August 26, 2026 | Uncategorized
When I explain my tummy tuck technique in consultation, I usually reach for the nearest waist trainer analogy, because it is the most accurate one available.
A waist trainer works because it has multiple seams. A standard tummy tuck has one. Mine has three.
This is the triple plication, a technique I have published on and performed for more than seventeen years, and it is the reason my tummy tuck patients get a waistline, not just a flat front.
First, the Problem the Tummy Tuck Solves
Women undergo changes during pregnancy or with weight changes: when the abdomen is fuller, the fascia on the abdomen is stretched. And unlike the muscles, the fascia does not contract back. If the patient exercises or does sit-ups, the muscles get stronger, but the fascia doesn’t contract, and there’s still an abdominal bulge, or a separation in the rectus, called rectus diastasis.
In a standard tummy tuck, most surgeons repair the midline of the rectus fascia to correct the diastasis. This flattens the abdomen and brings in the waistline somewhat. It is a good operation. It is also one-dimensional: it fixes the front.
The Triple Plication, Step by Step
I like to perform a triple plication. It includes the plication of the rectus muscles down the midline, from the sternum all the way down to the pubis. Then I also plicate the oblique muscles laterally to the lateral rectus fascia, on each side, which brings in the obliques just like a waist trainer and creates an internal corset.
This significantly reduces the waistline at the same time as it flattens the anterior abdomen. Instead of fixing only the front, we’re also bringing in the sides. Three seams instead of one.
Where the Technique Comes From
I can’t take the credit for inventing the triple plication. Brazilian plastic surgeons described it many years ago, but somehow a lot of plastic surgeons did not implement it into their procedures, and I remain one of the few who perform it routinely.
The article I published described using a triple plication during a mini tummy tuck, which is possible through a small incision. That surprises patients: the internal corset does not require the biggest version of the operation.
Who Gets It
Almost every female patient in my practice gets a triple plication, because they are looking for a flatter abdomen with a smaller waist. We usually don’t perform it on males, because we don’t want to create a waistline on a masculine torso. We do perform it on male-to-female patients who desire a more feminine figure.
For post-pregnancy patients this usually lives inside a full tummy tuck or a mommy makeover. Patients who want to go further can combine it with rib repositioning, which brings the waistline in even more.
What Else Happens in the Same Operation
All my tummy tucks include liposuction, especially of the anterior abdomen, waistline, and lower back. Many patients also have liposuction of the upper back and lateral chest. I often combine this with Renuvion J-Plasma for skin tightening. The plication shapes the wall; the liposuction shapes what sits on top of it.
Pain and Recovery
Patients do feel a tighter abdomen after surgery. I use Exparel injected into what we call a TAP block, which numbs the area for three days, and fifty percent of my patients experience no pain whatsoever. Everybody is different, but it makes the recovery much easier.
The triple plication adds only fifteen or twenty minutes of operating time. It doesn’t change how long drains stay in or the overall recovery: about two weeks to normal activity, and six weeks for exercise, running, jumping, and heavy lifting. In other words, the internal corset is close to free in recovery terms.
The Bottom Line
The best thing about this technique is that it creates a much more defined waistline and a flatter abdomen, and that’s what patients want after losing weight or having babies.
Why Choose Dr. Agullo
Double board certified. Mayo Clinic fellowship trained. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor thirteen consecutive years. And published on the triple plication technique itself.
Ready to Talk?
If your tummy tuck consultation has only ever mentioned one seam, come hear about three. Call (915) 590-7900, text 1-866-814-0038, or book a consultation online. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Companion reads: the editorial version on drworldwide.com, and the practice overview at swplasticsurgery.com.
