abdominoplasty Archives - Dr. WorldWide

July 13, 2026

The Skin Was Always the Problem: Seven Years of Renuvion J-Plasma

Black and white photo of a gloved surgeon's hand beside a slim handpiece on a surgical drape. Renuvion J-Plasma commentary by Dr. Frank Agullo, MD, FACS.

If you ask a plastic surgeon which part of liposuction is the hard part, and he answers you honestly, he will not tell you it is the fat.

I started using Renuvion J-Plasma in 2019. I was one of the very early adopters, and I saw a missing need after liposuction, which was skin tightening. We were able to perform liposuction effectively, but after deflating the subcutaneous tissue layer, many patients were left with loose skin, which required surgical excision. When we began using Renuvion, we noticed that the tissues would contract, and oftentimes the surgical excision of excess skin was not necessary anymore.

Read that last part again, because it is the whole reason I am writing this. Not that the skin looked somewhat better. The excision was not necessary anymore. A second operation, and a permanent scar, came off the table.

What It Is Doing Under There

This is the explanation I give in clinic, and I have never seen a reason to keep a simpler version for patients and a smarter one for colleagues.

Renuvion J-Plasma activates helium plasma and radiofrequency in the subcutaneous layers, making the connective tissue underneath shrink and contract, resulting in skin tightening and a smoother result. The helium plasma is important because it keeps the temperatures cool, which avoids burning.

That last sentence is where the engineering lives. Radiofrequency by itself will contract tissue. Radiofrequency by itself, at the wrong settings, will also cook it, and our literature has documented what that looks like. The helium is what lets the energy arrive hot and get out fast. The handpiece goes in through the same access sites the liposuction cannula already made, so nothing new is cut and nothing new is closed.

How Much I Use It

We use Renuvion J-Plasma almost every day, performing more than ten to twenty Renuvion cases per week. I am among the ten highest users in the world, according to Apyx, the company that manufactures the device.

I put that near the top rather than the bottom for a reason. When a surgeon speaks well of a device, you are entitled to know how far into it he already is before you weigh anything else he tells you. I am very far into this one.

The Huber Paper

Apyx circulated a study through its clinical newsletter this spring. I read manufacturer mailings the way most of us do, with a raised eyebrow, because the company sending the envelope has an obvious interest in what I conclude. This one held up.

Huber, Bittencourt, Koteski and colleagues published it in Plastic and Reconstructive Surgery Global Open in March 2026. They reviewed 113 consecutive patients from one surgeon’s practice, treated between October 2021 and October 2023. Seventy-three had power-assisted liposuction alone, and forty had power-assisted liposuction followed by Renuvion J-Plasma. Past the twelve-month mark, they went back and asked the patients themselves, using BODY-Q, a validated instrument rather than a satisfaction form somebody drew up in a marketing meeting.

Outcome (greater than 12 months)	Liposuction alone	Liposuction plus Renuvion J-Plasma
BODY-Q appraisal of excess skin	73.8	87.8
Same score, liposuction-only subgroup	64.0	92.8
BODY-Q abdominal appearance, no abdominoplasty	45.0	68.8
Surgical revision rate	37.5 percent	12 percent
Abdominoplasty rate	67.1 percent	30 percent
Complication rate	2.7 percent	2.5 percent

The revision row is the one that stopped me. Thirty-seven and a half percent down to twelve. Any surgeon who has had to bring a patient back for a skin excision that neither of them wanted knows that the distance between those two numbers is not measured in questionnaire points.

The complication row matters too, more quietly. Adding energy under the skin did not add risk here, 2.5 percent against 2.7 percent, and no complication was attributed to the device.

The caveat, which the newsletter was not built to emphasize, so I will. Retrospective, not randomized, one surgeon. The authors say so themselves. It is a strong signal that happens to match what I watch happen in my operating room every week, and a strong signal is not proof. I would rather hand you that limitation myself than have you find it in the discussion section and wonder why I skipped it.

Where I Use It, and Where I Stop

I prefer to use Renuvion J-Plasma in the abdomen, the flanks, the upper back, the lateral chest, and around the knees. We also use it on the arms and thighs. I prefer not to use it in overly thin skin. If I encounter overly thin skin, I transition to BodyTite.

There is a sweet spot in using J-Plasma, where more passes and more energy are not going to give you any further results. So being accurate in the number of passes and the energy for each area is extremely important to get the most benefit with the least risk.

