A mother of 3 in her early 30’s who is bothered by the appearance of her abdomen. She had hyper emesis through her pregnancy which caused her to develop a large umbilical hernia She would like to be able to wear a 2 piece bathing suit again, as well as fitting better in fitted clothing. She is shown before and again, 2 1/1 months after surgery. She is already wearing a 2 piece bathing suit. Scars are at their reddest and thickest at 6 weeks after surgery and then typically fade and improve over the next 2 years. Her scar has been hidden in a “thong” position where is can be hidden by most clothing styles. Patients typically have swelling of the abdomen after surgery that continues to improve for the first 6 momths. She is already thrilled with her early result.
A mother of 3 and a medical professional who is in her mid 40’s and who was bothered by skin hanging over her pants and the stretch marks of the skin. She had a painful umbilical hernia as well. She is shown before and again, 3 years after an extended abdominoplasty with a correction of her umbilical hernia by general surgery at the same time. She is 5’5” and was 150 lbs before her surgery. 1089 gms of skin were removed at the time of surgery (454 gms in a pound, so 2.4 lbs).
Since that time she has become active in fitness competitions and has lost additional weight, now being 136 lbs. She shared some photos from her recent competition and gave us permission to share these. She told us that she received many compliments from her fellow contestants on her abdomen and also on the placement of her abdominoplasty scar. They were amazed that it was low enough to be able to hide it with a thong!. I feel it is important to place the abdominoplasty scar in a thong position where it is low enough to be hidden by yoga pants or hip hugger pants, but high enough on the sides to still be hidden by a French-cut bathing suit. The umbilical stalk is kept short to try and keep the scar around the umbilicus hidden on the inside.
A 39 yo mother of 3 who was bothered by a “roll” of abdominal skin as well as by the appearance of the abdominal skin and bulging of the abdomen after pregnancies. She is shown before and again, 2 years after an extended abdominoplasty. A hernia of her umbilicus was repaired by general surgery at the same time. EXPAREL was used to decrease her need for narcotics after surgery. Progressive tension sutures were used to decrease her risk of seroma formation. Her scar is placed low, in a “thong” position. She is thrilled with the dramatic improvement of her stomach, and is happily wearing a 2-piece bathing suit again!
A mother of 3 in her mid 30’s who is bothered by the appearance of her abdomen after pregnancy. She has an umbilical hernia and bulging of the abdominal wall as well as excess skin.
She is shown before and again, just 6 weeks after an abdominoplasty. Her umbilical hernia was corrected by general surgery at the same time. Her abdominal wall muscles that were stretched from her pregnancy was repaired during the abdominplasty and the excess skin was excised. A “champagne groove” was fashioned in the fat above the umbilicus and a beautiful hollow was sculpted around the umbilicus. EXPAREL was used to limit her need for narcotics and pain medication after surgery. Her scar is placed in a “thong” position where it is low enough to be hidden by a thong or by yoga pants or most clothing styles. There is typically still swelling of the abdomen that will resolve over the next 6 months. And the scars are at the reddest and thickest at 6 weeks and will now begin to fade and improve over the next 2 years or longer. She is thrilled with her early improvement.
A mother of 2 in her late 40’s who lost 40 lbs following her pregnancies and is bothered by excess skin and bulging of her abdomen. She is shown just before and again, 5 months after an extended abdominoplasty. Her umbilicus is brought back to the midline while repairing her diastasis and bulging of the abdominal muscles by means of a “plumbline” suture. EXPAREL was used to limit her need for narcotics after surgery. She is just back from a cruise, where she was able to wear a bikini, and loves the new appearance of her stomach.
A mother of 3 in her early 50’s who is bothered by bulging and rolls of the abdomen> She has had previous laparoscopic gallbladder surgery. She is 5’6 and 146 lbs. Her photos are shown before and again, 11 months after surgery. Her case is made more challenging by a higher position of her umbilicus. In a normal abdominoplasty when the skin is elevated up to the rib cage and then pulled down like a window-shade and removed, the skin that was around the umbilicus is completed removed and falls below the abdominoplasty scar. But in this case, when the abdominal skin is elevated and pulled down like a window shade, the slit of the scar from around the umbilicus sits higher and is closed as a small vertical ( up and down) scar, allowing the abdominoplasty scar to stay low, in a “thong” position where it is hidden by most clothing styles. An alternative procedure when the umbilicus is high is an umbilical “float” where the umbilicus is detached at its base and pulled down slightly lower-but this does not work as well when the upper abdominal skin is also loose because the “sheet” of skin is not able to be pulled as tight.
