14 September 2026 · 35:49 · Spoken in Turkish
Turkish and English subtitles are available in the player.
Dr. Mustafa Aydınol and clinical coordinator Sibel Aydınol discuss how fat, loose skin and abdominal muscle separation influence the choice between liposuction and a tummy tuck after weight loss or pregnancy.
The conversation covers mini and full tummy tucks, VASER and 360 liposuction, J-Plasma/Renuvion, changes after Mounjaro or Ozempic weight loss, scars and recovery. They also answer common questions about compression garments, drains and massage.
Transcript of this episode.
Hello. Hello. Welcome to our programme. How are you, Doctor? I’m well. How are you? We’re well, too. Thank you. Doctor, some patients cannot decide between liposuction and a tummy tuck after weight loss. What determines that choice? The patient’s anatomy, loose skin, amount of fat and lax abdominal muscles are all important factors. A patient who wants to avoid scars may think liposuction can also address excess skin. How do you approach that expectation?
Managing the patient’s expectations is important. Of course, sometimes we have methods that can meet their wishes. If they are suitable, we can use them. I’m Sibel Aydınol, the clinical coordinator. I’m Dr. Mustafa Aydınol. We promised this in our first episode. Today: liposuction or a tummy tuck? That’s our topic. Yes, today we’ll explain liposuction and tummy tucks in detail. We’ll also cover important questions to ask during your consultation. As you know, we develop your individual treatment plan together, during and after your examination.
When a patient says, "I have a belly," what do you look at first? First, we need to understand what they mean by that. Are the muscles lax? Is there an issue with the skin or with the underlying fat? We need to assess each of these individually. A muscle problem needs one treatment; excess fat needs another. Sometimes all three occur together. We need to plan treatment accordingly.
Let’s distinguish fat under the skin from fat around the organs. How does that affect what liposuction can achieve? Well, conventional liposuction only addresses fat under the skin. During liposuction, we never touch the fat behind the muscles, around the organs. So if a patient has visceral fat, liposuction cannot treat it. Is a mirror or a photograph enough to tell the difference? It can help to some extent.
We already ask patients to send photographs. We ask you to send photographs. More or less, we can get an idea from them. But they cannot replace a detailed examination.
Let’s consider two examples. The first patient’s weight has been stable for a while. There is fat around the waist, but no obvious folds of skin. What would we think? Well, we shouldn’t generalise, but these patients may have a more athletic lifestyle. If their skin quality is good, they are young, and their skin’s collagen and elasticity are good, fat removal alone may be enough. If the skin isn’t very loose, a tightening procedure might also help. Let’s look at the second person.
She’s back to her pre-pregnancy weight but has a fold of skin on her lower tummy. She also says, "Let’s remove the fat." Again, how much the skin sags matters. Some patients are particularly concerned about scars. If there is a lot of loose skin, a tummy tuck may be the answer, but, as I said, we need to assess how much. Are there any problems with the abdominal muscles?
These are important factors in the decision. So is the decision based more on the tissues than on childbirth history? Of course, pregnancy doesn’t affect every woman in the same way. Some gain more weight; others gain less. Some have stronger abdominal muscles or other medical conditions, and so on. What matters more is the patient’s current condition. How much has the skin loosened with weight changes? How much fat is there?
The condition of the skin and muscles matters in men, too. So, during consultations, before naming an operation, we should assess what the patient wants to change. Yes, patients need to ask about that. They should say, "Doctor, this is what I want to improve," so we can plan treatment accordingly and help them.
Could we explain to our viewers how liposuction is performed? We generally make small incisions in areas covered by underwear and introduce a fluid. That fluid helps reduce both bleeding and pain. After waiting a little, we use hollow tubes and suction to draw out and remove the fat. Our aim is to shape the body, not to achieve weight loss.
The amount removed is sometimes seen as a measure of success. Yes, on social media you hear, "We removed 16 litres," or "15 litres." Some patients really do have very stubborn fat. It doesn’t go away after treatment or weight loss. Or, let’s say, their lifestyle isn’t suitable. For these patients, this can offer relief. But their health is important. If their body can tolerate it and bleeding can be controlled, it can be done. We take certain precautions during the operation.
