Joan had been working her way down in her makeover, and now she had literally reached the middle of her task. She had a bit of a belly, okay, a literal pouch had formed there that could carry a small family of kangaroos. And though she was an animal lover, she hated freeloaders and knew men were already scared away by women who were coming to the table with children, much less a small family of ’roos.
Stubbornly refusing the surgical route, she hatched a plan to banish the fat on her terms. She arrived at a theater in a tiny Cotswolds village in the English countryside that was home to a popular Japanese tourist attraction featuring actors in “Swinging ’60s” costumes. Unfortunately for our heroine, her costume was a miniskirt with white go-go boots. As she was no Twiggy—more like Saggy—the Asian shutterbugs hid their cameras when they saw her. Joan knew something drastic had to be done. (Note to self: when the Japanese won’t photograph you, something is terribly wrong.) Joan urgently phoned a plastic surgeon back home to schedule a tummy tuck or two. Unfortunately Star Jones had the week booked, but Joan was able to get in the following week.
In the hourglass that is my figure, most of the sand is stuck in the middle.
Actually, my boobs measure exactly the same as my waist, because my boobs are my waist.
I once complained to my husband about my belly fat, and he told me not to worry, because my breasts covered it.
A well-defined waist is often the most enviable body part in other women. Men like an itty-bitty waist. Across the globe, a tapered waist expanding into rounded hips is the key factor in a woman’s sexual attractiveness. You could have the face of a dog, but if you’ve got the waist of a wasp, men will swarm toward you.
Some ideas:
1. Curves are a sign of fertility. From an evolutionary standpoint, the earliest cavemen made the empirical connection between a woman with good hips and child-bearing. They also made a link between women with thick waists and their grandmothers.
2. Curves are fun to drive. Men love the metaphors that compare cars to women’s bodies and sex to driving. The poet e.e. cummings, in his poem “she being Brand” describes a man driving a new, hard-to-handle car for the first time—a metaphor about deflowering a jittery virgin. And people think poetry is boring.
3. Curves are dangerous. Anything a man doesn’t understand or possess is to be feared or coveted. We have curves, they don’t. Ergo, our figures are both intimidating and desirable.
4. Curves are sexy. That’s really the point. Sexually speaking—and don’t kid yourself, physical attractiveness is all about sex—most men adore a rounded, cushion-like bottom. However, without a trim waist to go with it, men won’t think “cushion.” They simply think “couch” and reach for the remote control.
The percentage of the waist circumference to the hip circumference is known as your waist-to-hip ratio or WHR. Although you might’ve never heard of the WHR* before, it’s a very important acronym. Even more important, according to scientists, than your BMI, or body mass index. Your BMI indicates how fat you are. But your WHR indicates how happy and healthy you are.
Along with being inundated with male attention, pear-shaped women (those with low WHRs) are smarter, more fertile, will live longer, will make more money, have bigger houses, wear nicer clothes, and drive better cars. Scientists have proven this! Most of it, anyway. I exaggerate for my own amusement. But I really did read about one study that found the children of small-waisted, ample-hipped mothers scored better on intelligence tests. It has to do with their having abundant quantities of polyunsaturated fat—the kind found in the butt and thighs—needed to feed the hungry fetal brain. And you thought your kid was a good student because she studies hard. Wrong. It’s because you, and I mean this as compliment, have a big fat ass.
Conversely, apple-shaped women (those with high WHRs) have an increased risk for diabetes, heart disease, some cancers, obesity, infertility, and I might add spinsterhood, poverty, and general misery.
Fashion exists to emphasize the WHR. Even cavewomen cinched their wildebeest-hide dresses with decorative vines. In modern times, women have used bustles, hoop skirts, petticoats, corsets, and girdles to shrink the waist and boost the bottom. The corset alone is singularly responsible for propagation of the species during times of sexual repression.
Victorian England—a corseted era—was so repressed, it was considered uncouth to display the legs of a piano. Would Rhett Butler have given a damn about Scarlett O’Hara if it weren’t for her eighteen-inch waist? Women used to pull corsets so tight that they were constantly swooning and fainting in warm rooms.
And it wasn’t because they were delicate, fragile, sickly creatures!
The blood flow to their brains was cut off by the lacing.
Thousands of whales died to bone ladies’ undergarments. Whales made women thin. Funny no one saw the irony of that. Until now.
