Patients nowadays are bombarded with infomercials for exercise apparatus to tighten your stomach. Does it work? Will exercise alone flatten your stomach? Or, do you really need a tummy tuck?
The answer is . . .
It depends on the condition of your rectus abdominis muscle. Do you have a muscle separation?
The rectus abdominis muscle is the vertical muscle in the middle of your abdomen. It functions much the same as how shoe laces work in a shoe. If your rectus abdominis muscles are intact (tightened), congratulations!–you may only need exercise to firm your tummy.
However, if your rectus abdominis muscles are separated, you can only firm up your tummy with a repair of the muscle, or a tummy tuck. Since your muscle is separated no amount of exercise can tighten that gap in the muscle. Instead, it must be stitched together.
In today’s video blog, I tell you how to examine yourself to determine if you have separated abdominis muscles, otherwise know as a rectus diastasis. Watch my video to find out if you just need more exercise or if what you really need is a tummy tuck.
Ricardo L Rodriguez, MD
Board-Certified Plastic Surgeon
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50 Comments
August 20, 2010 at 8:47 am
Dear Admin:
Thanks for commenting on our blog. As far as rectus muscle diastasis and body builders, I guess I had never thought of it that way.
I know that my Dad had it, I have it, and my son has it. Being conscious of it I feel for it on many of my patients that come in for different reasons. The condition is more common than you might think. My guess is that we see it on some weight lifters as they lose most of their body fat and the muscle increases definition, so the underlying defect becomes exposed.
Nevertheless, I think you may be on to something here.
August 19, 2010 at 2:28 am
I have found that body builders also experience the same problem of the separated rectus abdominis. It always pays to see your local GP before you make any exercise decision also.
July 7, 2010 at 8:40 am
Priscilla:
I do not think a muscle repair can alleviate all those pains you mention, but I have had some patients with low back pain who reported improvement.
I would not, however, say that that is to be expected. If it happens, we are happy, but we cannot count on it.
Unfortunately, this surgery is not covered by insurance.
If you are interested in in a study, or a pro bono case, you can contact the nearest university affiliated medical center near you. If they have a Plastic Surgery section, they will probably have a Plastic Surgery Clinic where they do these cases at very low cost.
You may also be interested in some companies that do financing for these procedures.
If you are truly motivated, your best bet is to go to a Plastic Surgery Clinic at a University Medical Center.
July 6, 2010 at 10:40 pm
Hello Dr. Rodriguez,
And yes your video was very helpful. Obviously I need surgery:( Three kids, three c-sections..go figure. I have a question..Can having a seperated muscle contribute to poor posture, buttocks spasms, buttocks pain, neck and back pain.. etc? Is that covered by my insurance? Can part of it be covered by my insurance and I finance the balance? Can I qualify for a study, or a probono case? So many questions…Please reply if you can. I would really like us to communicate.
June 19, 2010 at 10:23 am
Dear Julie:
The separation of the muscles is not correctable by excercise or diet.
Although it can be the result of pregnancy, in some cases it is there from birth. To give you an example, both my son and I have a rectus muscle separation. If I diet a lot and do sit ups, it is not noticeable, but if I drink a soda, I get a bulge in the upper part of my abdomen.
If you want to correct it, your only option may be a muscle repair. If your skin is not stretched, we might be able to do the whole repair through a belly button incision.
Contact Kelly at kelly@cosmeticsurg.net, we’d love to be able to help you.
June 10, 2010 at 1:14 pm
I’ve done lots of work outs and exercise just to achieve that flat stomach.But after reading this article I began to ponder on things if do my stomach need more exercise or do i need a tummy tuck of an age of 21.Just curious if I’ll do the kind of shaping.
June 6, 2010 at 9:22 am
Sandra:
It is very hard for me to know what you need unless I know more details about your condition. Talk to Kelly at Kelly@cosmeticsurg.net, she can find out more and give you some details and options. If you decide this is something you want, then we could have a virtual consultation to hammer down the details.
If you are healthy, and you want to look better, there is always something we can do to help you.
June 5, 2010 at 12:43 pm
i need to know if i need a tummy tuck. i am 44 year old mother of 2.
May 4, 2010 at 9:48 am
Phebe:
Thank you!