But it isn’t something we recommend in every case. The patient’s overall health is the main deciding factor. And it varies with each patient’s circumstances. Of course. We proceed with precautions.
Let’s move on to skin elasticity. How does it affect the appearance after fat removal? As we mentioned, if the collagen is good, once the fat is removed, some space is left in that area, and the skin goes through a period of adaptation. Good collagen and elasticity make that easier. But if there are stretch marks, loose skin, or a loss of those elements, the skin cannot adapt to that space, so it may sag further.
How do you discuss the options with a patient who doesn’t want to accept a scar? If they won’t accept one at all, I think we should explain. We need to be realistic. "There is another method, but it isn’t like surgery. Your expectations need to reflect that. Please understand this." I would want the patient to think it over. They don’t always have to have surgery.
They may decide against it, postpone it or take time to think. I think those are valid decisions, too.
Various treatments are advertised as a "non-surgical tummy tuck." How should we distinguish fat reduction from skin tightening? There are fat-freezing methods, as you know, and different laser treatments. "Non-surgical" is often presented as an advantage, but I don’t think that means much if it doesn’t deliver the desired result. With the necessary precautions and assessments, I think patients can get good results. I just don’t think it should be presented as inherently superior.
There are different devices. For patients with a pronounced skin fold, what are their limits, and how should they be used? What matters is how loose the patient’s skin is and how much the device can actually help them. Most of these treatments require several sessions, as they aren’t surgical. Laser treatment might take four or five sessions; the same goes for fat freezing. We need to explain this and make sure patients are properly informed.
For example, if there is some loose skin above the navel, laser treatment can genuinely improve it to some extent, but it takes sessions. It takes patience. It takes patience. The patient needs to be prepared for that. Results can be encouraging, but selecting suitable patients is crucial. Patience and time are essential. What do we think about directing a patient who is reluctant to have surgery towards a device first? Patients ask, "Doctor, I don’t want surgery.
I’d really prefer no scar." Let’s not say "absolutely no scar." Yes, a patient can be referred for that. But if it isn’t the right treatment, they lose both time and money. I think we need to explain that. Sometimes that option simply makes the patient more unhappy. Surgery might get them to their desired result sooner. Meeting expectations. Yes, meeting expectations is important. Does the word "non-surgical" make people overlook the risks?
I think so. People say, "There’s no surgery. I won’t have general anaesthesia. I’ll get a wonderful result." But sometimes they get neither that result nor the smooth experience they expected. There can be pain, burns, pigmentation changes, or an unsatisfactory result. The money may have been wasted. Sometimes, after fat is lost in that area, it can also return more quickly. That’s another risk. Now, VASER, laser, 360-degree liposuction and similar terms influence people’s decisions. They get confusing. How do we distinguish the technology from the scope of treatment? Each procedure has its place.
And there are ways to use them together. Since you’ve asked about each one, let me explain. VASER is a device that uses ultrasound energy. It is used as a preliminary step. It helps soften the fat cells. Laser has a similar effect. Laser also destroys fat cells by breaking them down. VASER uses ultrasound energy, so it is somewhat gentler. The cell survival rate is a little higher.
They have different uses. As I said, before the operation; then we use the hollow tubes I mentioned to remove the fat. So VASER is actually a surgical method, too. Of course. We use VASER before and during surgery. To distinguish it from non-surgical device treatments, how does it work? Rather than "non-surgical," if a patient doesn’t want general anaesthesia, it might be performed under local anaesthesia. That can be possible, too.
Yes, exactly. Which areas are covered by the term "360"? "360" generally refers to the area from the waist up. It covers the abdomen, back and waist, all the way around the upper body. The meaning is in the name. There’s no extra surgery. Just 360 liposuction. What should patients ask beyond the name of the device? I think that’s a good question. Patients abroad ask us, "Do you perform VASER liposuction? Do you have a laser?
