One of the most-asked question in my consultation room has been about pain. Here is what I tell patients now that I’ve stopped sending them home with opioids.
By Michael Spann, M.D. · Little Rock Plastic Surgery
Published September 2026 · 8-minute read
The short answer. A tummy tuck (abdominoplasty) is a slightly painful operation whose discomfort peaks in the first 72 hours and eases substantially by the end of the first week. Most of what patients feel is tightness from the muscle repair, not the incision. At Little Rock Plastic Surgery, we also manage it with an opioid-free protocol built around suzetrigine, a non-opioid pain medication the FDA approved in 2025. Most patients return to desk work in 7 to 10 days and to full exercise at six weeks.
One of the questions that I almost always get during a tummy tuck consultation is “does this hurt.”. After cost, after the scar, after the polite inquiry about what will become of the belly button: subject to many opinions. The patient leans forward a little, lowers her voice half a register, and asks the thing she actually came to ask.
How bad is it, really?
I have been answering that question in Little Rock for the better part of twenty years. For most of them, my honest answer carried an asterisk. Abdominoplasty is not a small operation. We remove skin, we tighten the abdominal wall, we rebuild the waist, and for two decades the price of that transformation was a week or so on narcotics, along with everything narcotics bring: the fog, the nausea, the constipation nobody mentions at cocktail parties, and the small but real possibility that a prescription written for ten days becomes something else entirely.
The asterisk is gone. Let me tell you why, and then let me tell you, with the specificity you deserve, what recovery actually looks like.
How painful is a tummy tuck?
A tummy tuck is more uncomfortable than a breast augmentation and less than most people fear. On a ten-point scale, patients typically describe the first two or three days as a two to five, dropping to a one to four by the end of the first week. The sensation is less “sharp pain” than “extraordinary tightness,” as if you’d done a thousand sit-ups and were then asked, politely, to stand up.
what surprises people isthe incision is not the problem. The incision is numb for weeks, sometimes months, because the small sensory nerves in the skin have been divided. What you feel is the repair beneath it. In nearly every tummy tuck I perform, I bring the two long vertical muscles of the abdomen (those separated by pregnancy or weight change, a condition called diastasis recti) back to the midline with a row of permanent sutures. That repair is what restores a flat, corseted waist. It is also what has you walking like a question mark for the first week.
That tightness is not a complication. It is the result, arriving early.
Why I stopped sending patients home with opioids
I want to be precise here, because precision is what separates a surgeon from a marketer.
Opioids work. That was never the issue. The issue is what they cost: the nausea that keeps you from eating, the constipation that becomes its own misery after abdominal surgery, the sedation that keeps you in bed when the single most important thing you can do for your recovery is walk. And underneath all of it, an uncomfortable statistic: a widely cited 2017 study in JAMA Surgery found that roughly six percent of patients who had never taken an opioid were still taking one three months after a routine operation. Six percent is not a rounding error. It is one patient in every seventeen.
In January 2025, the FDA approved suzetrigine (sold as Journavx), the first genuinely new class of medication for acute pain in more than twenty years. It works by blocking a specific sodium channel in the peripheral nerves, NaV1.8, that carries pain signals toward the spinal cord. It does not touch the brain’s reward pathways. There is no euphoria, no sedation, no addiction potential in the opioid sense, and no controlled-substance paperwork standing between you and your pharmacist.
I built a protocol around it. The full regimen is multimodal (long-acting local anesthetic placed into the muscle repair while you are still asleep, scheduled acetaminophen, an anti-inflammatory when it is safe for you, and suzetrigine as the backbone) and I am currently writing it up for publication. But the practical result is what matters to you and that is we go to a different level to minimize your pain.
They walk the evening of surgery. They eat dinner. They are lucid enough to text their sister. I did not fully appreciate, until I watched it happen, how much of what we used to call “recovery” was actually recovery from the pain medicine.
Opioid-free is not pain-free. I will not tell you it is. But it is a different, cleaner, shorter kind of hard.
What the first two weeks actually look like
Surgery day. You go home the same day from our accredited surgery center inside the practice on Rodney Parham Road or at CARTI. May be bent slightly at the waist (although we’re moving away from that) and wearing a compression garment. Your only job tonight: walk to the bathroom and back every couple of hours.
Days 1 through 3. The tight days. You’ll sleep in a recliner or propped on pillows with your knees bent, and getting up and down will be the hardest part of the day. Medication is scheduled rather than “as needed,” because staying ahead of discomfort is far easier than catching it.
Days 4 through 7. The corner. Sometime around day four or five, most patients wake up and realize the tightness has gone from a six to a three. You are walking the block, showering with a little help, sitting at a table for dinner.