If you’re feeling adventurous and want to calculate your WHR, here’s the step by step process:
1. Wrap a tape measure around the smallest part of your waist. Write down the number of inches.
2. Wrap the tape measure around the widest part of your hips. This is the only time you want your hips to be big, so you’ll do yourself no favors by skimping.
3. Calculators out! Divide waist measurement by hip measurement. If, in your case, it’s 26 divided by 36, that makes your waist-to-hip ratio 0.72. Same as Marilyn Monroe, Sophia Loren, and the Venus de Milo.
The ideal WHR for women, in terms of sexual attractiveness to men, is 0.7. For good health, it should be 0.8 or below. Higher than 0.85, expect to have a stern conversation with your doctor at your next checkup.
For men, the ideal WHR is 0.9. His hips and waist are almost the same measurement. Women, like men, are attracted to their opposite. A man with narrow hips and a big beer belly isn’t defining sexy. But he’s a bona fide hottie compared to a man with a small waist and a wide ass. Men with hips? Just thinking about it makes my last ovary shrivel.
Considering the desirability of a tiny waist, it should come as no surprise that abdominoplasty, aka the tummy tuck, was the fifth most popular plastic surgery in 2007. This procedure, usually in conjunction with strategic hate handle liposuction, flattened the bellies and cinched the waists of 148,000 patients last year. I’ll bet they all tried their hardest to get a slender waist on their own. Dieting. Crunches. Sit-ups on that big rubber ball at the gym. The Ab-Lounger. You do what you can, but at a certain point, you hit a wall. And that wall is made of spare tire, hate handle, and belly fat that has no intention of going away quietly.
Is there anything more frustrating than belly fat?* Women who’ve been pregnant are especially vexed by the flabby skin on the midsection. They might be skinny everywhere else, but the belly looks stretched out like a deflated tire. Having a plump belly because of pregnancy is nothing to be ashamed of. It’s a badge of horror—I mean honor!—to remind you what your body has been through. The sag of skin and extra padding, rest assured, is not your fault.
I had a tummy tuck about twenty years ago, as an adjunct to a hysterectomy. The ob/gyn surgeon removed my female bits, and then, in a move almost unheard of back then, I had a plastic surgeon come into the ER to finish the job.
I figured, if I’m going to be sliced open and have to endure that non-elective operation, I might as well come out of it with a nice, tight tummy.
And it was the best thing I ever did. I was thrilled with how it looked. All the other women in the ward who had had hysterectomies were all going around crying and saying, “Boo-hoo, I’ll never have any more children.” And there I was smiling and saying, “I can’t wait to get back in my bikini.” What’s more liberating than looking down and seeing a nice, flat stomach?
With the big-ticket operations, such as a tummy tuck, most women have some ambivalence and guilt to deal with beforehand. Why should you spend thousands of dollars and give up a month (or more) of your life to fix a problem surgically that can be corrected through sacrifice and suffering?
By “sacrifice and suffering,” of course, I’m referring to “diet and exercise.” Let me relieve you of your ambivalence now: For mommies, the abdomen is largely immune to the effects of diet and exercise.
When you’re pregnant, your belly skin is stretched (this we know). Unless you’re eighteen and have skin like a rubber band, it won’t snap back to the way it was before. Multiple pregnancies sap the elasticity out of the stomach skin no matter how springy it once was. This is the price of pregnancy. We give our babies life; they give us sagging, loose, stretched-out skin.
Even Cindy Crawford, a mother of two, has fleshy puckering underneath her belly button, as seen in paparazzi bikini pictures. You can diet away fat, yes. But you can’t diet away skin. The rest of your body could be as scrawny as a starved cat, but the stomach slack? Yours to keep.
What’s more, your abdominal muscles—the six-pack—were stretched and separated during pregnancy. Picture them in two vertical rows of three little muscle rectangles, all nice and neat. (I think of them as ab-dominos.) When you expand during pregnancy, the two vertical rows are pulled apart. The technical term is “diastasis.” Post-pregnancy, instead of the two, neat, tight, vertical rows of muscles, you have two curved parentheses, with a gap of nothing between them. That gap—which adds inches to your waist—can’t be closed, no matter how many Pilates core classes you take. You could do a thousand crunches a day, and your waist still won’t go back to its pre-pregnancy measurement.