In cases such as here, it is better to keep the abdominoplasty scar in the “thong” position where it is low enough to be hidden by yoga pants and bikini bottoms, and accept a small vertical slit scar that shows, rather than putting the entire scar higher where it cannot be hidden.
A mother of 3 ( including twins) in her early 40’s who is bothered by bulging and loose skin of her abdomen. She would like to be comfortable wearing fitted clothing. She is 4’10” and 124 lbs and is shown before and again, 11 months after an extended abdominoplasty. She has severe stretching of the abdominal wall from her pregnancies and her umbilicus is deviated to her right. An attempt was made to bring it closer to the midline with differential tightening of the muscle wall. She has had an excellent correction of her abdominal contour and loves being able to wear fitted clothes and t shirts now. The fat has been sculpted in the abdomen to give her a midline groove and a hollow around the umbilicus. Her scar has been placed in a thong position.
A mother of 2 in her early 40’s who is bothered by the appearance of her stomach. She was especially concerned about the scar placement and wanted to make sure that it would be placed in a thong position where it would be hidden by most clothing styles. She is shown before and again, 1 year after an extended abdominoplasty. EXPAREL was used during surgery to decrease her need for narcotics after surgery. Progressive Tension Sutures were placed at the time of surgery to decrease the risk of seroma. Her scar placement is 6.5 cm from the vaginal fornix to keep the scar low, in a “ thong” position. Tattoos have been blurred for her privacy. Nearly 5 lbs of skin were removed with the extended abdominoplasty.
A mother of 2 in her late 50’s who is bothered by bulging of her abdomen in clothing. She felt that her left side bulged more and on exam was noted to had an inguinal hernia on that side. She has had 2 C-sections. Her umbilicus is relatively high and in her case we “floated” the umbilicus by pulling it down lower, avoiding a scar around the umbilicus and a midline scar from the umbilical slit in the lower abdomen. She is shown before and again, more than 3 years after her extended abdominoplasty with floating of the umbilicus. Her inguinal hernia was repaired by General Surgery at the same time. Her scar is placed low in a “thong” position where it is hidden by most clothing styles.
Discussion: Floating of the umbilicus is a technique that I find useful in patients with a relatively high umbilicus that do not have much looseness in the upper stomach and wish to avoid a scar around the umbilicus and a vertical slit scar in the lower abdomen. The umbilicus is detached at its base and brought down lower, instead of cutting around the top of the umbilicus and popping it back up through in the new position. It does not “pull the sheet tight” in the upper abdomen as much as with a traditional technique but can work well in some cases as shown here. Liposuction was used to form a midline groove above the umbilicus. The abdominal muscles are still tightened and bring in the waist and correct the muscle bulge. Her incision is “extended” to allow better tightening of the sides and has higher tension placed on the sides to better shape the stomach.
A mother of 3, including twins, in her mid 40’s. She had gained 70 lbs with her pregnancy and “carried large”. She also had a hernia of the muscle wall above the umbilicus. (a ventral hernia).
Exparel was used during her surgery as part of our Enhanced Recovery after Surgery (ERAS) protocol. Exparel is a Liposomal Marcaine, an injection placed at the time of surgery that slowly breaks down and releases long-acting local anesthetic for the first 72 hours after surgery. Pain varies between patients but she was amazed that she did not require any narcotics after surgery, and stopped taking ibuprofen after two weeks. She reports that she is already down in size from a 10/8 to a 6.
She is 5’5” and 149 lbs and is shown just 6 weeks after her surgery. Her ventral hernia was repaired at the same time by general surgery. It is early to show her result, because swelling will continue to go away over the next 5 months and the scars will continue to fade for the next two years. Nonetheless, the early results are dramatic. She is thrilled to be able to wear fitted clothes now. The oblique view shows the “champagne groove” and the hollow around the umbilicus that were sculpted at the time of surgery.