A mother of 2 in her early 50’s who is bothered by laxity and rolls of the back around her bra area. She had a breast augmentation/ lift elsewhere 20 years before, and an abdominoplasty elsewhere 10 years before. She was seen by another plastic surgeon who had recommended liposuction but I did not feel that this was likely to be helpful in her specific case as the skin calipers showed just 3 cm of pinch in her back, the same as the skin thickness in her abdomen. This is a normal pinch and because this grasps a double layer of skin shows that the actual thickness of the skin and fat is just ½ that or 1.5 cm. Her issue is laxity of the skin, not excess fat and can be demonstrated by a “lift” maneuver. When the skin is manually lifted the rolls go away. The only way we know to reliably tighten loose skin is to take out a piece- in this case the incision is carefully hidden under the bra strap. A “bra-line back lift”. The results as seen here at just 6 week after surgery are dramatic. The scar will continue to fade over the next 2 years but is hidden under the bra. She is already thrilled with her new contour. EXPAREL was used at her request and she did need to take any narcotics after surgery. Tattoos are blurred for her privacy.
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.
An unusual case of a nurse in her late 50’s with lipodystrophy of the flanks. She is 5’2” and 292 lbs, giving her a BMI of 53.40. Her maximum weight was 450 lbs and she has had a panniculectomy of the abdomen in 2001 and a gastric bypass in 2006. She was referred by her orthopedic surgeon because the flank skin oscillates when she moves and causes a disturbance of her gait.
She is shown before and again, 3 months after a posterior-lateral thigh/buttock lift with the removal of more than 10 lbs of skin from each side, for a total of more than 20 lbs. Despite her high risk for surgical complications with her highly elevated BMI, she healed uneventfully. Although our main goal was a functional improvement in her gait, which was achieved by her surgery, she also has a significant improvement in her appearance as well.
A medical professional in her late 50’s who had a gastric bypass 12 years before and has lost 70 lbs. She has had an abdominoplasty with buttock lift and liposuction of the medial thighs by another plastic surgeon 5 years before but remained unhappy with prominence of the mons pubis that was not addressed at the time of her abdominoplasty as well as laxity and asymmetry of the medial thighs. Her mons remains too wide and is unnaturally prominent in her clothing. The thighs are asymmetric and the skin is loose.
She is shown before and again, 8 months after revision of her mons and lower abdomen with liposuction, as well as secondary liposuction of the medial thighs and knees combined with a medial thigh lift. She can stand with her legs closer together now without the skin touching and the thighs now match more closely in her leggings. An excision of the mons was marked but not required at the time of surgery.
An 80 yo who had had an abdominoplasty at the age of 70 by a general surgeon, but was still bothered by “rolls of skin” in the upper abdomen which she described as looking like a “second set of breasts” in her fitted clothing. She is an active 80 yo who still works full time and wanted to look better in her clothing. She is in good health otherwise.
When patients have gained and lost significant weight there frequently exists a horizontal excess of skin in the upper abdomen which is not typically improved with a traditional abdominoplasty. A vertical excision can be performed in the midline to correct this excess, and can be combined with power assisted liposuction as in her case to reduce the thickness as well. When the vertical excision is combined with the horizontal incision this is called a Fleur de Lis pattern. This trades a scar in the midline for a better contour. EXPAREL was used at the time of surgery to limit her need for pain medication and narcotics after surgery. She is shown before and again, just 6 weeks after her procedure. The scar will continue to fade over the next 2 years and swelling from the liposuction will continue to improve over the next 5 months. She is already thrilled with the early improvement.
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.