I hope to see you soon. In the meantime, here is a link to a post I made recently about what to ask the doctor before surgery so your type of situation can be avoided.
May 4, 2010 at 5:13 am
I had a tummy tuck years ago and my belly button is quite off center and looks strange. I think that maybe they did not have me lying straight on the table, before I was put out. It definitely felt like a rush job. It was done at a teaching hospital and i never saw the surgeon that I had signed up with. I don’t know if he even was there, for the operation. Then I got a huge infection where the new incision crossed an old gall bladder removal scar. The doctor took before pictures, but not after pictures. I guess that I know why! It is not a pretty sight. And this was done in the US. Dr. Rodriguez sounds like he really cares about the quality of his work. I plan to see him soon, for a consult.
April 18, 2010 at 5:21 pm
Michele:
Be sure to get more than one consult before you make your mind up. The American Society of Plastic Surgeons is a good online resource to find board certified Plastic Surgeons in your area.
Good Luck!
April 18, 2010 at 3:57 pm
I can’t tell if my muscles are separated above the belly button. Not much skin is there, approx. 1 1/2″ to pinch. I’ve been told a mini tuck would be the way to go but again, I wouldn’t want to go through the procedure and not be happy with the finished product.
Thanks for your response.
MH
April 18, 2010 at 12:28 am
Michelle:
Read this post about the difference between a mini and a full tummytuck.
First of all, are your muscles separated above the belly button? Secondly, how much excess skin is there? Once skin has been stretched out by pregnancy, it is very hard to regain elasticity, and the best answer to get tight skin is removal.
Muscle separation above the belly button usually means full tummy tuck, if your skin is loose. A mini tummy tuck will not tighten skin lateral to the pubic mound.
The best way to tell, of course, is to get the opinion of an expert- the plastic surgeon.
We do offer virtual consultations, if you are interested, contact Kelly at kelly@cosmeticsurg.net
April 17, 2010 at 10:07 pm
Dear Dr. Rodriguez,
How can I tell if I need a mini tuck or a full tuck? I am 5′2 and weigh 106 lbs. I am a Pilates Instructor who exercises 5 days a week. I can’t seem to get rid of the some extra skin from the belly button down. What options are available to me?
Thank you.
MH
April 16, 2010 at 9:23 pm
Jen:
People do travel to see me and get surgery done by me. About 30% of my clientele is from out of town. I am located in Baltimore.
Unfortunately, there is no way for me to know the quality of other surgeons. Call their office and ask for names of previous patients, then call those patients and see what their experience was like. Don’t just call one patient, ask for 3 names.
As far as what may help you, there is no way I can say anything meaningful unless I see pictures and talk to you personally. That is a virtual consult, and if you are interested, contact Kelly at kelly@cosmeticsurg.net.
April 16, 2010 at 2:09 pm
I have another question if you dont mind, have you heard of Dr Cepeda from Perfection clinic in Cancun, or Dr Chavarria in San Jose I found him through gosculptra.???
Thank you!!
April 16, 2010 at 10:28 am
Thanks for your comment. I hope Im not asking too much of you :s
Its just soo expensive here in Canada but their prices I can afford so its soo hard to say no and get it done out here. I wish I could find some legit cheaper places?? Where are you located? Do people ever travel to come to you? How do people know who is professional when going abroad? I just cant really afford the $$$ tag.
I was told that a mini tummy tuck might make my stomach “uneven” but I only really have a little bit of loose skin in the middle under belly button. Old stretchmarks across my tummy is what bothers me the most and Im hoping that with a mini tuck it will tighten my stomach enough to make them look better? Thanks alot for your time
April 14, 2010 at 9:53 pm
Jen:
Travelling from Canada to Mexico to get surgery done- bad idea. Just do a google search on it. What if you get a complication? Do you trust their hospitals to take care of you in the first world standard you are used to? Will the surgeon be as responsive to your calls?
Be careful.
In a University program in the US or Canada you are supervised by an experienced surgeon. If you get a complication you’ll be treated at a first rate university hospital.
I have just heard too many horror stories of medical tourism in Mexico and South America to recommend it.
