What is an extended tummy tuck?
A standard tummy tuck removes the loose skin of the abdomen through a hip-to-hip incision, repairs the abdominal wall and rebuilds the belly button. After a large weight loss the loose skin does not stop at the hips: it continues around the sides toward the back, and a hip-to-hip incision would leave a fold or a dog ear at each end. An extended tummy tuck carries the incision past the top of the hip bones toward the back, so the skin of the flanks is tightened with the front, and it includes the muscle repair, because most patients who have lost a lot of weight have a loosened abdominal wall (diastasis recti).
What an extended tummy tuck changes
- The apron of skin over the waistband, the rolls over the hips and flanks, and the stretch marks below the navel, which leave with the skin
- A separated abdominal wall, and an umbilical hernia when one is present
- A sagging mons pubis, lifted with a pubic lift in the same surgery
Extended vs full tummy tuck
The two share the muscle repair, the rebuilt belly button and the low incision. A full tummy tuck runs from hip to hip and takes about five and a half to seven hours; an extended tummy tuck continues past the hip bones and takes about nine hours. Our mini vs full tummy tuck comparison explains how Dr. Cat decides between a mini and a full; the step to an extended is decided with a pinch test at the consultation.
A revision tummy tuck is a different operation again: it corrects a previous tummy tuck, including one whose incision stopped short and left the sides loose.
Who is a good candidate for an extended tummy tuck?
Most of Dr. Cat's extended tummy tuck patients have lost a large amount of weight, through diet and exercise, medication or weight-loss surgery, and are left with skin that hangs over the waistband and folds over the flanks. On her quote, an extended tummy tuck is defined for patients over 170 pounds or with a BMI above 27 after losing a lot of weight, with excess skin extending around the sides to the back past the top of the hip bone; our page on apron belly and loose skin covers what surgery can change.
You may be a good candidate if
- You have lost a large amount of weight and are left with loose skin that continues around the sides toward the back
- Your weight has been stable for months, within 10 to 15 pounds of your goal, with a BMI of about 30 or less
- Your abdominal muscles have separated, or you have an umbilical hernia
- You are in good health, do not use nicotine, and accept a long, low scar for a flat abdomen and smooth sides
Not yet, or a different operation, if
- Your weight is still coming down: skin removed now loosens again with further loss
- You are planning a pregnancy, which will likely stretch the repair and the skin
- Your BMI is well above 30, or your diabetes or another condition is not yet controlled
- You use nicotine and cannot stop: the long incision depends on the blood supply nicotine restricts
Tummy tuck after weight loss
Weight loss loosens the skin everywhere, not only below the navel, so a mini tummy tuck is almost never the right operation after a large loss. Dr. Cat asks weight-loss patients to reach a stable weight first, because skin tightened now loosens again if another 30 pounds come off later. When the loose skin continues down the inner thighs, a thigh lift is planned on its own day.
Fleur-de-lis tummy tuck: when a vertical incision is added
A fleur-de-lis tummy tuck (fleur-de-lis abdominoplasty) adds a vertical incision up the midline, so skin is removed side to side as well as top to bottom and the scar is shaped like an anchor. It is reserved for patients, usually after a loss of 100 pounds or more, whose skin excess is so wide that pinching the flanks inward brings the loose skin together in the middle: the vertical component removes what a horizontal incision cannot, at the price of a visible midline scar. Whether your plan needs it is decided at the consultation with the pinch test; our post on the fleur-de-lis tummy tuck has the detail.
How Dr. Cat does it
Dr. Cat is a board-certified plastic surgeon who completed two surgical residencies, one in head and neck surgery, microvascular and facial reconstructive surgery, and advanced training in general plastic and reconstructive surgery, Harvard-educated and UCLA trained. These are the details that define her extended tummy tuck.
The incision: low, and as long as the loose skin requires
The extended incision continues past the top of the hip bones toward the back and ends where the loose skin ends, so there are no step-offs or dog ears at the sides. It sits low enough to hide under underwear or a bikini bottom; bring the pair you want to hide it under to the consultation. A C-section scar or another low scar is removed with the excess skin. Dr. Cat keeps the incision as short as the anatomy allows, and no shorter.
