Abdominoplasty (tummy tuck) is one of the most important cosmetic procedures for people today. It is often the primary treatment that people need as a starting point for achieving a healthy-appearing figure. If your problem is that you have too much skin laxity of your abdomen, you probably need tummy tuck.
Tummy tuck benefits include removal of all excess abdominal skin, leaving a patient with a much flatter abdomen and no skin laxity. Also, tummy tuck is the treatment for stretched and loosened abdominal wall muscles. Many people are born with abdominal wall muscle separation. This is called diastases recti. These can widen over the years. Also, pregnancy and other types of weight gain and weight loss cause permanent stretching and loosening of the abdominal wall with widening of muscle separation. Muscle separation can be closed during tummy tuck. Patients routinely lose 1-½ to 4 inches of abdominal wall circumference, with muscle tightening.
Tummy tuck is not liposuction. These 2 modalities get confused, often. Liposuction is for body contouring through fat removal, without significant skin laxity reduction. There is a component of skin tightening but the primary goal of liposuction is fat removal. Tummy tuck primarily for the removal of loose skin. Very often, both of these modalities are combined in patients who need both fat removal and skin tightening. They can have a synergistic effect on restoring a patient's natural contours.
How do I perform tummy tuck?
The most critical element of a perfect tummy tuck and a happy patient is the preoperative understanding that is achieved between surgeon and patient. I try to understand, perfectly, what patients are trying to achieve so that I can focus myself exactly on that. I meet with patients and discuss their goals, at least twice, before surgery. This involves looking in the mirror and drawing imagined incision lines and planning outcomes, together. Once the patient and I have agreed upon a surgical plan and an adequate understanding between us is achieved, surgery may proceed.
First, I separate the bellybutton from the surrounding skin. The belly button is left in place and is never removed from its original location. The transverse incision that was planned is made. This usually extends from hip to hip or wider. The width of the transverse incision depends on many factors including the amount of skin that is removed in the vertical dimension, the amounts of skin laxity and the locations of skin laxity of the patient and, finally, contouring of the corners of the incision so that no dogears or unnatural shapes result. Fat is then separated from the muscles, all the way up to the ribs and the xiphoid process. Separating the skin and fat from the muscles allows all the excess skin to be pulled down and then eventually, removed. Once the muscles have been exposed, I can determine if they need to be closed. If there is muscular laxity or muscular separation and then I suture the muscles together with permanent sutures. This closure of muscles can extend from the xiphoid process to the belly button or even from the xiphoid process to the pubes. This restores the natural shape of the abdominal wall. The skin is then pulled down to an appropriate amount of tightness and the excess skin is very carefully determined and then removed. Once the skin has been positioned in its new location, I bring the belly button out through the skin that is lying directly over it. The transverse incision is then closed after placing 2 drains. The final outcome should be a much flatter abdominal wall, with no loose skin on top. There should be no dogears. Dogears are an unnatural protrusion of the corners of the incision that happens when they have not been tapered out appropriately. These occur commonly in tummy tucks. I am very diligent about making sure my patients do not have dog ears.
Tummy tucks are done in the OR under general anesthesia. They generally take 1-½-2 hours to
finish. 60 to 70% of the operative time is suturing. Because of this, I have an assistant to help
me suture. This saves time and money but more importantly, makes your procedure safer.
What is the mini tummy tuck?
Mini tummy tuck is for tightening the abdominal skin between the umbilicus and the pubis. The incision might look the same as for a full tummy tuck but the separation of fat from muscles does not extend above the umbilicus, so therefore, there can be no skin tightening above the umbilicus. Also, the abdominal wall muscles are not exposed and cannot be sutured shut during mini tummy tuck. Mini tummy tuck is perfect for the person who does not have abdominal wall laxity and mostly only suffers from loose skin below the umbilicus. If the patient has significant amount of loose skin above the umbilicus and wants that fixed, full tummy tuck is likely the best option. Full tummy tuck is also the best option if there is quite a bit of abdominal wall separation. This is something that we can determine together when you come in for consultation. Mini tummy tuck can be performed in the office, under local anesthesia. It is a procedure that is well-tolerated and is the perfect treatment for some people.
