Not every patient needs the same operation. Dr. Karamanoukian evaluates each patient’s specific anatomy, degree of skin excess, muscle separation, and body goals to recommend the most appropriate procedure.
01
Full Abdominoplasty (Tummy Tuck)
The full abdominoplasty is the definitive abdominal body contouring procedure — addressing skin excess from the lower abdomen to the navel, diastasis recti muscle separation, residual fat deposits, and repositioning the navel (umbilicoplasty) to a naturally youthful location on the reconstructed abdominal surface. The low horizontal incision is placed precisely at or below the upper bikini line — where it is completely concealed by swimwear, underwear, and workout clothing — and extends from hip to hip in a gentle curve planned by Dr. Karamanoukian with the patient standing upright before surgery.
The procedure removes the entire lower abdominal skin panel between the navel and the pubic hairline — which typically contains the most severely stretch-marked and lax skin — then advances the upper abdominal skin downward, bringing the navel through a new opening in the repositioned skin at the correct anatomical position. The rectus abdominis muscles are plicated with permanent sutures along their entire midline length, creating a tighter, flatter abdominal wall that immediately corrects the diastasis and reduces the abdominal wall projection that sit-ups cannot address. The total procedure takes 2–3 hours under general anesthesia.
Best For: Patients with significant post-pregnancy or post-weight-loss skin excess from the lower abdomen to the navel, diastasis recti, and excess lower abdominal fat not responsive to exercise
02
Mini Tummy Tuck (Mini Abdominoplasty)
The mini tummy tuck uses a shorter incision than the full abdominoplasty and addresses only the skin of the lower abdominal panel below the navel — the area between the pubic hairline and approximately 5–8cm below the navel. It does not require repositioning the belly button, though mild umbilicoplasty (reshaping of the navel) can be performed simultaneously. The smaller incision and less extensive undermining result in a faster recovery of 7–10 days compared to the 2-week recovery of a full tummy tuck.
The mini tummy tuck is ideally suited for patients with a well-defined lower abdominal skin excess confined to the zone below the navel, with minimal or no diastasis of the upper abdominal muscles and good skin quality above the navel. It is Dr. Karamanoukian’s preferred option for the fit, athletic patient who is close to their ideal body composition but struggles with a persistent lower abdominal skin pouch from prior pregnancy or weight fluctuation that no amount of exercise corrects.
Best For: Lower abdominal skin pouch confined below the navel, minimal diastasis, near-ideal body weight, active patients wanting faster recovery; the “bikini line fix” for fit women with isolated lower abdominal laxity
03
Diastasis Recti Repair
Diastasis recti — the separation of the paired rectus abdominis muscles along the midline of the abdomen — is present in the majority of women after pregnancy and is the primary reason that post-partum abdominal exercises produce disappointing results: when the muscles are separated, core exercises build the individual muscle bellies but cannot close the gap between them. The protruding, rounded lower abdominal contour that mothers describe as their “mommy pouch” is often as much a diastasis problem as a skin problem — and addressing skin without repairing the diastasis produces an incomplete result.
Dr. Karamanoukian repairs diastasis recti by placing a series of permanent, slowly dissolving sutures (typically Ethibond or Nylon) along the linea alba from the xiphoid process to the pubic symphysis — the full length of the midline — drawing the separated muscle edges together and recreating the flat, tense fascial foundation of the abdominal wall. This repair is performed as a component of every full abdominoplasty at Kare and can also be performed as a standalone procedure through a small midline incision when the patient has diastasis without significant skin excess.
Best For: Post-pregnancy abdominal muscle separation causing lower abdominal protrusion, the “mummy tummy” that does not respond to exercise, lower back pain from weakened core support
04
Liposuction Body Contouring
Liposuction is a powerful complement to abdominoplasty and an essential component of most mommy makeover procedures at Kare Plastic Surgery. While abdominoplasty removes excess skin and tightens the abdominal wall, liposuction addresses the three-dimensional fat deposits of the flanks, waist, hips, and outer thighs that determine the overall body silhouette and the definition of the waistline. Dr. Karamanoukian performs VASER ultrasound-assisted liposuction and traditional tumescent liposuction, selectively treating the fat compartments that resist diet and exercise while preserving the blood supply to the abdominal skin flap that is critical for safe wound healing after abdominoplasty.
Liposuction of the flanks and waist in combination with abdominal skin excision dramatically improves the three-dimensional hourglass contour visible from all angles — the “360-degree result” that is the hallmark of comprehensive body contouring. For many patients, the waist circumference reduction achieved by combining liposuction with tummy tuck is the most dramatic cosmetic change they have ever experienced.
Best For: Flanks, waist, hips, outer thighs, and love handles concurrent with abdominoplasty; essential component of most mommy makeover procedures; 360-degree waist definition and hourglass silhouette creation
05
Reverse Tummy Tuck
The reverse tummy tuck (reverse abdominoplasty) is a specialized technique indicated for patients with skin laxity confined to the upper abdominal region — the area above the navel that is not adequately addressed by a standard abdominoplasty, which excises the lower abdominal panel and advances skin downward. In a reverse tummy tuck, the incision is placed in the inframammary fold (the natural crease beneath the breasts), allowing the upper abdominal skin to be elevated and the excess excised through a scar that is completely concealed by the bra line and swimsuit top.
The reverse tummy tuck is most commonly indicated for patients who have previously undergone a standard abdominoplasty and developed new skin excess in the upper abdomen over time, for patients with post-bariatric skin excess limited to the upper abdominal zone, and for patients combining breast surgery with abdominal contouring where the inframammary access is already being used. Dr. Karamanoukian evaluates each patient’s specific distribution of skin excess at consultation to determine whether a standard, reverse, or extended abdominoplasty is the most appropriate approach.
Best For: Upper abdominal skin laxity above the navel, post-bariatric upper abdominal excess, post-standard-abdominoplasty upper abdominal recurrence, patients combining breast and abdominal surgery
06
Umbilical Hernia Repair
Umbilical hernias — protrusions of abdominal contents through a defect in the umbilical ring — are a common accompaniment to diastasis recti after pregnancy and are frequently identified at the tummy tuck consultation. While umbilical hernias are a medical condition covered by many PPO insurance plans when symptomatic, they are most practically and efficiently repaired simultaneously with abdominoplasty, as the operative access required for abdominoplasty provides excellent visualization and approach to the umbilical defect without requiring a separate incision or procedure.
Dr. Karamanoukian repairs umbilical hernias using a standard technique of reducing the herniated contents and closing the fascial defect with permanent sutures — providing durable, reliable hernia repair with essentially no additional recovery beyond the abdominoplasty itself. He coordinates with the patient’s insurance company for pre-authorization of the hernia repair component when combining this with cosmetic abdominoplasty, potentially offsetting a portion of the total surgical cost. All combined cosmetic/medical procedures are planned and documented with complete transparency at consultation.
Best For: Umbilical hernias identified at tummy tuck consultation; simultaneous repair during abdominoplasty avoids second procedure and anesthetic; insurance coverage for hernia component possible with appropriate documentation