This content is for general informational purposes only and should not be taken as medical or other professional advice. Readers should consult a qualified licensed professional for advice about their specific situation. Reading this page does not create a physician-patient relationship. All surgery carries risk, and individual results vary. Seek immediate emergency care for severe or urgent symptoms.
No single body contouring procedure is best for everyone. Work out the answer in five steps: identify which layer is driving the change you want (fat, skin, or muscle), match that layer to the procedure built for it, check whether more than one area is involved, screen for the one procedure with special safety rules, then confirm with an exam.
Different sources recommend different operations because they treat different problems. The five steps below organise the operations by the tissue layer they treat, helping you arrive at a consultation with specific questions rather than general dissatisfaction. The notes from Step 1 and the comparison table in Step 3 are yours to take with you.
If you would rather have the assessment done for you, you can request a consultation or contact the practice with a question first. Aesthetic Plastic Surgery & Laser Center is on Orchard Lake Road in Farmington Hills, where Dr. Michelle Hardaway has over 20 years of experience as a board-certified plastic surgeon. You can also call (248) 221-1957.
Key takeaways
- There is no single best procedure. The operations treat different tissue layers, which is why different sources recommend different things.
- Start with the tissue layer. Fat, loose skin, and separated abdominal muscle each point to a different category of surgery.
- Liposuction removes fat and does not tighten skin. The American Society of Plastic Surgeons states that liposuction is not a treatment for obesity, not a substitute for diet and exercise, and not effective for cellulite.
- A tummy tuck and a panniculectomy are not the same operation. One usually repairs separated muscles; the other does not touch the muscles at all.
- A Brazilian butt lift carries safety rules worth knowing before you book. A multi-society task force including ASPS issued a joint safety statement covering injection plane, imaging guidance, facility credentialing, and postoperative care.
- Only an examination settles it. Every step below tells you what to verify and what to ask. None of them tells you what you have or what you need.
Step 1: Identify which layer is driving the change you want
Do this: make three observations about the area that bothers you, and write down what you notice. These are not diagnostic tests, and they do not settle anything. They make you raise specific things at an examination instead of a general dissatisfaction.
What the tissue feels like. Note whether there is a soft, movable layer you can take hold of or whether the area feels firm against the abdominal wall.
How the skin behaves. Note whether the skin springs back after you lift it gently or whether it stays stretched. Skin elasticity is one of the factors a surgeon assesses: the ASPS names firm, elastic skin and good muscle tone among the criteria it uses for liposuction candidacy.
What the midline looks like. Note any visible ridge running down the center of the abdomen or a soft gap along the midline. Note it rather than interpret it. That pattern is worth asking a surgeon about, and only a physical exam confirms separated abdominal muscles (diastasis recti).
What you are checking: body contouring works on three layers, and the procedures are built around them. Fat is the localized deposit that remains after diet and exercise. Skin is tissue that no longer retracts, usually following weight loss, pregnancy, or aging. Muscle is the abdominal wall itself, which can separate during pregnancy, a condition called diastasis recti.
A bad sign: settling on a procedure before any of this has been assessed. Liposuction on skin that has lost its elasticity can leave the contour looser than it was. The American Society of Plastic Surgeons lists rippling or loose skin among liposuction’s recognized risks.
Step 2: If the issue is fat, match it to liposuction
Do this: read the criteria ASPS publishes for liposuction candidacy and note which ones you want to ask about. Candidacy is settled at an examination, not against a list. ASPS describes candidates as adults within 30% of their ideal weight, with firm, elastic skin and good muscle tone, who do not smoke or vape, and who are healthy individuals without a life-threatening illness or medical conditions that can impair healing.
What you are checking: liposuction removes excess fat from specific areas of the body. ASPS is direct that it is not a treatment for obesity or a substitute for proper diet and exercise and that it is not an effective treatment for cellulite. Dr. Hardaway performs liposuction including 360° treatment of the trunk.
A bad sign: skin thinned by stretch marks, weight loss, or natural aging. ASPS states this skin will not reshape as well. Where loose skin rather than fat volume is the main concern, Step 3 covers the procedures built to remove it.
The recognized risks ASPS lists include rippling or loose skin and worsening of cellulite, irregular contours or asymmetries, and changes in skin sensation that may persist. The list also covers fluid accumulation, infection, poor wound healing and the need for revision surgery. Special considerations are needed when large amounts of fat, usually more than five liters, are suctioned.
If your goal is more volume, not less: Brazilian butt lift
A Brazilian butt lift uses the same harvesting step as liposuction, then transfers the fat to the buttocks. It answers a different question than the rest of this page, added volume rather than removed fat, and it carries safety recommendations worth knowing before you book anything.
Do this: ask four questions: which plane the fat is injected into, whether real-time ultrasound guidance is used to confirm it, whether the surgeon is privileged to perform the procedure at an accredited facility, and who manages your care afterward if a complication develops.
