Sydney

Body Sculpting Surgery

Liposuction removes fat. Abdominoplasty removes skin and fat and can repair separated abdominal muscles. If your skin is firm and the concern is a localised pocket of fat, liposuction may suit. If you have loose skin, stretch marks below the navel or muscle separation, liposuction alone will not address it.

Liposuction does not tighten skin. In someone whose skin has lost elasticity, taking the fat out from underneath can leave the skin looser than it was. Abdominoplasty involves a considerably longer scar and a longer recovery, but it is the operation that deals with excess skin. The two are sometimes combined. Which you need is usually settled by examination rather than by looking at photographs, because skin quality has to be assessed in person.

No. Body contouring is not a weight loss treatment and is not a substitute for one. Medicare’s own guidance states that lipectomy is not intended as a primary procedure to correct obesity. These operations reshape the body; they do not treat excess weight.

How much tissue comes off varies from person to person. What surprises most people is the scales afterwards, where the number tends to move far less than they had pictured. There is a safety side to weight too. Wound healing problems and blood clots both become more likely the heavier a patient is on the day of surgery. Where losing weight is really the goal, your GP is the right starting point rather than a plastic surgeon. Weight management has its own medical and surgical options, and they sit in a different part of medicine entirely. Most people come to body contouring at the end of that road, once the weight has gone and stayed gone.

Generally yes. Surgery gives a more predictable result once your weight has settled, and significant gain or loss afterwards can change the outcome. Where a Medicare item applies, weight stability is a formal eligibility criterion rather than simply a recommendation.

MBS item 30177 requires weight to have been stable for at least six months following significant weight loss before the lipectomy. Beyond the rebate question there are practical reasons. Skin that is still changing makes it harder to judge how much to remove, and further weight loss afterwards can leave new looseness. Future pregnancy has a similar effect on abdominal surgery, so if one is planned, raise it beforehand rather than afterwards. Timing is a discussion to have at consultation rather than a fixed rule.

Sometimes, where specific criteria are met. Two items are relevant. Item 30175 covers radical abdominoplasty with repair of rectus diastasis following pregnancy. Item 30177 covers lipectomy with radical abdominoplasty for redundant skin and fat that is a direct consequence of significant weight loss. Abdominoplasty for appearance alone attracts no rebate.

The criteria are specific and evidence is required. For item 30175 there must be a diastasis of at least 3 cm measured on diagnostic imaging before the service, moderate pain or discomfort at the site during functional use and/or lower back pain or urinary symptoms, and a failure to respond to non-surgical treatment including physiotherapy. For item 30177 there must be intertrigo or another skin condition risking loss of skin integrity that has failed three months of non-surgical treatment, the redundant skin and fat must interfere with activities of daily living, and weight must have been stable for at least six months. Whether you meet these is a clinical assessment, not something to assume from the procedure name.

Funds tend to follow what Medicare does. Where no MBS item applies, your fund will usually pay nothing towards hospital or theatre costs, and the procedure is treated as cosmetic. Where an item does apply, you are still not quite in the clear. Cover then comes down to your policy tier, any waiting periods you have not yet served, and the clinical category your fund has filed that item under.

Here is where people come unstuck. Insurers do not always file diastasis repair after pregnancy and skin removal after weight loss under the same clinical category, so a policy that pays for one can decline the other. Ring your fund and quote the item number, not the name of the operation. Ask about waiting periods while you have them on the phone, especially if the policy is new or you upgraded it recently. Cover is not the whole story either. Out of pocket amounts for the surgeon, the assistant and the anaesthetist are normal, so ask for a written estimate before you commit to anything.

Often it is possible, but combining procedures lengthens the operation and increases the risk of complications, particularly blood clots. Reported deep vein thrombosis risk after abdominoplasty alone is roughly 0.3 to 0.6 per cent, rising to around 2 per cent or more for combined or circumferential procedures.