Do you use plasma or Renuvion?" Those aren’t the key questions. What matters is: "How much will your procedure improve my concern? How happy will I be? What might arise? What will remain?" Will it meet expectations? Yes, will it meet expectations? I think it’s more useful to understand the extent of treatment and what will be done than to focus on the technology.
We touched on J-Plasma. Let’s discuss it now. In which patients does adding J-Plasma or Renuvion affect the decision to have a tummy tuck? Well, it doesn’t actually change that decision. If a tummy tuck is needed, it’s a major operation in its own right. Renuvion simply doesn’t have that capability. But say there is mild sagging above the navel, or the patient’s skin elasticity is somewhere in the middle.
Little sagging, but they want tightening. Renuvion can be used in that situation. So here’s a question. How do the amount of skin and the expected change affect the choice? That’s what I was just explaining. A patient might say, "Doctor, a slight improvement would be enough, but I don’t want a scar. My body is already in good shape. Just a little contouring would do." "My tummy doesn’t have to be completely flat."
Yes. If they accept that some wrinkling may remain and are mentally prepared for that, I think Renuvion is a suitable choice. It works better in younger patients. Yes, it works better in younger patients. For example, if a woman has had five or six children and has extensive stretch marks on her abdomen, Renuvion doesn’t make much sense. Then we would consider surgery. Some patients still request it even then, but it’s worth explaining what results they can expect.
Let’s also make clear that this involves working beneath the skin. I’m referring to Renuvion. Some patients ask, "Doctor, is that surgery, too?" Yes, it is. It doesn’t have to be a lot, but first we need to do some liposuction to create space so Renuvion can work. What matters for safety here? Again, the usual considerations when assessing patients: Are they in good health?
Is there anything that would prevent them from having surgery? Has their weight loss stopped? Is their condition stable? We need to consider all of these.
A patient who wants a shorter scar may consider a mini tummy tuck. What findings make a mini tummy tuck suitable? Patients requesting one generally don’t have extensive sagging. When they sit down, there is usually some loose skin below the navel. It can suit those patients, but a mini tummy tuck doesn’t mean a risk-free procedure. The word "mini" sounds more appealing, but as we’ve said throughout, if it doesn’t deliver the desired result, the patient can be unhappy with a mini tummy tuck, too.
How does the plan change if the upper abdomen is also noticeably loose? A mini tummy tuck won’t help there. We need to consider a reverse tummy tuck. Or if the problem is extensive, it’s worth considering a standard tummy tuck. That was the case with a patient we operated on last week. They’d had liposuction. There was a substantial amount of loose skin above the navel.
They were 60. It looked wavy. Exactly, a wavy appearance. We performed a standard tummy tuck.
One very common question concerns the term "muscle repair." It can sometimes be misunderstood. Which tissue are we actually tightening in abdominal muscle repair? We really are repairing the abdominal muscles here. But patients sometimes think that muscle repair, or something they feel they don’t need, is unnecessary. However, after childbirth or major weight loss, there can be laxity in this area. Perhaps "bringing them together" is more accurate than "repairing."
In some patients, the abdominal muscles have actually separated after childbirth. It goes beyond laxity. Right in the middle… Particularly after multiple pregnancies… It’s no exaggeration to call it an empty strip. In those cases, it can reach the point of requiring a repair. Generally, we pass stitches through the muscle covering, bringing the muscles together to strengthen that area. That’s the right description. Here’s another related question.
Diastasis. Diastasis and a hernia. How do you distinguish them? How does that affect treatment decisions? We establish a definite diagnosis of diastasis using imaging such as ultrasound or a CT scan. But the patient may give us clues: multiple pregnancies, large weight gains and losses, for example. Twins. Yes, twins or triplets. That already points us towards diastasis. In some patients, it is extensive enough to cause symptoms, so they have already had an ultrasound.
They send us the report. It states the extent of the separation. A hernia is different, because it means tissue from inside the abdomen protrudes through. Treatment can vary according to the size of the hernia. The good news is that both can be treated in the same operation. So, if we have those problems, they can be addressed together during a tummy tuck. Another question concerns the navel.