Women who’ve never reproduced* but have a genetic predisposition to carrying their fat around the middle will also find relief via tummy tuck. I have a friend who runs marathons, is a vegetarian, never drinks beer, has never been pregnant, and yet, since she was ten years old, has had this little pouch. She’s an ideal candidate for a tummy tuck.
Every doctor on our advisory panel wanted me to make it absolutely clear that a tummy tuck is not a weight-loss strategy: obese women, especially those with diabetes or heart problems, would put themselves at risk of a heart attack or a dangerous infection if they had a tummy tuck or any plastic surgery.
In fact, even if you’re not obese, a lot of doctors would advise you to go on a diet and exercise plan before your surgery. Lose whatever weight you can first and then let them do the rest. Streamlining your body will streamline the operation.
To renovate the entire midsection, from rib cage to public bone, you’ll need a full tummy tuck, most likely with a chaser of hate handle/belly liposuction.
The severity of an operation can be judged by recovery time. As a full tummy tuck is a major operation, it will take up to two months to fully recover. After a month, however, your belly will be so flat, you can bounce quarters, or a quarterback, off it. You could iron on it. Your waist will be wispy. Belt-worthy.
Fair warning: Reading a description of the full tummy tuck isn’t for the faint of stomach. If you’re squeamish and wish to keep your lunch, skip ahead a few paragraphs.
The full tummy tuck is usually done under general anesthesia. Some mavericks will do it under a local, just numbing the area, as ob/ gyn surgeons often do to perform caesarians. Personally, as during sex, I would rather be sound asleep.
Once you’re under, the doctor will draw the dotted guidelines for the incisions. If you’re having lipo too, you’ll be marked where the cannula will be inserted. Because tumescent fluid needs to be inside the body for at least ten minutes, optimally forty minutes, before the fat can be suctioned away, doctors will usually infuse the area with the fluid first, then start making the tummy tuck incisions. After forty minutes or an hour of tummy tucking, they’ll then return to the lipo-suction procedure to aspirate the fat.
Typically, for the full tummy tuck, the first cut is a curved line, from hip to hip, that runs below your stomach pouch and above the pubic bone. The second cut is a lollipop incision: a circle around the belly button and a vertical line straight down to the hip-to-hip incision.
Next, the doctor will use a cautery device and scissors or a scalpel to peel the large flaps of skin up and away from the muscle wall from pubic bone to rib cage.
Your abdominal wall is now exposed. Remember the two curved rows of muscles, the six-pack parentheses? Using a diagonal stitch, the doctor sews the rows of muscles back into their pre-pregnancy position.
It’s like lacing sneakers and pulling them tight, narrowing the waist in the process. The sutures will dissolve on their own and won’t need to be removed later on.
Next, it’s time to drape the skin/fat layer tight over the tightened abdominal muscle wall. The excess skin will be trimmed. How much? “Let’s say you have a patient who had gained weight in pregnancy and then returned to her weight prior to the pregnancy,” said Dr. Zevon. “If there was fifteen centimeters of excess skin vertically, the optimal length of the incision would be forty-five centimeters for a three-to-one ratio. That allows there to be a smooth, flat scar without excess tissue, sometimes called ‘dog ears,’ at the end of the skin closure.” The excised skin weighs a few pounds.
At this point (or before), the doctor will go back to the lipo part of the procedure and use a suction cannula to aspirate fat from the belly, hate handles, and, sometimes, the lower back.
If the operation were to end there, you’d have a flat belly and tighter waist, with one big problem: no belly button. The internal navel is where it used to be, but the hole opening had been part of the excised skin. Unless you want people to think you’re a clone, the doctor then cuts a new hole in the skin, like opening a window for your navel to show through, and makes a circle of stitches to sew the navel to the hole of skin.
Next, the doctor will insert some drainage tubes into the abdomen and sew up the bottom incision. You’ll have two scars—a long curved one running hip-to-hip, and a small round one encircling the new belly button. The drainage tubes will stay in place for a few days. You’ll have to wear a girdle-type compression garment for a few weeks, too. The whole operation will last from three to five hours.
A mini tummy tuck, unlike its big sister, is for women who have loose skin below the belly button only. No bulging upper-abdominal sag. A mini is for women, like my marathoner friend, who are skinny, except for the one infuriating roll between the navel and the pubic bone, or for women who have puckered, hanging skin from pregnancy that they have to tuck into their jeans like a shirt tail. The mini can take care of that, with less hassle and pain than a full. But, alas, it’s still heavy-duty surgery. Any tummy tuck is significant—in time, money, and pain. Consider yourself warned.