Week 2. Standing straighter. Most people are fully upright by day 10 to 14. Driving returns when you can brake hard and check a blind spot without hesitation, which for opioid-free patients is often earlier than the old “once you’re off narcotics” rule. Desk work is realistic here.
Weeks 3 through 6. Swelling is the story now, not pain. The lower abdomen will feel firm and a little puffy, worse at night and better in the morning. Activity expands; lifting stays capped at about ten pounds until you’re cleared
Week 6 and beyond. Full exercise, including core work, once the repair is secure. The scar begins its long fade from pink to silver. The final contour reveals itself somewhere between six and twelve months.
When can I go back to work after a tummy tuck?
Desk or remote work in 7 top 10 days; jobs that involve lifting, standing all day, or caring for patients or small children in four to six weeks. Take the full two weeks if you can. The patients who try to shave it to one do not heal faster. They simply spend the second week uncomfortable at a desk instead of comfortable at home.
Will I need drains after a tummy tuck?
Not always. We have a couple of options: drainless, 1 drain that almost always comes out at 5 to 7 days.
When can I stand up straight, drive, sleep flat, and exercise?
- Stand fully upright: most patients by day one but don’t force it. The repair sets the pace.
- Drive: when you can brake hard and turn to check your blind spot without wincing, usually week one to two.
- Sleep flat: typically week two, once the tightness allows.
- Intimacy: roughly three to four weeks, gently, with nothing that strains the core.
- Exercise: walking from day one; cardio at four weeks; lifting and core at six weeks with clearance.
- Final result: six to twelve months, as swelling resolves and the scar matures.
What makes recovery harder and what makes it easier
Harder: nicotine in any form (I do not operate on smokers), poor protein intake, a weight that is still in flux, and the big one. doing too much on the first good day. Easier: walking, water, protein, a recliner, someone to help for the first 72 hours, and a surgical team that answers the phone. Ours does.
One more thing, because it is on more minds every year. If you have lost significant weight with a GLP-1 medication, you belong to the fastest-growing group in my consultation room. The American Society of Plastic Surgeons reported this month that 82 percent of its member surgeons fielded GLP-1-related consultations in 2025, and that abdominoplasty remains one of the three most-performed cosmetic operations in the country. Your recovery follows the same map. The nutrition conversation beforehand simply matters more and we will have it.
Recovery at Little Rock Plastic Surgery
Every abdominoplasty I perform takes place in either our AAAASF-accredited surgery center inside the practice at 2200 N. Rodney Parham Road or our ASC. But you’ll see our same team, from the first consultation through the last follow-up visit. You are never handed off. That continuity is not a luxury. In my experience it is the single largest variable in how recovery feels.
Frequently asked questions
Is a tummy tuck more painful than a C-section?
The tightness is similar. Most patients who have had both tell me the tummy tuck is comparable or somewhat easier, partly because there is no newborn to lift afterward. In both cases, the abdominal wall is the source of the discomfort, not the skin incision.
How long does the pain last after a tummy tuck?
Some discomfort lasts about five to seven days. Tightness and swelling persist for four to six weeks. Numbness along the incision can last several months and is normal.
Can you have a tummy tuck without opioids?
Yes. At Little Rock Plastic Surgery, our standard abdominoplasty protocol is opioid-free. It is built around suzetrigine, a non-opioid pain medication approved by the FDA in January 2025, combined with long-acting local anesthetic and scheduled non-narcotic medication.
What is the hardest day after a tummy tuck?
Usually day two or three, when the local anesthetic has fully worn off and swelling peaks. Most patients turn a corner between days four and six.
How long until I can stand up straight after a tummy tuck?
Most patients are fully upright within a couple days. Walking slightly bent in the first week protects the muscle repair and the incision; it is expected, not a setback.
Does a tummy tuck fix diastasis recti?
Yes. Repairing the separated rectus abdominis muscles is a core part of a full abdominoplasty, and it is what restores a flat, supported abdomen after pregnancy or significant weight change.
About the author. Michael Spann, M.D., is a double board-certified plastic and reconstructive surgeon and the founder of Little Rock Plastic Surgery, P.A., an AAAASF-accredited practice with an in-house surgery center at 2200 N. Rodney Parham Road, Suite 200, Little Rock, Arkansas. He is board-certified in both plastic surgery and general surgery, a member of the American Society of Plastic Surgeons and The Aesthetic Society. He has practiced in Little Rock for nearly 20 years and is the author of a forthcoming clinical manuscript on opioid-free abdominoplasty.
Last medically reviewed: September 2026.
