An abdominoplasty, commonly known as a tummy tuck, is a surgical procedure designed to address skin laxity and excess fat in the mid-to-lower abdominal region. The term “FUPA” is an acronym referring to the Fat Upper Pubic Area, which is the mound of tissue located directly over the pubic bone, medically termed the mons pubis. A standard tummy tuck focuses on the abdomen, and a separate, dedicated procedure is usually required to fully reshape the FUPA.
Defining the Scope of a Standard Tummy Tuck
A traditional abdominoplasty primarily targets the area between the rib cage and the pubic region, focusing on the skin and fat located below the navel. The main goal of this surgery is to remove redundant skin and fat, which often accumulates after pregnancy or significant weight loss. This procedure also commonly involves repairing separated abdominal muscles, known as diastasis recti, to create a flatter, more toned abdominal wall.
The incision for a full tummy tuck is placed low on the abdomen, extending horizontally from hip bone to hip bone, where it can be easily concealed by underwear or a bikini. The surgeon lifts the skin and fat layer up to the ribs, removes the excess tissue from the lower portion, and then stretches the remaining upper abdominal skin downward. While the incision is positioned just above the pubic area, the bulk of the procedure’s tissue removal and tightening effect is directed superiorly, or above, the mons pubis.
The tightening effect from pulling the abdominal skin downward can sometimes provide a small degree of lift to the upper pubic area. However, the standard abdominoplasty technique does not involve direct excision of excess tissue from the mons pubis itself. If the FUPA has significant excess fat or loose, sagging skin, the procedure will likely leave a residual bulge or an undesirable “shelf” appearance immediately above the new scar line. This anatomical separation highlights why the primary tummy tuck alone may not achieve a smooth transition in this area.
Targeting the FUPA: The Role of Monsplasty
Addressing the fullness or laxity of the mons pubis requires a specialized surgical intervention called a monsplasty, often referred to as a pubic lift or reduction. This procedure is specifically designed to reduce the volume and tighten the skin of the fatty mound that sits directly over the pubic bone. Monsplasty is the direct answer for patients seeking comprehensive contouring in the area below the main abdominal wall.
The technique for monsplasty often begins with liposuction to remove excess fatty tissue and reduce the overall volume of the mons pubis. Following volume reduction, the surgeon removes loose or hanging skin through direct excision. The incision for a standalone monsplasty is typically a horizontal line placed low in the pubic hairline, ensuring the resulting scar is discreetly hidden.
The primary difference from an abdominoplasty is the focus on the distinct anatomical boundary of the mons pubis. This area consists of a dense layer of subcutaneous fat and skin directly overlying the pubic symphysis. The surgical action is focused on lifting and firming this specific mound, rather than tightening the entire abdominal flap. This targeted approach is necessary because the tissue composition and laxity of the mons pubis often differ from the rest of the abdomen.
Combining Procedures for Comprehensive Results
For patients who have both significant abdominal skin laxity and an enlarged or sagging mons pubis, plastic surgeons frequently recommend combining abdominoplasty and monsplasty into a single operation. This integrated approach is often necessary to achieve a harmonious and aesthetically pleasing contour from the ribs down to the upper thighs. Combining the procedures prevents the isolated appearance of the pubic mound relative to the newly flattened abdomen.
The key to combining these procedures lies in the strategic planning of the incision. The surgeon adapts the standard low, horizontal tummy tuck incision to extend downward to encompass the area needed for the monsplasty excision. This technique allows both procedures to be performed through a merged scar, avoiding the creation of additional, separate incisions. The combined surgery ensures a seamless transition and a unified aesthetic result in the entire lower trunk.
While combining the two surgeries offers the most comprehensive contouring, it also involves increased surgical complexity and may extend the recovery period. Patients undergoing the combined procedure must be in good overall health and have realistic expectations regarding the recovery timeline. Integrating the monsplasty effectively eliminates the potential for a noticeable ledge or abrupt change in contour that can occur when a full tummy tuck fails to adequately address the pubic region.