What you are checking: a multi-society task force including ASPS issued a joint safety statement after deaths associated with gluteal fat grafting. It recommends that fat be injected only into the subcutaneous space, above the gluteal fascia, and describes real-time imaging during gluteal injection as a common-sense step toward keeping the cannula above the fascia of the gluteal muscles. It also calls for the procedure to be performed only by surgeons who have privileges to perform it in a state-approved or licensed ambulatory surgery center or hospital, with the surgeon available to manage complications afterward, including for patients treated at a distance.
A bad sign is hesitation on any of the four, not just the injection-plane question. In the task force’s review of fatal cases, every autopsy revealed fat within and beneath the gluteal muscles, damage to the superior or inferior gluteal vein, and massive fat emboli in the heart or lungs, and the authors report no case of fat embolism in which fat was injected solely into the subcutaneous plane. Those findings are the reason the task force made the four recommendations above. They are risk-reduction measures, not a guarantee against complications, which is why the questions are worth asking directly rather than assumed.
Step 3: If the issue is skin, or skin and muscle, match it to the right excisional procedure
To do this, use the table below to determine which column your situation is closer to, based on the notes from Step 1. The table sorts the two operations; it does not determine which one you should have, and only an examination does that.
| Tummy tuck (abdominoplasty) | Panniculectomy | |
| Removes excess skin and fat | Yes | Yes |
| Repairs separated muscle (diastasis) | Usually | No |
| Typical patient | After pregnancy | After major weight loss |
| Primary concern addressed | Abdominal contour | The overhanging pannus, including mobility and hygiene |
| ASPS candidate criteria | Physically healthy and at a stable weight, realistic expectations, nonsmoker, bothered by the appearance of your abdomen | The same four, plus recurring or persistent rashes or infections underneath the hanging fold of skin |
| How ASPS describes the population | Predominantly female and postpartum | Massive weight loss patients who are not candidates for abdominoplasty, and some obese individuals who are also not candidates |
What you are checking: a tummy tuck removes excess fat and skin and restores weakened or separated muscles, creating an abdominal profile that is smoother and firmer. A panniculectomy removes the pannus, an apron of skin and subcutaneous tissue that hangs below and covers the pubic area, and does not touch the muscles. ASPS characterizes abdominoplasty patients as predominantly female and postpartum. It describes panniculectomy patients as massive weight loss patients who are not candidates for abdominoplasty because they are limited to excess skin and adds that some obese individuals who are also not candidates fall into the same group. Mobility and hygiene difficulties are part of what the procedure addresses. Neither operation is a substitute for weight loss or an appropriate exercise program.
A bad sign: a recommendation for one without the other being ruled out. One repairs muscle, and one does not. That difference is among the things a surgeon weighs at examination. Both involve removing skin, which requires an incision that heals into a permanent line.
For a tummy tuck, ASPS lists unfavorable scarring, fluid accumulation, infection, poor wound healing, and deep vein thrombosis among the recognized risks. It also lists recurrent looseness of skin, numbness or other changes in skin sensation, and the possibility of revisional surgery.
ASPS lists a closely overlapping set of risks for panniculectomy, among them unfavorable scarring, bleeding, hematoma, fluid accumulation and infection. Poor healing of incisions, anesthesia risks, asymmetry and fat necrosis are on the same list. So are deep vein thrombosis with cardiac and pulmonary complications, numbness or other changes in skin sensation, recurrent looseness of skin, persistent pain, skin loss, and the possibility of revisional surgery.
One difference is worth raising directly. ASPS notes that some panniculectomy patients have more comorbidities, such as diabetes or mobility issues, and so may be a little more at risk of a complication afterward. Ask what your history means for that.
Non-surgical options, and where they stop
Some skin laxity responds to non-surgical treatment and some does not, and the two categories are not interchangeable. This practice offers radiofrequency skin tightening among its minimally invasive treatments. Non-surgical skin tightening and surgical skin removal address different degrees of laxity and produce different orders of change. Where a significant amount of skin needs to come off, no non-surgical treatment substitutes for excision.
Non-surgical treatments carry their risks and limits. Ask what a particular device is cleared to do and, separately, what it can reasonably be expected to do for your skin. Those are two different questions. Which category your skin laxity falls into is assessed at examination.
Step 4: Check whether more than one area or layer is involved
Do this: note whether your concern spans more than one area, such as abdomen and thighs or abdomen and breasts after childbearing, and whether it followed major weight loss, specifically.
What you are checking: two situations combine what Steps 1 through 3 treat separately.
