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Abdominal Sagging

Abdominal Sagging: Causes and how to firm it up

“A flat and firm belly is often seen as a symbol of good health and body aesthetics.” However, abdominal sagging is a complex issue that can manifest differently. It is essential to identify the sagging one is experiencing to achieve lasting results.

 

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The three types of abdominal sagging :

1- Muscle relaxation

Muscular relaxation is characterized by a lack of tone in the abdominal muscles. Sometimes, it can be a diastasis, a separation of the rectus abdominis muscles. This condition is prevalent after pregnancy or with significant weight fluctuations.

2- Abdominal fat accumulation

Abdominal fat can be subcutaneous (just under the skin) or visceral (around the organs). It gives the belly a relaxed appearance and may be accompanied by a general loss of firmness.

3- Sagging skin

“Natural aging and weight fluctuations can cause relaxation of the abdominal skin.” This type of relaxation is characterized by a loss of skin elasticity, which may appear wrinkled or form folds.

Causes of abdominal relaxation

1- Causes of muscle relaxation :

Pregnancy and Childbirth

“During pregnancy, the expansion of the uterus and weight gain cause significant stretching” of the abdominal muscles. This phenomenon can lead to diastasis recti, where the muscles separate along the midline.

Sedentarism

Lack of regular physical activity leads to a gradual loss of muscle tone. Abdominal muscles, like all muscles in the body, need to be engaged to maintain their firmness.

Poor Posture

An inadequate posture, especially when sitting for long periods, can weaken the abdominal muscles and contribute to muscular relaxation.

2- Causes of fat accumulation :

Hormonal imbalances:

“Certain hormones play a key role in fat distribution.” Chronic stress, for example, increases cortisol production, favouring abdominal fat storage.

Unbalanced diet:

“An unbalanced lifestyle, including a diet low in nutrients” and high in refined sugars and saturated fats, promotes visceral fat accumulation.

Age and metabolism:

With age, metabolism naturally slows down, making it more challenging to eliminate abdominal fat.

3- Causes of sagging skin :

Collagen and Elastin Deficiency

“With age, collagen and elastin production naturally decreases. These proteins are essential for maintaining skin elasticity and firmness.” Collagen, the skin’s structural support, begins to decline at 25, with a yearly loss of about 1%. Meanwhile, elastin fibres, responsible for skin elasticity, become less effective. This progressive decrease directly affects the firmness of the abdominal skin.

Weight Fluctuations

“Whether due to rapid weight gain or significant weight loss, these sudden changes can cause excessive skin stretching. When stretched beyond its elastic limits, the skin finds it difficult to regain its initial firmness.” These repeated stretches damage existing collagen and elastin fibres.

Environmental and Lifestyle Factors

Several external factors accelerate collagen breakdown:

  • Excessive sun exposure destroys collagen fibres
  • Smoking, which disrupts collagen synthesis
  • Pollution, which generates free radicals
  • Poor hydration, which affects skin elasticity
  • Oxidative stress that damages support fibers
  • Solutions for a Firm Belly

Natural solutions for firming the belly

For muscle relaxation:

  • Crunches: Lie on your back, bend your knees, and place your hands behind your head.
  • Plank: Get into a push-up position, supported on your forearms and toes.
  • Mountain Climbers: In a high plank position, alternate, bringing each knee toward the opposite elbow.
  • Hypopressive Exercises for Diastasis
  • Dynamic Planking
  • Deep Breathing Exercises

For abdominal fat:

  • Cardiovascular Exercises (HIIT, running, swimming)
  • Leg Raises: Lie on your back and lift your legs to a 90-degree angle.
  • Bicycle Crunches: Lying on your back, perform pedalling movements.

For sagging skin:

  • Overall strengthening exercises
  • Slow movements with resistance
  • Yoga to improve elasticity

Specific diet :

A varied and nutritious diet is essential to support skin health. Choose:

  • Fresh fruits and vegetables
  • Whole grains
  • Lean proteins
  • Healthy fats

Specific foods for :

  • Collagen production (fish, eggs, citrus fruits)
  • Fighting inflammation (omega-3, antioxidants)
  • Elimination of toxins (fibre, water)

Manual techniques: 

Some massage techniques can help firm up the belly skin:

  • Pinch-Rolling: A manual technique involving kneading the skin.
  • Circular Massage: Use a slimming cream and massage in circular motions.
  • Draining Massage: Gently bring the tissues closer using the edges of your hands.