The muscle repair and the belly button
Almost every patient who has lost a large amount of weight has a loosened abdominal wall, so the repair is part of every extended tummy tuck: the rectus muscles are brought back together with a precise double-layer repair, tight but never over-pulled, so the abdomen looks like abs, and an umbilical hernia is repaired at the same time. The belly button is rebuilt as her signature natural innie: centered where yours naturally sits, proportional, with a dimple, the incision inset deep at its base, and no sutures crossing the line.
The closure: measured, layered, no dog ears
The skin removed is measured to the millimeter on each side so the two sides match, and the closure is layered so the abdomen blends into the pubic area and the flanks without shelves or bunching. The ends of a long incision are where most surgeons leave dog ears; Dr. Cat tapers each end cleanly toward the back.
About nine hours, one patient, every step by Dr. Cat
An extended tummy tuck takes about nine hours under general anesthesia, and Dr. Cat schedules nothing else that day. She performs every step herself, with a board-certified physician anesthesiologist for the whole case, in the practice's QUAD A accredited surgery center on Rodeo Drive. Because the surgery is long, the first night in a plastic surgery aftercare center with nursing is required.
Combining an extended tummy tuck with other procedures
Pubic lift
Most patients with loose skin around the sides also have loose skin over the mons pubis, and a pubic lift is performed in the same surgery so the tightening is uniform from the ribs to the pubic hairline, never pulled so far that the hairline sits too high.
Liposuction of the mons or the love handles
Conservative liposuction of the mons pubis can be added for about $4,750 all in, and of the love handles at about $6,500 to $7,500 per area when the operating time allows. Dr. Cat does not perform aggressive or 360-degree liposuction in the same surgery, because the blood supply to the lifted skin travels through that fat; lipo 360 is a separate surgery on a separate day.
Staged on a separate day
A Brazilian butt lift is never performed on the same day as a tummy tuck: after a BBL you cannot lie on your back, and after a tummy tuck you cannot lie on your stomach. A tummy tuck is never done on the same day as a breast augmentation with implants, a breast lift is staged, a labiaplasty is never done the same day, and a thigh lift is its own surgery, so that the anesthesia stays short and the recovery manageable.
Extended tummy tuck recovery timeline
Recovery follows the same path as a standard tummy tuck, with more swelling along the sides because more skin was lifted; the long version is in our tummy tuck recovery guide, week by week.
- The night of surgeryYou wake with little to no pain and, after about an hour, go to a plastic surgery aftercare center, where nurses monitor you, manage your drains and get you up to walk that evening.
- Day oneThe aftercare center brings you to the office, where Dr. Cat checks the whole incision and reviews your instructions. Most patients have little pain and no bruising, only swelling; you walk slightly bent and use your arms, not your abdomen, to get out of bed.
- One weekYou stand almost straight, and Dr. Cat removes all or most of the drains, gently. Gentle walks only.
- Two weeksThe remaining drains come out, desk work resumes and silicone strips start. Out-of-town patients can fly home once cleared.
- One monthDaily activities, social events and walking are back; the garment and the silicone strips continue to six weeks.
- Six weeksFull exercise resumes, except sit-ups, planks and crunches, which wait until three months after a hernia repair. Swelling at the flanks settles more slowly than at the front.
- Three months to one yearDr. Cat reviews your photographs at three months, and scar care continues with silicone gel. The result is fully visible at six months and the incision is a thin, faded line at one year.
The extended tummy tuck scar
The scar runs low across the front in a gentle curve and continues past the hip bones toward the back, under the waistband of underwear or a bikini bottom; the belly button scar is inset inside the navel. Because the closure is layered and the ends tapered, there is no ridge and no dog ear at the sides. Silicone strips start at two weeks and continue for six, then silicone gel; the scar is pink at first and a thin white line at one year, and keloid-prone patients can still do well. Our tummy tuck scar guide shows the stages month by month.
