Washboard abs. Everybody wants them. Movie stars have them. Wouldn’t you like some? Here’s how you get them: eat less and exercise, exercise, exercise.

Oh, already tried that?

Occasionally wheatgrass juice and situps are not enough to sculpt rock-hard abs, no matter what all the women’s magazines say. If genetics predisposes you to a persistent paunch, or a big weight loss has left you with a major muffin top that won’t go away no matter how fit the rest of you has become, an abdominoplasty – aka tummy tuck - might be the answer.

Tummy tucks have become quite the chi-chi cosmetic surgery for the over-thirty set. According to the America Society of Plastic Surgeons, the number performed in the U.S. soared 60 percent in the last three years, more than any other type of cosmetic surgery, so a post-partum Britney Spears is clearly not the only one opting for this procedure.. Chances are you personally know someone who’s had a tummy tuck and is happy to talk about it. But make no mistake: despite their increasing acceptance and cute moniker, tummy tucks are major undertakings.

The surgery, which involves removing excess fat and skin and suturing the underlying muscles to make them tighter, has the highest fatality rate of all cosmetic procedures because of infections and blood clots. Even when things go well (as they usually do when you’re in good health with no underlying medical problem such as heart or lung disease), there’s considerable post-op pain, a long recovery and big scar. The price tag is not for the faint of heart or low of bank account. Depending on how much work you need and where it’s done – an office or outpatient service center, which are the most common sites, or the hospital, where you have the option of staying a few days – cost ranges from $3,000 to $9,000. Be ready to dip into your rainy-day jar, because insurance policies are unlikely to cover this splurge. (There are a few exceptions. If you have a hernia or the abdominal muscles are found to be unusually lax, insurance might help with part of the surgery.)

Tummy tucks are not for women who plan on getting pregnant (that would, after all, restretch the very muscles the surgeon tightens). Nor are they a quick fix for couch potatoes looking for an easy way out. You’ll have to maintain your good results; tucks don’t give you carte blanche to overeat or shirk exercise forevermore. And even if you keep fit, gravity will win out eventually and your nice flat stomach will probably start looking a little pudgy again.

But if your heart is set on a flat midriff, here’s what’s involved. First, a quick primer on human anatomy. We have several different types of abs, or abdominal muscles. The ones we use when doing crunches – and that are stitched together during a tummy tuck - are a set of paired vertical muscles that run roughly from the pubic bone to the rib cage called the rectus abdominus. (A little additional side trivia: the two rectus muscles are connected by three horizontal bands of tissue, and when these bands are so well defined by diet and exercise that they ripple, you’ve achieved the much-coveted washboard look. Yowzah.)

If you do take the leap, make sure you have a trusted friend or loved one on hand to help you out for the first two to three weeks while you recover. If that’s too much of a commitment, consider hiring a nurse until you’re back on your feet.

A full abdominoplasty entails all the pleasures of major surgery, including having your pubic area shaved. Most doctors prefer general anesthesia because it fully relaxes the abdominal muscles. The surgeon makes a horizontal incision from hipbone to hipbone and a small circular one around the belly button. Your skin is peeled up to your ribs in one big flap, leaving the navel on a stalk of tissue that remains attached to the abdominal wall. The surgeon takes out all the fat and snips away all the excess skin he needs to, and sutures the vertical abdominal muscles closer together to give your waist a firmer, tighter look. Then he puts you back together. He pulls the skin flap back down and repositions the midline over the belly button. He makes a tiny incision in the newly taut skin, pulls the old navel on its tissue stalk through the hole like a button through a buttonhole, and sutures it in place, creating an aesthetically pleasing innie or outie.

Two to five hours later, depending on the complexity of your surgery, you will awaken to a trimmer, flatter-bellied you, albeit it with a two-foot-long incision, lots of dressings and, occasionally, a temporary tube implanted to drain excess fluid (the doctor will remove this in a few days later).

Mini tummy tucks are similar to full procedures except you’re spared the incision around the navel and the surgery goes much more quickly, clocking in at an hour or two at most, so twilight sleep is an option. A local anesthetic with a sedative makes you drowsy and impervious to pain. You’ll be aware of tugs and pressure but should feel little discomfort.

• Someone to drive you home and be present for at least the first 72 hours
• Ice packs
• Loose, comfortable clothing
• Prepackaged meals for two weeks
• A snug-fitting support garment (usually provided by your doctor) to promote circulation, minimize swelling and help skin fit its new contours
• Petroleum jelly for incisions to minimize scarring
• Hand-held shower head/bathtub chair
• Prescription painkillers
• Laxatives to ease constipation caused by painkillers

Arrange for plenty of time off work for a tummy tuck because you’ll need it. If you’ve had a full tuck, expect to spend at least the first couple of days hospitalized, mostly confined to bed. (Uncomplicated partial tucks can spring you the same day.) Swelling and oozing from the incisions are common immediately post-op. Bruising, numbness around the stitches and lethargy are some of the other friends your surgery will bring with it. Keeping your legs a little bent at the hips in bed takes undue strain off your abs. An abdominal “binder” gives your clinched ab muscles additional support. But as with most types of surgery, your doctor will encourage you to start moving around as soon as you can stand up, usually within the first day or two.

You’ll get all the info you need from your surgeon on basics such as how to shower, how to change your surgical dressings, and how you might be walking funny for a few days. You’ll go back to the doctor within a week of surgery to have the superficial sutures removed. The deeper ones, beneath the skin, are removed about three weeks later. (The doctor plucks these out by their protruding ends using surgical forceps, but it doesn’t hurt as bad as it sounds.)

You’ll need someone to baby you for at least the first few days and drive you to appointments. Abdominal surgery gives most people a new appreciation for all the mundane activities their vertical abs support – such as standing up straight, pressing the brake pedal, sneezing. It usually takes at least two weeks to recover enough to function on your own, and often months for the soreness to completely subside.

Long term, all you’ll have to show for your tummy tuck is a nice flat belly, a mostly hidden hip-to-hip scar and maybe a smaller scar around the belly button. For most people, tummy tuck scars lighten within a year, though this depends on your surgeon’s skill and how quickly you heal. Eventually they’ll be almost invisible, but you’ll probably always have a fine white line and a little numbness over the old incision to remind you of your experience.

If you’ve already modified your diet and fitness habits , there aren’t many backup plans for taming a jelly belly (And if you haven’t gone the route of meticulous self-improvement, eat your greens and get thee to a treadmill!)

However, your doc might very well recommend liposuction as an alternative to an abdominoplasty, or as a complementary procedure for a mini tummy-tuck. It’s a much less invasive surgery than a tummy tuck, has a shorter recovery time, and is ideal for people who suffer from excess fat rather than excess skin. However, lipo won’t create the appearance of a toned belly like a tummy tuck does because the vertical abs aren’t tightened as part of the procedure.

The market’s rife with lotions and vitamin supplements that purport to vanquish cellulite and baggy skin. Experimenting with such products can’t hurt (not to mention it makes for a much smaller chunk of change spent), but as far as science goes, the jury’s still out on whether they’re the real deal or not.

--Nirmala Nataraj