April 14, 2010 at 6:18 pm
Thank you, I dont think I would be okay with having someone learning to do it, its already a little nerve racking. Is the tummy tuck considered dangerous? Whats your opinion on traveling from Canada to Mexico for this? I found a few somewhat affordable places but how do I know if they are what they seem? Ive talked to a few over the phone and email. If you dont mind answering these questions that would be very appreciated.
Thank you.
Jen
April 11, 2010 at 9:18 am
Jen:
Unfortunately, stretch marks are permanent. Surgery is the only answer so far. No lasers or creams will get rid of them, and don’t waste your money on treatments that don’t work.
As far as affordability, most Medical Schools with a plastic surgery program have plastic surgery clinics where residents do cosmetic surgery supervised by attending physicians. You should try this near where you live.
April 9, 2010 at 8:52 pm
Hi, Im 20 years old and had two children. With my first (who is 3) I got REALLY bad stretch marks. Now they are no longer colored but they are really deep and noticable. They go from above the pubic area to my belly button across the front of my stomach. They bother me so much being only 20 years old and Im only 5′5 and 110 pounds. I also have a little bit of saggy looking skin to go along with it. Ive worked out a little bit and it seems to be getting harder underneath but I think thats about it. Does that mean it would eventually tighten and make the stretch marks look better or do you think I would need surgary to ever get rid of the skin and stretch marks?? I do not want to live with this forever but I cannot afford to get this done and I do not want a very noticable scar I wear my pants pretty low. What would my options be? Ive been very blessed with my children but have a unnattractive stomach and also lost my breast do to breast feeding. I cannot afford to get these done but really want to do something about it. Also, do you have an opinion on which one would give me better results? If its one or the other, which one would be more “worth it”, would the tummy tuck get rid of these stretchmarks and skin without a bug ugly scar?? I hope you can help me with some adivice! Thanks.
March 14, 2010 at 11:28 pm
Rudy:
It is possible to do a full plication under direct vision, and I mean a solid job, using just the C-section incision and a small incision around the belly button. Check out the video here where a patient had the plication using only the belly button incision. The patient is the second one, near the end of the video.
Good luck! If you have any questions, contact Kelly at kelly@cosmeticsurg.net. Have a good week!
March 14, 2010 at 4:31 am
My wife had a laparoscopic plication of the abd red muscles on nov/09 but her problems have not been fully resolved, still has some separation and bulging, though improved. She is small and likes to work out. Has had 3 c/sections for her preg. and was recomended to do the proced laparoscopically to avoid the big incision and because she didn’t have any need for the abdominoplasty, as she doesn’t have any lose skin. She just wants this fixed and wants to know if should go laparoscopic again or open. Txs
February 5, 2010 at 2:51 pm
Caron:
The reason exercise cannot solve the problem is that it is the ligament between the muscles that gets stretched, not the muscle itself.
There is a surgery where we go through the belly button to fix the diastasis, so there is no major scar. I love doing it and one of our surgical techs signed up for it after seein me do it.
She had thought about it for years but, like you, she wanted to avoid the large scar. She loves the result and if patients want to hear about the procedure, I will have them contact her.
February 1, 2010 at 3:04 am
I appreciate the comments. I have had had two children and I work out every day. I bike, run, ski, weights and despite what I do my stomache will not tighten up. As a matter of fact the loose skin becomes more obvious. I am not prepared for any major surgery to correct this. I just wish there was some exercise that could help to repair the muscle.
January 18, 2010 at 5:08 pm
Angie:
I am so sorry you are having this problem.
I will tell you that surgeons are not God, that the body sometimes heals in unpredictable ways, but luckily, in the US, the vast majority of Plastic Surgeons want their patients to be happy.
It looks like your surgeon is on the right track. I have used those barbed sutures and I love them. They redistribute the wound tension really well.
I also would advise against a mesh at this point. They are really more appropriate for people who have had a major ventral hernia.
January 18, 2010 at 1:35 am
Dr. Ricardo & a writter named Craig.
Dr. Ricardo, I too had surgery 8 months ago and my stomach has come back giving me the prego look again. I did not gain really any weight (1-2pds.). I also work out and was told before surgery and now, that I am not carry a ton of fat. My PS is semi stumped by my problem and clame’s he has never had this happen to him. He does not feel that my stiches came loose, he feels that I might have fat around my organs. Could he have known this before my surgery? Would I have had to be fat all my life? My stomach was flat after the sugrery and slowly got this way again. He mentioned before surgery, that I did not even need my lipo really that I did not have a lot of fat, that my stomach was out truly because of mussels being seperated. I am 128, 5′ 2. I have being reading on “mesh”, but my PS does not want to use it. He is mentioning some sort of barbed wire stiches. I am will to have the surgery again, I just want to make sure it is going to work. Any advice?
