What is Abdominoplasty?
Abdominoplasty, also known as a tummy tuck, removes excess skin and fat, as well as restore weakened or separated abdominal muscles. Factors that often contribute to these issues include aging, pregnancy, genetics, prior surgeries, and significant weight fluctuations. A tummy tuck results in a flatter abdomen that is proportionate with your body type.
Am I a good candidate for abdominoplasty?
Candidates for abdominoplasty surgery in Boston and Worcester, Massachusetts are healthy men or women who are unhappy with the appearance of their abdomen. It is important that patients are at a stable weight, are non-smokers, and have realistic expectations for the outcome of their surgery. Furthermore, patients should be aware that a tummy tuck should not be used as a primary weight loss solution. A consultation with Dr. Hall can help you decide if a tummy tuck is right for you or if you might benefit from a different procedure.
Abdominoplasty – Patient 162
A mother of 4 in her early 50’s was bothered by the appearance of her abdomen which she describes as a “loaf of bread” when she is leaning forward. She finds it difficult to wear fitted clothing and is also bothered by the wrinkled appearance of the skin. She is shown before and again, 6 months after an extended abdominoplasty. She is thrilled by the new appearance of her abdomen, and is able to reach into her closet and grab some clothing without worrying about how it will hide her abdomen. Her scar is placed in a “thong” position where it is hiddent by most clothing styles.
Abdominoplasty – Patient 161
A mother of 2 in her early 50’s who is bothered by the appearance of her stomach. She has had two treatments elsewhere with cool sculpting, but did not see any improvement. This is not surprising. She does have excess fat of the stomach wall, but her main issue is stretching of the abdominal muscles and skin from pregnancy, neither of which are treated or improved with cool sculpting. When she first saw me her BMI was 33 and I had her lose 25 lbs with diet and exercise to get ready for her surgery to bring her BMI down below 30. Abdominplasty is not procedure for patients who are significantly overweight. Fat that is inside the abdomen, around the intestines (omental fat) can make it difficult to tighten the abdominal wall. I tell my patients that you cannot put 40 lbs of potatoes in a 20 lb bag. Not only will the muscles stretch back out, but there would be a much greater risk of having a blood clot from increased pressure on the abdominal veins, as well as difficulty taking deep breaths because the diaphragms are at the bottom of the lungs but at the top of the abdomen and would not be able to descend normally.
She still has a thicker layer of subcutaneous fat over her abdomen, and chose to have a “lipo-abdominplasty” which combines liposuction of this fat at the time of the abdominoplasty. The technique is modified to limit the undermining of the abdominal skin to better preserve the blood supply. In her case, an “extended lipo-abdominoplasty” was performed to give better tightening of her sides. A “high lateral tension” pattern was used which has visibly improved her upper thighs. She is shown just 7 weeks after her surgery. There is typically significant swelling in the lower abdomen that takes 6 months to fully resolve. And the scars around the umbilicus and in the “thong line” are at their thickest and reddest at this time, and gradually improve over the next 2 years. Even so, she has a dramatic improvement in her contour. Her waistline is narrower and her stomach is flatter from the muscle tightening. The abdomen has a beautiful contour from liposuction of 1050 cc from the abdomen. And the skin is dramatically tighter after the excision of 5 ½ lbs of skin. Her umbilicus (belly button) was deviated to her left side by uneven stretching of her pregnancies. I have brought it back to the midline using our plumb-line technique with differential tightening of the abdominal muscles.
She is thrilled with her early result and is happy to be able to head back to the gym now.
Abdominoplasty – Patient 160
A mother of one in her late 50’s who is shown just before and again, nearly 10 years after an extended abdominoplasty with the removal of 4 ½ lbs of skin. A “champagne groove” has been fashioned in the midline of the abdomen and a hollow sculpted around the umbilicus to give her abdomen an even more beautiful shape.