That is the sentence I would put on the wall of every practice that just bought one of these. The dose does not scale in a straight line. Past a point you are collecting risk and buying nothing with it, and the device will happily let you keep going, because it has no way of telling you that what you have already done is enough. That judgment belongs to the surgeon.

The Unpopular Part

The most important thing is really knowing the limitations, and knowing that J-Plasma will not tighten extremely loose skin after pregnancy or massive weight loss. It is very powerful in contracting the skin, and it often keeps patients away from needing a brachioplasty or excision of back rolls.

Both halves of that are true at once, and the industry has a habit of quoting whichever half suits it that quarter. It really is strong enough to spare somebody an arm lift or an excision of the back rolls, and those are not small scars to spare a person. It is also nowhere near strong enough to replace a tummy tuck in a patient who needs one. Stretch marks it does nothing for at all, because a stretch mark is a tear in the dermis, and contracting the tissue under a tear does not repair the tear.

So here is the candidate, exactly as I describe him or her in the room.

In the right patient, one who does not have a lot of skin laxity or stretch marks and no rectus diastasis, the Renuvion J-Plasma can help keep patients away from an abdominoplasty and let them have just liposuction.

Three conditions, and all three are required. If the rectus muscles have separated, the abdomen is pushing forward because the wall came apart, and energy delivered into the fat layer above that wall does nothing about it.

Recovery Does Not Change

I lead with this now, because patients assume the opposite.

It is important to know that Renuvion J-Plasma is not going to increase recovery times. The recovery itself and the protocol are the same with or without Renuvion J-Plasma when you have liposuction. We still use the garments, and we still use lymphatic massages.

You are not buying downtime here. You are buying a better envelope at the end of the downtime you had already agreed to. The skin also keeps contracting for months after you go home, which is why judging an abdomen at six weeks is a mistake, and why I spend part of nearly every week talking somebody down off that ledge.

Why I Am the One Saying This

I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, I completed my plastic surgery fellowship at Mayo Clinic, and I have taught as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine since 2011. Castle Connolly has named me a Top Doctor for thirteen consecutive years.

None of that is why I trust this device. Seven years of using it almost daily is why. The credentials are why I am comfortable telling you where it fails.

#StayBeautiful

Ready To Talk?

If someone has told you that you will need a tummy tuck no matter what, it is worth a second opinion before you accept a scar you cannot undo. Call the office at (915) 590-7900, text 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. You can also read more about liposuction at Southwest Plastic Surgery.

Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

July 11, 2026

The Tummy Tuck, Off the Record: Muscle Repair, Smooth Results, and the “Is This a Seroma?” Panic

Black and white editorial portrait, soft studio light. Tummy tuck commentary by Dr. Frank Agullo, MD, FACS.

A patient came in last month convinced she had a fluid pocket that three other offices had been draining with a needle for the better part of a year. She had been stuck. Aspirated, told to wait, aspirated again, no real answer.

I put an ultrasound on her belly for ninety seconds and the whole story changed. There was no fluid. There never had been.

That moment is half of why I wanted to write this. A tummy tuck is the operation people most often confuse with liposuction, and the difference matters enormously. The other half is the steady stream of second opinions I see from patients worried about a bulge after a tummy tuck done somewhere else. Here is how I explain all of it, from real consultations, anonymized.

Liposuction Will Not Do What a Tummy Tuck Does

This is the most common mix-up I run into, so let me clear it up before anything else.

When the abdominal muscles split apart during pregnancy or big weight swings, liposuction does nothing for it. Liposuction handles what we can pinch, and that is all. Relax those muscles and the bulge from the separation is still right there, and the only thing that touches it is a tummy tuck. A tummy tuck flattens everything, tightens it, and repairs that muscle wall, like building you a corset on the inside. It buys you a lot more than liposuction can, and the cost of admission is a scar across the lower abdomen. That trade is the entire decision.

What a Tummy Tuck Actually Repairs

Two things liposuction and dieting cannot touch.

Problem	What Fixes It
Loose, excess skin	Removed during the tummy tuck
Separated muscles (rectus diastasis)	Sutured back together down the midline
Pinchable fat	Liposuction (often added to the tummy tuck)

I take out the excess skin and stitch those separated muscles, the rectus diastasis, back together down the midline. That midline repair is what hands you a flat, supported abdomen, not just a thinner layer of fat sitting over the same loose wall.

“I Had a Tummy Tuck Elsewhere and Still Have a Bulge. Is It a Seroma?”