Non-invasive aesthetic solutions

Technologies targeting skin firmness

Radiofrequency :

  • Technologies: Exilis®, Thermage®, Venus Legacy™, EndyMed™
  • Principle: Controlled heat penetrating deep layers of the skin
  • Action: Stimulates collagen production and firms tissues
  • Protocol: A series of sessions is recommended
  • Advantages: Painless, no downtime
  • Disadvantages: Multiple sessions are required for optimal results

Radiofrequency with Potenza micro-needling

  • Principle: Combines micro-needles with radiofrequency
  • Action:
    • Deep stimulation of collagen production
    • Improved skin texture and firmness
    • Firms tissues at more profound levels
  • Advantages :
    • Customizable treatment
    • Targets different skin depths
    • Long-lasting results
  • Disadvantages :
    • 24-48h recovery time
    • Temporary redness possible

Focused ultrasound (HIFU):

  • Principle: High-intensity ultrasound generates targeted heat deep in the skin
  • Action: Stimulates collagen production and tightens tissues
  • Technologies: Ultraformer®, Ultherapy®
  • Results: Lifting effect visible after 2-3 months
  • Advantages: Single session required, long-lasting results
  • Disadvantages: Sensation of heat during treatment

Technologies targeting fat

1- Cryolipolysis (CoolSculpting)

  • Principle: Fat cells destroyed by cold temperatures
  • Action: Permanent elimination of treated fat cells
  • Treated Area: Localized fat folds
  • Advantages: Permanent results in treated areas
  • Disadvantages: Potential discomfort during treatment

2- Focused radiofrequency with Vanquish ME

  • Principle: Fat cells destroyed by selective heat
  • Action: Eliminates fat cells without skin contact
  • Treated Area: Large abdominal area and flanks
  • Advantages: Comfortable, contact-free treatment, covers a large area
  • Disadvantages: Multiple sessions are required for optimal results

Technologies targeting muscles

Electromagnetic stimulation :

  • Technologies: EMSCULPT
  • Principle: Intense muscle contractions induced by electromagnetic fields
  • Action: Muscle strengthening and fat reduction
  • Benefits: Equivalent to thousands of muscle contractions
  • Results: Visible after 2-4 weeks
  • Disadvantages: High cost per session

Mechanical massage technologies :

1- Endermology

  • Technologies: Cellu M6® Alliance, ICOONE®
  • Principle: Deep mechanical massage using suction and rollers
  • Action: Improves circulation and drainage
  • Advantages: Comfortable and relaxing treatment
  • Disadvantages: Requires regular maintenance

2- Cellutone

  • Principle: Therapeutic acoustic waves
  • Action: Improves blood circulation and lymphatic drainage
  • Treated Area: Entire body, particularly effective on the abdomen
  • Advantages:
    • Enhances results of other treatments
    • Painless
    • No recovery time
  • Disadvantages: Optimal results when combined with other treatments

This technology can be especially effective with other therapies like cryolipolysis or radiofrequency.

Invasive aesthetic solutions

Classic liposuction

  • Principle: Mechanical suction of fat deposits
  • Technique: Performed under general or local anesthesia depending on the area
  • Types of Procedures:
    • Traditional liposuction
    • Ultrasound-assisted liposuction
    • Laser liposuction
  • Results: Permanent in treated areas
  • Recovery Time: 1–2 weeks
  • Limitations: Does not address skin laxity

Abdominoplasty

  • Principle: Surgical removal of excess skin and fat
  • Indications: Significant skin laxity
  • Technique:
    • Horizontal incision above the pubic area
    • Removal of excess skin
    • Repositioning of the navel
    • Tightening of abdominal muscles if needed
  • Results: Major body contour transformation
  • Recovery Time: 3–4 weeks
  • Scar: Horizontal, can be concealed under underwear

Mini-abdominoplasty

  • Principle: A lighter version of traditional abdominoplasty
  • Indications: Moderate laxity below the navel
  • Technique:
    • Shorter incision
    • No repositioning of the navel
    • Limited skin removal
  • Recovery Time: 2–3 weeks
  • Advantages: Shorter scar, quicker recovery

Surgical indications :

  • Post-pregnancy with significant diastasis
  • Massive weight loss
  • Significant age-related skin laxity
  • Failure of non-invasive methods

Contraindications:

  • Uncontrolled health issues
  • Blood clotting disorders
  • Active smoking
  • Excessively high BMI
  • Current or planned pregnancy
  • Exceptional Cases Requiring Medical Advice

Abdominal firming requires a prior medical consultation in several situations:

Post-pregnancy :

  • In cases of diastasis recti
  • The presence of significant stretch marks
  • Multiple pregnancies
  • Within 6 months postpartum
  • During breastfeeding

Significant Weight Loss:

  • Weight loss exceeding 10 kg
  • Rapid weight loss
  • After bariatric surgery
  • In cases of significant weight fluctuations

Specific Medical Conditions:

  • Hormonal issues
  • Chronic illnesses
  • Abdominal hernias
  • Significant scars
  • Circulatory problems

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