The appearance of the navel. How is it reshaped in a full tummy tuck? Of course, we preserve the navel’s own structure. We don’t cut it out and discard it, but we need to free it from the skin. That’s why we make a circular incision around it. Then we bring it through a new opening in its anatomical position. That leaves a small scar around the navel.
Its shape can be round or oval. Some want it oval, some round, some narrow. A recent patient specifically asked for an oval navel. So we made it oval.
Another question we hear very often concerns the lower scar. Where does that scar sit? I specifically tell patients: "Please come wearing your favourite underwear, or the kind you wear most often." We make our markings to fit it as closely as possible. Of course, if you pull your underwear up, the scar may show, but when worn normally, it is generally concealed underneath. Could we also suggest bringing bikini bottoms?
Of course. They can bring different styles. If there are suitable overlapping lines, we can plan the scar accordingly. What expectations should we set when explaining how a scar changes over time? A scar is permanent; it never disappears completely. Genetics can mean faster or slower healing, or a better or worse scar. Some become raised, some don’t, and some turn pale very quickly. Sometimes the ends of our stitches can be visible. But the good news is that they all heal in some way. Silicone creams and tapes can help manage scars. Laser treatments are available.
If a scar becomes raised, we sometimes inject steroids into it. With measures like these, a scar can eventually become almost invisible. If the patient is still very bothered, they can have micropigmentation or a tattoo. But laser treatment should be tried over several sessions. I recommend a course of sessions. If the patient is nearby, or there is a laser centre near where they live, it can certainly help.
There is also the C-section scar. Where do C-section scars and stretch marks fit into the plan? As far as possible… Actually, I’ve never done otherwise. I shouldn’t say "as far as possible." I include the C-section scar so there is just one scar. Of course, if it’s in a difficult position, some deviation from the usual incision line is unavoidable. Otherwise, there is just one scar.
As for stretch marks, those on the skin we remove go with it. But we can’t do anything about those above that line. They remain. Perhaps laser treatment for those, too. Laser, mesotherapy, yes, such treatments are possible. They may be needed. So discussing the scar’s position is as important as discussing the change in shape. Exactly.
Exactly. If waist fat and excess abdominal skin occur together, when do you plan both procedures in one operation? We generally combine 360-degree liposuction with a tummy tuck. Very occasionally we don’t, if the patient is slim. But generally, patients come in concerned about fat around their waist. So they are done together. But the situation can vary. When is it more important to perform the procedures in stages?
We very often combine 360-degree liposuction and a tummy tuck, but there may be a significant bleeding issue. Something may prevent anaesthesia. Then we can separate the procedures. That applies to every operation.
Right. One of the questions I hear most concerns risks. Which risks frighten people most, and what problems could occur? We’d like to discuss them. Of course, there can be infection or bleeding, or an embolism, where a blood clot travels. But we take precautions against all of these. We put anti-embolism stockings on the patient. We give medication to help prevent blood clots. Our anaesthesia team is on standby.
We do whatever modern medicine requires. With these measures, we generally don’t encounter very serious adverse events or complications. Wonderful. What health information should patients share for a safe plan? Previous surgery, their medications, and any family history of illness are important. We need to know these things. Any previous surgery? Did they experience any problems with it? The more information we have, the better.
Right? If they’re taking medication, what about starting or stopping it? They shouldn’t decide on their own. Some drugs are critical. For example, patients with a heart condition often take blood thinners. They absolutely need to discuss these with their own doctors. Stop and restart only after discussing it. We can decide on some medications ourselves, but these critical ones are important. Right.
Do we assess someone after childbirth differently from someone who has lost a lot of weight? Muscles and loose skin are the key points. Someone who has lost a lot of weight may come in with loose skin. Someone after pregnancy may have muscle separation. I think it makes sense to plan treatment accordingly. If the loose skin extends to the sides, is a standard tummy tuck enough?