Abdominoplasty/Massive Weight Loss – Patient 159
A woman in her mid 50’s who has lost 148 lbs after a gastric bypass more than 15 years before through an open upper abdominal midline incision. She had had Coolsculpting treatment of the abdomen 3 months before coming to see me, but didn’t report any improvement. Of course cryolipolysis is s treatment for fat, and her problem is excess skin, so the lack of improvement is not a surprise. It is always important to make the diagnosis before selecting a treatment.
She is shown just before and again, 1 year after a Fleur de Lis abdominoplasty (she is 6 weeks after a mastopexy and brachioplasty). The Fleur de Lis involves a midline scar and does give additional tightening of the midline skin at the expense of a vertical scar. It is usually most appropriate in patients that already have a midline scar, as is the case here.
Abdominoplasty – Patient 158
A mother of 2 in her mid 40’s who is bothered by bulging and rolls of her stomach after pregnancies. She feels like she is 3 months pregnant. She had polyhydramnios with her second pregnancy and was more severely stretched than typical. She has had some problems with hypertrophic scarring with her c sections. She is 5’4” and 136 lbs and is shown before and again, 5 months after abdominoplasty. An umbilical hernia was corrected by her general surgeon at the same time. Her case illustrates some typical challenges and how I like to address them. Her skin laxity is not at severe as her muscle stretching but is still present. But not enough to fully remove the vertical slit of the skin that was previously around her umbilicus. One option would be to put her entire horizontal scar much higher, where we see the vertical slit scar. This is rarely satisfactory, in my experience, because she now would have a visible scar across her entire abdomen. Instead, as I have done in her case, it is better to place the main scar low, in the “thong” position where is can be covered by most clothing styles and accept a small vertical scar in the lower abdomen as a necessary tradeoff to allow us to tighten the abdominal skin. I have formed a periumbilical hollow by sculpting the fat around her umbilicus as well as a “champagne groove” by shaping the fat in the midline above the umbilicus to give the abdomen an even more beautiful appearance after her surgery, not just tighter. She was surprised to find that she has dropped 4 dress sizes after her surgery, and loves being able to reach in her closet an grab some clothes without worrying what she might need to wear to hide the buldge. Scars will typically continue to improve for 2 years after abdominoplasty- her main scar is hidden under the thong line. The vertical scar will continue to fade and improve over the next 18 months. Because of her history of unfavorable scarring, I have started her on taping for the first 6 weeks and then topical silicone.
How is an abdominoplasty performed?
How your abdominoplasty procedure is performed will depend on your specific needs and body concerns. Patients choosing to undergo abdominoplasty surgery have the choice of intravenous sedation and general anesthesia, and Dr. Hall will recommend which choice is best for you. During the surgery, Dr. Hall creates a horizontal incision between the belly button and the public hairline, where a bikini can easily cover. The skin is then lifted, and the weakened abdominal muscles will be tightened. Depending on how much excess skin is being removed, a second incision around the naval may be necessary. Skin on the upper abdomen is pulled down, and a new opening for the belly button is created. Incisions will be closed with sutures, tapes, or skin adhesives.
What should I expect during recovery?
During abdominoplasty recovery, dressings are applied to incision sites and a compression garment may be worn to minimize swelling and provide support. Small tubes may also be inserted to drain any excess blood or fluids. You can expect to be assisted with walking as soon as the next day to prevent the formation of blood clots, however, you should be resting for the first week or two after surgery. After your procedure, you will likely experience some swelling and discomfort. Dr. Hall can provide you with prescription medication to manage your pain and make your recovery more comfortable. You will also have some activity restrictions in the first few months. You should avoid strenuous activity or movement such as bending at the waist, that might strain the incision site. Dr. Hall will provide you with specific instructions about your recovery and activity restrictions.
The result of your abdominoplasty can be distorted due to swelling in the first few weeks, however as swelling diminishes you will begin to notice your results and can enjoy a toned abdominal area. Abdominoplasty results are permanent, although substantial fluctuations in weight can greatly diminish these results. Patients who are planning on losing a substantial amount of weight or future pregnancies are advised to delay tummy tuck surgery.
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