Against that, combining means one anaesthetic and one recovery instead of two, which is why post pregnancy surgery is often planned as a combined procedure. Longer operating times are independently associated with more complications, with the effect becoming significant beyond about three hours. The decision is a genuine trade-off rather than a matter of convenience, and it turns on your health, your weight, which procedures are involved and how long the combined operation would take. Ask how long your proposed operation is expected to run and what clot prevention measures will be used.

It depends on why the surgery is being done. Where a body contouring procedure is performed only for cosmetic or aesthetic reasons, the Medical Board of Australia’s cosmetic surgery guidelines apply, including a cooling-off period of at least seven days after informed consent before the surgery can be booked or a deposit paid.

Those guidelines also require a referral from an independent medical practitioner, at least two pre-operative consultations with one of them in person with the surgeon who will operate, and assessment for psychological conditions using a validated screening tool. Patients under 18 require independent evaluation and a cooling-off period of at least three months. The guidelines state that they do not apply to reconstructive surgery, so where a procedure is medically justified, for example an abdominoplasty meeting the criteria for a Medicare item, the position differs. Ask which pathway applies to you at your first appointment, since it changes your timeline.

Yes. A GP referral is essential to see A/Prof Bish Soliman for any type of surgery. Where the procedure is cosmetic, a referral from an independent medical practitioner is a regulatory requirement under the Medical Board’s guidelines rather than only a billing matter.

If you think you may qualify for a Medicare item, the referral is where the documentation starts. For post-pregnancy diastasis, your GP can arrange the imaging needed to measure the separation and can record your symptoms and any physiotherapy you have completed. For post-weight-loss surgery, documenting skin problems and the treatments already tried matters. A GP referral form is available on A/Prof Soliman’s website, and consultations are booked by paying the consultation fee in advance at the time you make the appointment.

All of these operations carry risk. Reported complications include bleeding, infection, wound breakdown, fluid collections, poor or widened scarring, changes in skin sensation, asymmetry or an unsatisfactory result, blood clots including deep vein thrombosis and pulmonary embolism, complications of anaesthesia, and the possible need for further surgery.

Certain things push that risk higher: smoking, a higher body weight, diabetes, and operations that run long or combine procedures. Numbness across the lower abdomen is common in the early weeks after abdominoplasty, and for some patients it never fully goes. Wound healing suffers when a closure is pulled tight, which is another reason your weight needs to be settled first. Tell your surgeon what you take, particularly anything that affects bleeding or healing, and mention any past trouble with an anaesthetic. One thing to hold on to once you are home: chest pain, breathlessness, or pain or swelling in a calf all need urgent medical attention. Do not sit on them until your next appointment.

That depends on what you have had done. Liposuction on its own is usually the fastest to get over. Abdominoplasty and excess skin removal ask a good deal more of you, with several weeks before normal activity resumes and limits on lifting and exercise for roughly six weeks. A compression garment is generally worn for that stretch.

Drains are used in some cases. Swelling is the slow part, measured in months rather than weeks, so the shape you end up with reveals itself gradually. Walking early on is encouraged, since moving about lowers clot risk. Heavy lifting and anything that loads the core are off the table for a while, more strictly so if your muscles have been repaired. When you plan time off, think about what your job actually asks of your body rather than copying a standard figure, and line up help at home for that first week. Ask for your timelines in writing, covering driving, lifting, work and exercise for the procedure you are actually having.

The skin and fat removed do not come back, but the result is not fixed for life. Significant weight gain, pregnancy and ageing all continue to affect the body afterwards. Keeping a stable weight is the main factor within your control.

Liposuction takes fat cells away and those particular cells are gone for good. Fat cells in other areas can still grow if you put weight on, and that can shift your proportions in ways nobody can forecast. A pregnancy after abdominoplasty can stretch a muscle repair, which is why finishing your family first tends to be suggested when that is practical. Ageing carries on changing skin quality whether or not you have had surgery. Outcomes differ from patient to patient, and no particular result can be promised.