This is one of the most common second opinions to land in my office, and my first move is always to look rather than guess.

I reach for an ultrasound right there in the room. It color-codes the tissue for you. Yellow is fat. Red is muscle. Fluid lights up blue. No blue on the screen means no fluid, which means no seroma. For a patient who has been stuck under a needle over and over with no real answer, that single image is a relief in itself.

What is usually going on instead is residual diastasis. On the same scan you can see the muscle on each side and the gap running between them. Up high, where the muscles nearly touch, that is normal. Drop lower, where they stayed separated, and the abdominal wall goes slack and pushes outward, and that is the fullness people keep feeling. Now and then someone has a connective tissue disorder, and a perfectly correct repair simply stretches back out over time. Nobody’s fault.

“How Do You Fix Residual Diastasis?”

If it is a true diastasis, there is only one real fix: go back in, open it up, and re-suture the muscles tighter.

When a patient’s tissue is very elastic, I will sometimes add a mesh to back up the repair, an internal version of the binder you wear after surgery. My preference is a mesh that dissolves and gets replaced by your own collagen, about as biocompatible as it gets. The alternative is traditional sutures laid down with a few extra reinforcing layers. Which way I go comes down to your tissue, not a rulebook.

“Why Was My Upper Belly Not Liposuctioned During the Tummy Tuck?”

On purpose, and it is a safety decision, not an oversight.

When we do the tummy tuck initially, we do not aggressively liposuction the upper abdomen, because removing too much fat there can compromise the blood supply to the skin, and the skin can die. Once everything is healed, a little liposuction later can safely make that area look less bloated. The staged approach protects the result.

“If the Bulge Does Not Hurt, Do I Have to Do Anything?”

Not necessarily, and I will tell you that honestly even though it is not the answer that books surgery.

If there is no hernia, no seroma, and no fluid collection, then nothing is a health risk. At that point a small residual bulge is more about how it looks than a physical problem, and it is not something I would rush to fix. I would rather you make that decision with clear information than be scared into an operation you do not need.

The Credential Behind the Imaging

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, with a plastic surgery fellowship from the Mayo Clinic, and I teach as a Clinical Associate Professor at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. With abdominal surgery, the honest, useful answer usually comes from imaging and an exam, not assumptions.

For the full patient walkthrough, see the tummy tuck page at agulloplasticsurgery.com and the El Paso version at swplasticsurgery.com. If your concern is the whole post-pregnancy picture, that lives on the mommy makeover page.

Ready to Talk?

Whether it is a first tummy tuck or a worry about one you already had, let us actually look together. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

May 12, 2026

The Repair Your Insurance Calls Cosmetic: Diastasis Recti After Three Babies

Last week HuffPost ran a piece by a mother of three who paid out of pocket to repair the abdominal wall that pregnancy had separated. The editor reached out to me for the surgeon’s perspective. I will repeat here what I told them.

Insurance companies will prescribe painkillers for decades to manage the back problems caused by an unrepaired diastasis recti. They will not pay to repair the separation itself. They will call the repair cosmetic, because the separation is not an emergency. That word, “cosmetic,” is doing an enormous amount of work in that sentence, and most of it is wrong.

Diastasis recti is not a flat-stomach problem. It is a structural problem with a cosmetic side effect.

What Diastasis Recti Actually Is

You have two long bands of abdominal muscle running down the front of your torso, one on each side of your midline. They are connected in the middle by a thin sheet of connective tissue called the linea alba. Pregnancy stretches that sheet. So does certain types of weight gain. In some women, the sheet stretches and recovers. In others, it stretches and stays stretched, and the two muscle bands stay further apart than they were before.

That is diastasis recti. The muscles themselves are fine. The wall between them is not.

When the wall between them is loose, the core can no longer brace the way a closed abdominal wall braces. Standing posture changes. The lower back has to do more work. Pelvic floor symptoms get worse. Some patients develop a visible dome that appears when they try to sit up out of bed. Some develop a true ventral hernia at the umbilicus and need a repair regardless of how the rest of the abdomen looks.

None of that is cosmetic.

How to Tell Diastasis Recti from the Other Things It Gets Confused With

This is the comparison most postpartum women are not given. They walk into a primary care visit, they describe a soft belly that did not bounce back, and they leave with “try some core work.” That is sometimes the answer. Sometimes it very much is not.