Craig,
What did your wife do? does she still have the problem?
Any advice or help by anyone would be helpful. I feel lost with no answers at this point. You think having a tummy tuck is a last resort because diet and working out do not work. You never think the surgery wont work either. I mean wow, what a blow…
Thank you,
A
January 17, 2010 at 5:27 pm
Catrina:
About 40% of our patients are African American.
A large part of our practice is body contouring and we love doing it, so come on down!
We’d love to help you!
Call Kelly at kelly@cosmeticsurg.net
January 12, 2010 at 6:03 pm
Belly fat is a big problem within my entire family and in my African-American culture its unheard of to surgically remove anything they feel God intended U to have…. I’m not a small girl nor have I ever been, but Im too small to have the belly that I have; which has come in the last 10 years. I’m hoping to have the surgery and the rest of my family and some friends will follow because belly fat is our problem no matter if wear a 5 or 16 everyone should have a nice figure!!!
December 4, 2009 at 1:17 pm
Kimberly:
Healing time should be 4 weeks. Otherwise you risk disrupting the muscle repair.
As for cost, contact Kelly at kelly@cosmeticsurg.net
We’d be delighted to hear from you, we get a lot of out of town patients.
December 4, 2009 at 1:14 pm
Craig:
If the muscle feels solid, it may be that she needs to work her abs more.
The second possibility is that she has had a buildup of fat tissue. This happens because even though you take out fat, as long as calories in is greater than calories out, patients drift back up to their presurgical weight. If this is the case, she might respond to lipo. Her weight will come back, but in another area.
The third possibility is that she may have separated the muscle after surgery if she coughed too much or something else stressed the sutures.
I’d get a second opinion before trying a mesh.
December 4, 2009 at 11:22 am
I am considering having my stomach muscles sewn.. I got muscle seperation during my second pregnancy. What is the average cost for the procedure? Also, how much healing time should one expect?
Thank you for your time.
Kim
December 3, 2009 at 5:27 pm
Hi Dr. Rodriguez, my wife had a tummy tuck by what we believe to be a very good surgeon. She had excellent results at first, but now 9-10 months later, her stomach seems to protrude a little too much. She is petite and in good shape (works out) and this does not appear to be weight gain. The doctor said to try pilates or abdominal exercises to strengthen her core, or he might recommend another surgery with adding a mesh on top of the muscle? Any insight as to why this might be happening? The Doctor says the muscles still feel tight. Thanks so much, Craig.
October 6, 2009 at 10:35 am
Well, as you well have said, you have tried excercise and it doesn’t work.
Sometimes, the muscle can be intact, but the skin is loose. Once skin has stretched beyond a certain point it is very hard to get it back to where it was. In those cases a procedure where only the skin is excised can help a lot. This is called a dermatolipectomy.
Let Kelly know if we can be of more help to you, and thanks for reading our blog!
You can contact Kelly at kelly@cosmeticsurg.net
October 4, 2009 at 11:24 pm
Well i have skin and fat that is mainly around my belly button area and it hangs off to the sides…….i have tried swimming,running in the mornings and eating smaller meals for about a month now but no dice i still look the same……..i dont have any illnesses like blood pressure or diabetes i’m perfectly healthy except for my belly situation…….so what would you recommend? what exercise or operation?
October 2, 2009 at 10:37 am
Yes, it is possible to have a partial separation.
I myself have a partial separation. It can be very effectively fixed.
We’d love to hear from you!
October 1, 2009 at 10:12 pm
I TRIED IT AND I WANTED TO ASK IF YOU CAN HAVE A SEMI-SEPERATION BECAUSE MY STOMACHE IS TIGHT ON THE TOP BUT I CAN KINDA FEEL A SPACE ABOUT AN INCH ABOVE MY BELLY BUTTON AND IVE HAD 4 SINGLES PREGNANCIES AND ONE MULTIPLE PREGNANCY.