A body lift improves the shape and tone of the underlying tissue that supports skin and fat, and excess sagging skin and fat are removed. ASPS notes body lifts are not intended strictly for the removal of excess fat: where skin has good elasticity and can conform naturally to new contours, liposuction alone can remove the fat deposits, and where skin elasticity is poor, body lift techniques along with liposuction may be recommended. Recognized risks of a body lift include unfavorable scarring, fluid accumulation, infection and poor wound healing. ASPS also lists deep vein thrombosis, numbness or other changes in skin sensation, recurrent looseness of skin, pain that may persist, persistent swelling in the legs, and the possible need for revisionary surgery. Whether that work is done in one operation or separated into stages is a judgment made at examination rather than in advance.
A mommy makeover restores the shape and appearance of a woman’s body after childbearing by combining procedures into one surgical plan, commonly breast augmentation or a breast lift, liposuction, and a tummy tuck.
ASPS describes it as typically performed as a single-stage procedure, and the advantage is sequencing: one anesthetic and one recovery rather than several spread across years.
Combining operations lengthens the time spent under anesthesia, which is part of why splitting a mommy makeover into two surgeries is worth raising at consultation rather than assuming either way. ASPS lists bleeding, infection and poor healing of incisions among the risks, along with hematoma and seroma. It also names unfavorable scarring, recurrent looseness of skin, fat necrosis, asymmetry, and persistent pain. Deep venous thrombosis, cardiac and pulmonary complications and anesthesia risks are on the same list, and each component procedure you choose adds its own.
A bad sign: a combination plan proposed before your weight is stable or before you are finished having children if pregnancy is still a possibility. Which procedures belong together, and in what order, is a question for the examination.
Step 5: Confirm your answer at a consultation
Do this: bring your Step 1 self-check and the Step 3 table into the consultation, and ask which layer Dr. Hardaway identifies as the primary driver of your concern.
What you are checking: whether her assessment matches your own self-check, and if not, why. At consultation, she examines the area, reviews your medical and weight history, and discusses what you want changed. She will look at skin quality, fat distribution, muscle integrity, and any previous surgery. Ask which of those she considers the limiting factor in your case. You should understand what the procedure involves, what recovery will require, its limits, and what can go wrong.
A bad sign: a plan that skips the exam, or one that never explains why a particular layer was ruled in or out. Individual results vary, and a plan made before an examination is worth very little.
All consultations are paid and appointment-based to ensure dedicated time and a personalized plan. We do not accept insurance. If Dr. Hardaway is who you would like to see, you can request a consultation or call (248) 221-1957.
About Dr. Michelle Hardaway
Dr. Michelle Hardaway is a board-certified plastic surgeon with over 20 years of experience. She is certified by the American Board of Plastic Surgery and in general surgery and is a Fellow of the American College of Surgeons.
She was appointed Chief of Plastic and Reconstructive Surgery at Detroit Receiving Hospital and served as Director of its Burn Center. She has taught as an Assistant Clinical Professor at Wayne State University School of Medicine.
Her practice, Aesthetic Plastic Surgery & Laser Center, sits on Orchard Lake Road in Farmington Hills and serves patients across Oakland County and Metro Detroit. Consultations are conducted personally, every plan is tailored specifically to each patient, and the aim throughout is natural-looking results. You can read more about Dr. Hardaway or review patient feedback.
Frequently asked questions
Which body contouring procedure removes the most fat?
Liposuction is the procedure built for removing fat, and it has practical limits. ASPS notes that when surgeons suction large amounts, usually more than five liters, they need to consider special factors. It also states that skin thinned by stretch marks, weight loss or natural aging will not reshape as well, so the volume of fat removed is not the only thing a surgeon weighs. Which tissue layer is driving the change you want is the question Step 1 is built around.
Can liposuction tighten loose skin?
No. Liposuction removes fat. ASPS states that skin soft and thin from stretch marks, weight loss, or natural aging will not reshape as well, and lists rippling or loose skin among the recognized risks. Where loose skin is the main issue, an excisional procedure such as a tummy tuck, panniculectomy or body lift is what addresses it.
Do I need to be at my goal weight before body contouring?
ASPS lists being physically healthy and at a stable weight among its candidate criteria for a tummy tuck and describes liposuction candidates as adults within 30% of their ideal weight. Whether your current weight is workable is a judgment made at examination rather than from a number alone.
Can body contouring procedures be combined?
They frequently are, and a mommy makeover is the common example, covered in Step 4. Combining procedures changes the length of the operation, and ASPS notes that each component procedure adds its own risks. Which combinations are appropriate for a given patient is decided at consultation.
Does a body contouring consultation cost anything?
At this practice, yes. All consultations are paid and appointment-based to ensure dedicated time and a personalized plan. We do not accept insurance.
Speak With a Board-Certified Plastic Surgeon in Farmington Hills
If you would like to discuss body contouring with a board-certified plastic surgeon in Farmington Hills, you can request a consultation, contact the practice, or call (248) 221-1957.
You can also read more about the individual procedures: liposuction, tummy tuck, panniculectomy, Brazilian butt lift, body lift, mommy makeover, and male plastic surgery.
How Do I Choose a Good Plastic Surgeon in Farmington Hills?