For the mini tummy tuck, you’ll be put under—or, for the brave, shot full of a local numbing agent. The surgeon will draw the dotted curved line just above the pubic bone and under your pouch. The mini-tuck incision is shorter—six to eight inches across—and the scar will be hidden entirely by your panties or a bikini bottom.
Once the incision has been made, the doctor will separate the skin/fat layer from the abdominal wall with a cautery device and a scalpel. He’ll peel the skin upward to expose the vertical rows of muscle, aka the six-pack. But since he’s working on the lower abdominal wall only, he’ll be attending to only four of the muscles, which he’ll suture closer together, using a criss-cross stitch, into neater vertical rows.
Again, it looks like lacing up a sneaker and pulling it tight.
Next, he’ll pull the skin tightly back over the lower abdomen and cut off whatever hangs over the incision line. It’s like hemming your stomach. He’ll put some drainage tubes in the belly to prevent fluid accumulation, and then he’ll close you up neatly. Since he worked on the lower region only, the belly button won’t need to be repositioned. The operation will last three hours or so. You’ll have to leave the drains in for a few days, as well as wear a girdle-esque garment to prevent swelling.*
For a full tummy tuck, you’re looking at as little as $6,000 and as much as $15,000. It’s a huge range. If you’re getting liposuction of the belly and/or hate handles along with the tuck, expect a quote at the high end of the range. For a mini, the range is smaller: $5,000 to $8,000. Remember, you’re paying for the surgeon, the facility, the anesthesiologist, the nurses and assistants, the meds (before, during, and after surgery), the follow-up care. * For any major cosmetic surgery, expect to pay $5,000 just to walk in the door.
The rewards:
A week recuperating. If you’ve got enough magazines, dirty novels, and romantic comedies, a week’s time-out shouldn’t be too taxing. For the first two days, you won’t be able to stand up. Let your staff of servants (aka, your friends and family) cater to your every whim. It’s only temporary.
Two months’ gym reprieve. No strenuous exercise for two months? No problem! Next time you hit the gym, all the regulars will be amazed by your new body. Tell them that, instead of working out, you sat on your ass for eight weeks, and look what happened.
No more trapeze tops. Sick to death of bubble dresses and swing jackets? After your tummy tuck, say good-bye to Lane Bryant separates. You’ll be shopping for body-clinging, tight, form-fitting dresses, blouses, and blazers that would look good on Ashlee Simpson. After years of dressing to camouflage your mid-section, you can now set it free. Go ahead, show an inch of skin above your pants.
Confidence. Nothing makes you feel quite as secure as walking down the street with the utter confidence that your stomach is not jiggling. Or to pose for a photo without hiding your gut behind a briefcase or a purse or a midget friend. After a tummy tuck, you can put yourself front and center.
The risks:
Death. With any procedure that requires general anesthesia, there’s a 1 in 100,000 chance of going to sleep and never waking up. A tummy tuck is major surgery and should be considered with the proper gravity.
Infection. Another omnipresent risk when you’re being cut into, your insides exposed to the air, tools, gloved hands. I’ve heard several doctors say the risk of infection is why going to a private office surgical facility is actually safer than going to a hospital where there are sick people and germs. Make sure the facility is AAAASF-accredited (American Association for Accreditation of Ambulatory Surgery Facilities). Pre- and post-op, just to be sure, you’ll probably get antibiotics anyway.
Bleeding/embolism. During surgery, the doctor will cauterize the cut vessels to prevent internal bleeding. But he might miss a few. Most bleeders stop on their own. If not, the doctor might have to go back in to take care of it. Check for excessive bruising and swelling— beyond what you can normally expect. Also, a bubble of air can sneak its way into a vessel. If the bubble reaches your brain or lungs, that would be bad. Both risks are rare.
Swelling/bruising. The drainage tubes and compression garment keep swelling and discoloration under some control. But you should still expect a lot of both. You’ve been cut wide open, after all. Your blood and lymph systems will rush to your defense, whether you want their help or not. Swelling is part of healing. The drains come out after a few days. Fluids start to recede after two weeks. By the end of three months, it’s 90 percent gone. As far as the bruising, your skin will be normal in color after six weeks, if not sooner.