Extended tummy tuck before and after photos
Look at the sides as well as the front. Case TTK-0644 lost 70 pounds and had loose skin past the hip bones on both sides; Dr. Cat removed 18 inches of skin weighing over 9 pounds in an extended tummy tuck with a pubic lift, photographed at one year. Case TTK-0709 is an extended abdominoplasty with a pubic lift and hernia repair after two pregnancies, with 12 inches of skin removed and a 6-centimeter muscle separation repaired; case TTK-0549 is an extended abdominoplasty with a pubic lift. TTK-0824 (more than 50 pounds lost), TTK-0735 (a significant weight loss) and TTK-0743 (40 pounds lost) are standard tummy tucks after weight loss, shown for comparison: their loose skin stopped at the hips. More cases are in our tummy tuck before and after photos.
Risks and safety
Here is what can happen after an extended tummy tuck, what Dr. Cat does to prevent it, and when to call us.
What can go wrong
- A fluid collection (seroma) or a blood collection (hematoma) under the lifted skin, more likely when more skin is lifted
- Infection at the incision or around a drain
- Delayed healing or a small opening of the incision, most often at the center, where the tension is highest
- Skin or fat necrosis when part of the lifted skin loses its blood supply: the reason aggressive liposuction is never added and nicotine is stopped
- A scar that heals wider or raised, asymmetry, residual loose skin at the sides, or a belly button that needs a touch-up
- A blood clot in the leg that can travel to the lungs: rare, serious, and the reason you walk the night of surgery
How Dr. Cat reduces these risks
- Careful patient selection: a stable weight, BMI, nicotine, diabetes control, and a full review of your medical and weight-loss history
- Medical clearance and lab work for every patient, and a pre-operative appointment covering what to avoid before surgery
- A QUAD A accredited facility, a physician anesthesiologist for the whole case, and a team dedicated to one tummy tuck that day
- Little to no bleeding, muscles never over-pulled, skin removal measured to the millimeter, and attention to positioning, padding and temperature over a nine-hour case
- No aggressive liposuction and no Brazilian butt lift in the same operation
- The first night in an aftercare center, walking that evening and every other hour afterward, a compression garment, drains out at one to two weeks, and follow-up visits from day one to three months
Call us right away for a fever over 101°F, chills, or spreading redness, warmth or foul-smelling drainage along the incision or at a drain; swelling or pain that keeps getting worse on one side, or a firm, enlarging bulge; any opening of the incision, or bleeding that does not stop with gentle pressure.
Call 911 first, then us, for calf pain or swelling in one leg, chest pain, or shortness of breath. For anything else that worries you, Dr. Cat and our staff are available throughout your recovery.
How much does an extended tummy tuck cost in Beverly Hills?
An extended tummy tuck with Dr. Cat is $75,000 to $95,000 surgeon's fee plus the operating room and the physician anesthesiologist, quoted in writing at your consultation; the surgery center portion follows the operating time. A pubic lift or a hernia repair adds to the quote, liposuction of the mons is about $4,750 all in, and the first night in a plastic surgery aftercare center is arranged for you. For comparison, a standard full tummy tuck with muscle repair is about $53,000 to $77,000 all in. Every quote is itemized, with your garment and follow-up visits included.
The price reflects one surgeon who performs every step of a nine-hour operation herself, a physician anesthesiologist for the whole case and an accredited facility. Please do not fall for cheap or fast surgery: after major weight loss a short incision or a skipped muscle repair shows most, and a revision costs more than the original surgery would have done well. Our tummy tuck cost guide explains what a quote is made of.
Consultation fee and financing
A consultation with Dr. Cat is $500, or $1,500 for a revision consultation, credited in full toward your surgery. The practice partners with Cherry, its primary financing partner, and also accepts CareCredit and Alphaeon Credit; see financing and payment plans. An extended tummy tuck is cosmetic and not covered by insurance; how a hernia repair is handled is explained at your consultation.
Your consultation with Dr. Cat
It starts with a free 15-minute discovery call with our Patient Concierge, who books your consultation. At the consultation, in person on Rodeo Drive or, for out-of-town patients, by private video consultation through OnPatient, the HIPAA-secure patient portal, Dr. Cat reviews your weight, medical and surgical history, then examines the whole trunk: how far the loose skin continues around the sides, the pinch test for a vertical component, the abdominal wall, the mons pubis, and where the incision will sit under the underwear you bring. She tells you plainly whether you need a full or an extended tummy tuck, and you leave with an itemized written quote.