September 24, 2009 at 8:57 pm
Thanx for the compliment!
September 18, 2009 at 4:39 pm
If you are looking for an awesome belly button please go see Dr. Rodriguez. He did my TT and I totally love my cute, perfect belly button. He knows his stuff!
August 26, 2009 at 2:59 pm
Private reply done thru your email.
That’s great work you ladies do at tummytucktalk!
August 20, 2009 at 8:38 pm
Doctor Rodriquez, thank you so much for all the support you gave us on tummytucktalk.ning.com
You truly helped so many ladies with all their tummytuck questions and even though we are a wonderful support group for tummy tuckers. Their is nothing like a wonderful doctor like yourself to advice as you can.
I do have a question for you, I dont like my bellybutton after the tuck I had with another ps… and I read that you actually do belly button repairs. I know that I would like to come see you myself to see if you can revise my belly button with internal bb stiching as opposed to the ring around my bb I have now. I hate it absolutely hate it !!! It has almost been two years since my abdominioplasty and would like to know if this is just a simple in house procedure.. with lidocane?, if their is much down time? and do you do only internal stiching so their isnt a ring outside of the belly button?
Thanks so much,
The belly button is so far important then one realizes until they have a tuck.. and then see others with normal belly buttons .. and want one like theres..
Thanks again Dr. R
August 20, 2009 at 10:31 am
Hi doctor I love your blogs keep up the good work. I tried emailing you using the website but i don’t believe it went through. Is there a email address you can send me so I can email you? Thank you!
July 22, 2009 at 9:43 pm
If your muscles are not separated, you may be a candidate for just the skin part of the procedure. This is called a dermatolipectomy, and it is a shorter, less painful procedure than the full tummy tuck. It also has a much shorter recovery time. For the right patient, and it seems you are, Dermatolipectomy is a great choice.
July 22, 2009 at 4:03 pm
Thank you for your funny and informative video. While I do not have a separation in my rectus abdominis, I do have pouches of loose skin - one on the right side, one on the left - as well as some fat tissue mostly below my navel. I’ve been doing weight training and deep water fitness workouts for 18 months with good results generally but I despair of losing the pouches and lower belly fat.
Is mine a tummy tuck situation?
July 17, 2009 at 3:54 pm
Sorry, wish I could help you, but I just don’t know any surgeons there.
If you do price comparisons, you may find coming to the US may be an alternative to consider.
July 17, 2009 at 4:35 am
It kinds of convinced me on going for a Tummy Tuck. The problem now is to find a good one in Britain.
July 15, 2009 at 6:41 pm
Scar care depends on the cause of the scar.
If the scar is due to excessive tension on the skin, no massage or cream will improve it.
Treatment of the scar depends on where it is located, what the cause of it is, how old is the scar., etc. Some scars do better than others depending on location, for example, a scar near a joint is always difficult to treat. Scars that are along skin flexion lines do very well.
Although massage may help in some cases, it may aggravate conditions in other cases.
If you are very concerned about a particular scar, the “Best way to Care for a scar” is to go see a plastic surgeon near you who has experience in treating scars and is able to individualize your treatment.
It is extremely hard to make recommendations, not having seen the scar or knowing how it originated, or to give any meaningful advice until I know more information.
Thanks for the interest!
July 11, 2009 at 12:24 pm
Can you please answer some questions about scar care? What is the best way to care for a scar? What products do you recommend using? What kind of “massage” do you recommend and how do you do this “massage”? What do you think of silicone strips/bandages?
July 8, 2009 at 5:59 pm
The length of the scar depends on how much loose skin you have.
If your skin has relatively good tone I might be able to do all the work from your previous scars, plus a scar hidden in the belly button. The patient in the video had a lot of very loose skin so her scar is from hip bone to hip bone. Even if you are built like her, the most important factor is skin laxity.
Thanx for visiting our blog!
July 8, 2009 at 5:04 pm
Thanks for the video. I do have abdominal separation; no amount of exercise has helped; I also have a small umbilical hernia (according to an xray I recently had to assess my tummy situation). I am very interested in a tummy tuck but I am concerned about the scar. I have had 3 c-sections, so I have a small scar. How long does the tummy tuck scar need to be? How long was the scar on the woman in the video (she and I are built the same).