Pain. Doctors liken the pain of a tummy tuck to that of a caesarian. You may experience muscle cramps. Achingly tight skin. Not being able to stand upright for a week. The chafing from drainage tubes. Ice packs and the compression garments help a little. Pain meds help a lot. This is not the time to be prudent or “brave.” Take the pills! Be prudent and brave next week. And be sure to blame it on your kids. Again.
Numbness. Prepare for spotty numbness on the surface of your skin around the incision area. Usually, sensation returns after a month. Sometimes, it’s gone for good.
Scarring. There will be permanent scars. No sugar-coating the reality of tummy tucking. For the full treatment, the scar will run hip to hip. Mine was along the bikini line, and eventually turned white and all but disappeared. Also, you’ll have a ring-shaped scar around your new belly button. If you have a good surgeon and good skin, it’s virtually invisible after it’s healed. Even in the best of all possible worlds, though, you don’t always get a perfect outcome.
Patricia “Everyone Loves Plastic Surgery” Heaton, mother of four, admitted to having had a tummy tuck. She didn’t do so well with her scars, especially around her herniated navel, which appeared to have folded over itself. She still said she’d recommend a tummy tuck to anyone.
“There is no way to guarantee how the scar will look in any particular individual,” said Dr. Scott Zevon. “You can do the same procedure on different people and get a different-quality scar. There is an element of scar maturation that’s out of the surgeon’s control. If someone has multiple scars that have healed poorly without due cause, the surgeon would raise the possibility that they will scar poorly again.”
Disappointment. You thought you’d be a goddess, but turned out to be You, Only Better. Maybe you thought your stretch marks would disappear. FYI: stretch marks on the excised skin are gone from your life forever. Others, on your sides, for instance, won’t be fixed via tummy tuck. After all that pain and money, you do not have the belly of your dreams. This is why doctors chant the phrase “realistic expectations.” With all treatments and surgeries, you’re paying for visible improvement. A tummy tuck will definitely improve the appearance of your stomach. It won’t miraculously transform you into Beyoncé.
No matter how much money you spend, you are still you. Which is exactly how it should be.
Maybe you’ve heard about the Mommy Makeover: a combination of procedures for women whose body parts suffered during pregnancies. Perhaps the breasts got big during nursing and then deflated. Or the once narrow waist stretched out during pregnancy, and extra skin around the middle hangs off your formerly flat stomach. Your friendly neighborhood plastic surgeon will be happy to put that bounce back in your boobs and the tight back in your tummy all in one shot, a double-whammy job. It’s a full day on the table—a minimum of six hours—and it’s a major hit on your bank account, cost starting at $15,000. The recovery isn’t easy. You’ll be chin to crotch in bandages. Maybe it should be called the Mummy Makeover. You won’t be able to lift anything heavier than a pint of ice cream for a month post-op: make sure that your husband/lover/ the bastard who got you pregnant is available to get the kids in and out of car seats and the bathtub. I would urge anyone to wait for a full year after you’ve finished breast-feeding your last kid to do this.
This double-whammy procedure is one example of the new trend of having two or more major plastic surgeries in one shot. The theory is that you save money by paying for anesthesia only once. Indeed, most doctors will give multiple-procedure discounts. Also, you get it all over with quickly. Although the recovery might be twice as painful by doing a lot of surgery at once, it’ll take half as long as staging two procedures over time.
“At some point it is likely that there is a greater risk with combined procedures than of the abdominoplasty alone but not necessarily greater than the risks of the two procedures performed at different times,” said Dr. Zevon. “There comes a point where you want to stage operations done on an ambulatory basis. I’d say six hours is the maximum.” Surely, surgery that long takes a physical toll on the surgeon, as well? “Performing surgery can be relaxing,” Dr. Zevon says.
Personally, I like the small-tweaks approach. God knows, I’ve had a lot done over the years, but I chose to do it a little at a time. Doing an extreme makeover involves six hours of anesthesia—at least—and cutting into multiple body parts all in one day. That scares me, and it can be a major shock to the body.*
The best of all possible worlds? I saw an ad on Craig’s List recently, posted by a plastic surgeon in the Hamptons, offering the June to September rental of his beachfront mansion, as well as all the plastic surgery the renter desires, for the price of $500,000. What could be better? Staggering procedures every couple of weeks, recuperating in a beautiful setting, under the twenty-four-hour care of your surgeon? A summer of rebirth on the beach! It sounds like a little bit of heaven, for whoever can afford it.