	Diastasis Recti	Loose Skin Only	Soft Postpartum Belly
What is separated	Linea alba is stretched, rectus muscles sit apart	Nothing structural	Nothing structural
Visible sign	A dome or ridge when you try to sit up from lying flat	Skin laxity, stretch marks	Soft fullness that responds to weight loss
Back pain pattern	Common, often years of it	Uncommon	Uncommon
Hernia risk	Real	Low	Low
Helped by core PT alone	Sometimes, sometimes not	No	Yes
What a real repair requires	Plicating the rectus muscles back to midline, surgically	Skin excision	No surgery at all
Insurance label	“Cosmetic”	“Cosmetic”	N/A

The table is honest about what physical therapy can do and what it cannot. For some patients, a good pelvic floor and core program closes the gap enough that they live a normal active life. For others, the connective tissue is permanently stretched, and no amount of training will rejoin it. PT cannot reattach a ligament. PT cannot close a hernia. PT cannot bring two muscle bellies that have been pulled apart by three pregnancies back to the midline.

When PT is the answer, I send patients to PT. When PT is not the answer, I tell them that too.

Who Is a Candidate for Surgical Repair

I look for three things in consultation. First, a real, measurable diastasis on physical exam, ideally confirmed on ultrasound or CT if the case is complicated. Second, symptoms that match the anatomy: back pain that started or worsened after pregnancy, core weakness, pelvic floor strain, the visible dome, or an umbilical hernia. Third, a patient who is finished having children and is at a weight she can hold steady through recovery.

If all three are present, surgical repair (most often as part of a tummy tuck, sometimes as a standalone abdominal wall reconstruction) is the operation that actually solves the problem. The rectus muscles are plicated back to the midline with permanent or long-acting suture. Loose skin and stretched lower-abdominal tissue are addressed at the same time. A hernia, if there is one, is repaired in the same operation.

That is a real surgery. It is not a vanity procedure. The fact that the patient also looks like herself again when she heals does not retroactively make the medical problem cosmetic.

Why the Insurance Argument Bothers Me

Here is what insurance pays for happily. Years of physical therapy that did not work. Anti-inflammatory medications. Muscle relaxants. Eventually opioids for the back pain. Specialist visits for the pelvic floor. Hernia repairs when the umbilical hernia finally herniates, because at that point the structural argument is impossible to deny.

Here is what insurance will not pay for. The one operation that addresses the root cause before the years of medication and the eventual hernia repair.

That is not medical sense. That is accounting.

I told HuffPost what I will tell you. The word “cosmetic” is being used as an exclusion code, not a clinical description. Diastasis recti repair has a strong functional rationale. The peer-reviewed literature has been catching up for years. A handful of insurers are starting to cover it under narrow circumstances. Most still will not.

Why You Want This Done Right

A diastasis repair done poorly recurs. The suture line pops, the dome comes back, the symptoms come back, and the patient now has a scar and a redo on her list. A diastasis repair done well lasts decades.

What separates the two is technique. The closure has to be tension-balanced and layered. The plication has to extend the full length of the diastasis, not just the visible portion. The surgeon has to understand the umbilical stalk well enough to address a small hernia if one is hiding there. The recovery instructions have to actually protect the repair while it heals.

I trained in general surgery before I trained in plastic surgery. I did my plastic surgery fellowship at Mayo Clinic. I teach abdominal wall and body contouring as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. I have been Castle Connolly Top Doctor for thirteen consecutive years. I am explaining the procedure to you the way I explain it to the residents and fellows who scrub with me. Because that is the version that actually holds up.

Why Choose Dr. Agullo

Double board-certified (American Board of Plastic Surgery, American Board of Surgery). Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery, Texas Tech University Health Sciences Center. Affiliate Professor, UTEP. Castle Connolly Top Doctor, thirteen consecutive years. Founder of Southwest Plastic Surgery and Plastic Surgery Studios. Quoted in HuffPost, USA Today, Allure, Texas Today, and Featured.com on procedures across the face and body. Over 3.5 million followers across Instagram, TikTok, and Snapchat.

Ready to Talk?

If you have been told for years that what you are feeling in your abdomen is “just being a mom,” or that the back pain that started after your last delivery is something you need to live with, come see me. I will examine you, tell you whether what you have is a diastasis, and tell you honestly whether surgery is the right answer for your case. If physical therapy is still your best move, I will say that. If repair is the right answer, I will explain what that operation involves and what your recovery looks like.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful.