The Abdomen: Why Does it Sag?
The abdomen is the entire area between the ribs and the pubic bone. It contains a cavity which holds the digestive system and other organs such as the liver and spleen. The cavity is enclosed in front by the abdominal wall, composed of muscle, fat and membranes.
The abdominal wall has five muscles and their fibers run diagonally, horizontally, and vertically. They are in layers with various membranes in between known as fascia. Directly beneath the abdominal skin is a fascial layer with fat. When we gain weight, this layer expands as the fat cells store more fat.
Less Muscle Support
The muscles in the lower abdominal wall have less support than most other muscles in the body. They have fascia on their front side but not on their back side (the internal side bordering on the abdominal cavity). This means that they more easily become lax and are harder to keep well-toned.
During pregnancy or massive weight gain, the abdominal muscles are stretched. They sag and provide less containment for the abdominal contents. The skin stretches over them and the body now has a bulging look which makes many people feel uncomfortably “middle-aged”. Extra fat accumulates inside the abdominal wall and cavity. Diet and exercise can tone and reduce most other body areas, but the abdomen may remain pouchy.
An abdominoplasty (tummy tuck) tightens the abdominal fascia and one of the abdominal muscles called the rectus abdominis. It is a long, flat muscle which runs vertically for the full length of the abdominal wall. It is divided vertically in its center by a long fibrous band called the linea alba. The fibers on each side of this band can be stitched towards this center line to provide a stronger outside wall for the abdomen.
Excess skin is removed and both excision and liposuction remove unwanted fatty tissue. The navel is repositioned higher on the abdomen, now that sagging is removed.
If you have faithfully followed an exercise regimen and a nutritious diet but still have a protruding abdomen, please do not feel that you have failed. The natural lack of fascial support for abdominal muscles makes it virtually impossible to flatten the abdomen with diet and exercise once it has been expanded.
Please contact our cosmetic surgery office if you would like to know more about tummy tucks. We will schedule a personal consultation for you with one of our cosmetic surgeons.