In that situation, we extend the tummy tuck incision towards the back. If the standard is 180 degrees, we might call this a 270-degree tummy tuck, or an extended tummy tuck. Some patients lose 50 or 60 kilograms. Their abdominal skin also sags sideways. Then we can perform a vertical tummy tuck, known as a fleur-de-lis tummy tuck. What can exercise and physiotherapy contribute here?
I think exercise and physiotherapy have a limited role in reducing loose skin. They may improve things a little. For example, they may help tighten lax abdominal muscles to some degree. But with major separation or very significant sagging, unfortunately the treatment is surgery. How do we approach timing for someone planning a pregnancy soon? If pregnancy is planned, I think surgery should wait. The body will change during pregnancy anyway.
Why operate and knowingly allow the result to be affected again a while later? Some change in shape is inevitable. It’s best to go through pregnancy comfortably, then come for surgery.
Let’s return to the medications from our first episode. Mounjaro and Ozempic. What do we look at when assessing abdominal concerns in someone who has lost weight with these? They affect skin quality quickly, so skin elasticity matters. We need to assess how much sagging these medications have caused. If they haven’t caused much sagging, then instead of a tummy tuck, liposuction and J-Plasma may be possible. But if the sagging is substantial, then a tummy tuck. We should consider surgery.
Does reaching your target weight mean you’re ready for surgery? As we said, reaching your target weight doesn’t mean you’re ready for surgery. You need to maintain a stable weight. You need to maintain your lifestyle. It’s about consistency. Not, "I’ve reached 75 kilograms, so I’ll have surgery immediately." You need to stay at that weight for several months. Why is assessing nutrition separately important during this time?
There can be mineral and vitamin deficiencies, reduced protein levels and iron deficiency. All of these affect healing. So patients need to be aware of this and take care. I’ll return to something we discussed earlier. Which doctors should help plan medication before surgery? For gynaecological medication, for example, with a gynaecologist. For heart medication… Hormone treatment, for instance. Yes. For heart medication, with cardiology. If they’re taking psychiatric medication, then with psychology. These critical medications must be assessed.
Right. This is another frequently asked question. Work and home arrangements. They need to be planned. Returning to daily life. Which activities do we consider separately? Not every job is the same. Someone who stays at home may return to their routine sooner, but if they have a physically active job, it will take longer. We’re talking about a period of weeks. A tummy tuck requires at least four to six weeks of recovery. When planning time off after a tummy tuck, what timeline do we discuss? The skin takes about a month to heal.
Afterwards, patients use silicone scar tape, and the scar gradually becomes less noticeable over the years. We explain that to patients throughout this period. Of course, after a while, wound healing slows, so if they can come to us or go somewhere themselves, laser treatment can be more helpful. Another critical point: rest versus early mobilisation. After surgery, we start at around four hours, once the patient feels well, and we tell them to walk. Walking early is important for their overall health and their recovery.
Returning to an active life varies from patient to patient, but I think they should keep up daily activities without overexerting themselves. It reduces their stress levels and helps them feel better. How does early swelling affect a patient’s assessment of the result? Patients can really panic. "Doctor, this is swollen. Something looks strange. Will it stay like this?" I see that online often, too.
Most early swelling like this goes away in the longer term, or even in the medium term. So I think it’s best not to judge too early and panic.
An important topic we need to cover: compression garments. Drains. What do they each do? A compression garment isn’t intended to make the body slimmer. Some patients don’t want to wear one. That’s quite normal. Its purpose is to help the patient manage or clear the remaining swelling and fluid more comfortably. A drain similarly collects fluid that builds up after surgery in a more hygienic, controlled way.
Without a drain, the fluid either leaks out, leaving blood on the garment and making a mess, or, if the opening is closed, it builds up inside and causes bruising. That’s why I think a drain is necessary. A garment’s purpose is sometimes confused with getting a slimmer waist. No. That’s not what it does. This is how we understand its actual purpose. Why shouldn’t someone follow another patient’s schedule for wearing a garment?
