks fat.
The end result after the two types of abdominoplasty is the same: a flat abdomen. The road to get there is just a little different!