What is an extended tummy tuck?
Circumferential tummy tucks are performed for patients who need skin laxity taken in from their flanks and their back as well as from the abdomen. This can be performed all at once or in a staged procedure. This is usually only necessary after massive weight loss.
Another extended tummy tuck can be performed by adding a fleur-de-lis incision. That means that besides having a transverse incision that goes from hip to hip, a vertical incision also exists that goes from the transverse incision to the xiphoid. The resulting incision is shaped like an anchor. This allows me to Paul skin and from the sides as well as from top to bottom. If a person’s skin laxity is primarily from side to side, they may need an additional vertical incision. This is also very rare and usually only performed after massive weight loss. I have performed repeat tummy tucks on patient’s who became obese years after their initial tummy tuck and the fleur-de-lis incision is often the best way to gather skin from the sides, when needed.
Am I a candidate for tummy tuck?
If you have troubling skin laxity in your abdomen and you feel like some skin would need to be removed in order to achieve a flat tummy, you likely need a tummy tuck. Not every person is a candidate for tummy tuck. People who smoke tobacco, people with inadequate exercise tolerance and people with uncontrolled medical conditions are not candidates for tummy tuck. If your BMI is higher than a normal BMI, you may still be a tummy tuck candidate but you need to have excellent exercise tolerance and no uncontrolled medical conditions. Because of my long career as a general surgeon, I have acquired years and years of experience and expertise operating on people who are overweight. Your weight may not preclude you from having a tummy tuck but your lack of exercise tolerance or your out-of-control medical problems will. Physical fitness directly correlates with your ability to heal. Even though tummy tuck is not an operation where a major body cavity is entered and it just deals with skin and fat, the surface area of the wound is large enough that, without exercise tolerance, you might not heal well-enough and your risk for complication is higher. No tummy tuck is worth suffering avoidable complications. When I talk to you, we will go through your health history, your surgical history and your exercise history. I want to be able to ensure your safety and your good outcome, as much as is possible.
Risks of tummy tuck and other considerations
As with any operation, tummy tuck comes with its own possible complications. There is a risk of bleeding and infection. This risk is very minor. There is a risk of poor healing along the incisions. This usually is a self-limited problem that resolves after 6-8 weeks of surgery. Tummy tuck patients always have some degree of numbness along their transverse incision. That is usually in the middle of the abdomen and just above the incision. This should be expected. Most people are not too troubled by this. This does improve somewhat with time. A surgical patient is at risk of developing blood clot. Your risk of any complication goes down as your health, nutrition and exercise tolerance improve. We will try to maximize your safe and excellent outcomes with simple preop and postop routines. After surgery, I see patients on a weekly basis, until I do not feel like they need to see me any longer. For some patients, postoperative care may only be needed for a few weeks but others, may need regular visits, for a longer period of time. Generally, you will recover faster if you go into surgery in a more fit and healthy condition.
What is recovery like?
Tummy tuck as an outpatient operation so you will go home once you have recovered. You will leave the hospital with a set of self-care instructions and we will give you instructions in the office, before surgery. There will be instructions on how to shower, how to take care of your drains, how to remain active but not get in the way of healing, how to minimize your risk of blood clots and infection, what to do about binders and compressive garments. These instructions are easy to follow. You should expect 4-6 weeks of recovery time. The time I released you to return to full activity will depend on how quickly you heal. That can be very different for different people. Just like for everyone else, you will follow a customized treatment plan which will be designed specifically for you.
Before and After
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Case 6
Re-do Tummy Tucks
Case 1
This patient underwent a Tummy Tuck, which required both a fleur-de-lis incision (the vertical incision in the midline) and a circumferential incision (the incision that goes around the beltline).
Case 2
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