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.
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.
A mother of 2 in her late 40’s who is bothered by a” bump” in her lower abdomen and stretch marks. She is 5’4” and 122 lbs and is seen before and again, 7 ½ months after an extended abdominplasty. An umbilical hernia was repaired by general surgery at the same time.
A 2 ½ year followup on a mother of two who was bothered by hanging skin and fullness in the mons area. She is shown before and again, 2 ½ years after an abdominoplasty with translocation of the umbilicus. Her scar is nicely hidden in the “thong line”
A woman in her early 40’s who is bothered by the appearance of her abdomen, despite having liposuction of the abdomen elsewhere 13 years before. She has also had liposuction reduction of her breasts 15 years before, also elsewhere, and feels that her breasts have regrown. She is especially bothered by “rolls” of the abdomen that show through her clothing. She has not had children. She is 5’6” and 170 lbs and is shown before and again, 7 months aften extended abdominoplasty. She had the excision of more than 4 lbs of skin. We can expect scars to continue to fade over the next 18 months. She is thrilled to be able to wear fitted clothes now, without seeing “rolls” of skin in her abdominal area.
mother of 3 in her late 30’s who is bothered by the appearance of her abdomen after pregnancy. She gained 65 lbs with her last pregnancy and wished to be able to feel comfortable wearing a 2- piece bathing suit again. Many patients mistake the bulging of the abdomen after pregnancy with somehow being overweight. They come in to see me and feel guilty, as if they could correct their problem with further weight loss or exercise. That is certainly not the case here, as she is 5 4 ½ inches and 122 lbs, giving her a BMII of 20.62, and is extremely physically fit. The problem is skin and muscle that was stretched with her pregnancies. Her umbilicus is high, and we need to decide between placing the entire abdominal scar higher, or placing it in the best “thong line” position and accepting a small vertical scar in the lower abdomen that represents the skin that was previously around the umbilicus. In other words, we cut around the outside of the umbilicus (belly button) and leave the belly button attached where it is- after repairing the stretched muscles, the skin is pulled down like a window shade and the excess skin is removed, ant the belly button is popped back up through a new incision. She is shown before and again, 3 years after surgery. The abdominal scar is in the optimal “thong” position, placed 6 ½ cm above where the vaginal lips come together. The small vertical scar is seen just above this and is from the skin that was previously around her umbilicus before the skin was detached and pulled down. She has an excellent contour to her abdomen, and now feels comfortable again in a 2-piece bathing suit.
A mother of 3 in her early 40’s who is bothered by a ”bump” of her stomach after pregnancy, despite diet and exercise. She is also bothered by unfavorable scarring after gallbladder surgery at the age of 21. She had had this revised by a plastic surgeon 12 months before seeing me but was still unhappy with the scar. A subcostal incision is sometimes called a “Kocher” incision and can make an abdominoplasty more challenging. Limited undermining can allow us to maintain the blood supply to the lower abdominal skin. Liposuction of the abdomen can also increase the risk of healing problems with an abdominoplasty. Sometimes a scar can be improved further by releasing and breaking up the scar tissue and fat grafting around the scar.
Lipoabdominoplasty utilizing Power assisted liposuction was used to break up the fat around the old scar using a “Becker” type cannula and judicious liposuction was performed to remove 400 cc of fat from the upper abdomen. Then an abdominplasty was performed with limited undermining to preserve the blood supply to the lower abdominal skin. Fat equalization was performed to break up and smooth the fat under the scar.
She is shown before and again, 4 years after surgery.