Each patient is different. A liposuction patient and a tummy tuck patient, for example, are different. We shouldn’t rely on hearsay. Yes, that happens a lot. Drains also frighten patients a little. Yes, but removing them is virtually painless, and they’re actually helpful. I very rarely see problems with drain removal. There’s no need to be afraid. Can the word "drainless" be a measure of quality on its own?
Not for every operation. I’ve seen many patients treated without drains, with a lot of fluid accumulation and bruising. Of course, it can be done in suitable patients. But I always use drains in my own practice. Let me open another topic.
Swelling and massage: for us, these are all connected. But social media says, "Without massage, your result will be ruined." Does everyone need massage? The role of massage depends on the procedure. I don’t think it’s particularly necessary after a tummy tuck, but after extensive liposuction, yes. Because you remove the fat tissue from beneath the skin. For the skin to reattach smoothly, it needs some energy.
That’s massage: smoothing the skin by hand. The aim is for the skin to heal more evenly. Patients understand its importance when they see it. Let’s say it depends on the operation, rather than saying it’ll be ruined. Yes, it’s important for patients who need it. What findings should we assess before trying to treat swelling with massage? We said earlier that swelling initially upsets patients.
Of course, but not every swelling will go away with massage. Sometimes there can be a dangerous situation. For example, some patients develop a seroma, which is fluid collecting under the skin. Or a haematoma: a collection of blood. If an area swells quickly or painfully, you need to contact your doctor immediately. Call the team straight away. Not every swelling can be resolved with massage.
Which symptoms need urgent assessment without waiting for the scheduled follow-up? Good question. Bleeding at the wound, a stained dressing, chest pain or sudden pain in a leg can indicate serious problems. Please contact your team and doctor as soon as possible. Don’t wait. Your doctor is there for you, wherever you have surgery. Your health is always the most important thing. So having a clear follow-up and contact plan at discharge is very important. The team should always be reachable.
Let’s move on to the quick questions. Okay. A few questions before we finish. I won’t wear you out. Let’s see if I can manage. You won’t give long answers. Maybe. The subject is very complex. Let’s see what happens. How does gaining weight after surgery affect the result? Negatively. Negatively. One people may hesitate to ask: when can they resume sex? I think patients should feel comfortable asking, but sometimes they hesitate. They can consider their recovery and listen to their bodies when making that decision.
But if they have concerns, I think they should ask their surgeon whenever they want. To make the right decision. What should patients look at when comparing different price quotes? This happens all the time. As you know, patients ask around as if visiting shops. I think they should ask which procedures will be done and where: a medical centre or a hospital? Is there an intensive care unit?
What’s included in the package: hotel, accommodation, dressings, and so on? I think comparing these is sensible. What do you say to a patient afraid they might regret having surgery? That’s a question with a heavy moral responsibility. I’d never say… Shall we skip this? "Have surgery." I wouldn’t want to say that. I think the question of regret is this: how much will the operation change the patient’s life, affect it, and contribute to it? We need to consider that.
If they think surgery will make them happy and contribute significantly to their life, I think they should have it. Right.
Let’s finish with questions to ask at the consultation. What should we ask to know whether the operation meets our expectations? I think the question is this. We mentioned it at the start. "What will you do during this operation? Which technique will you use? And which problem will it address? Will I be happy? Which problem will remain?" I think that’s the key question.
Right. Let’s discuss a similar distinction for breasts in the next episode. Okay. Of course. "My breasts have sagged. I don’t want implants. Reshape them with my own tissue? Do I need implants, or not?" We’ll see. Let’s discuss it. Or after childbirth or weight loss. Some patients come before pregnancy and ask, "Should I do this? I’m planning a pregnancy." We can discuss these things. It’s relevant to weight loss, too.
I think it’ll be a good topic. You can contact us with any questions about liposuction and tummy tucks. And your questions about breasts, too, right? Share them with us. Yes. You can always write to us. Please don’t hesitate to ask questions. See you in the next episode. Wishing you all the best. See you. Stay well.
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