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.
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.
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.
Our patient is now seen 18 months after her abdominoplasty. The scars have continued to fade.
A mother of 2 in her early 50’s whose children are grown and who is now ready to do something for herself. She has lost 20 lbs with diet and exercise but is still bothered by the appearance of her abdomen in clothing. She feels that her breasts are too full and droopy after children. Her case is interesting for a few reasons. She has a large scar in her right upper abdomen ( a right subcostal incision or sometimes called a “Kocher incision” ) from an open gallbladder removal in the past. This can make the abdominoplasty more challenging by potentially interfering with the blood supply to the abdominal skin during an abdominoplasty.
She also has ‘fat pockets” in her anterior axilla which bother her in an evening dress. They can be treated at the time of a reduction mastopexy with liposuction. I generally to not perform the abdominplasty and a breast reduction at the same time-it is too much surgery for most patients and difficult early in the recovery of an abdominoplasty when a patient needs to use her arms to get in and out of bed.
She is shown 2 years after her abdominoplasty, and 21 months after her reduction mastopexy and liposuction of the axilla. I like to place the abdominoplasty scars low, in a “thong line” position where they can be hidden by most clothing styles. Her scars are quite good, but are easily hidden by her two piece bathing suit. She reports that her abdomen feels much stronger now when she does Yoga, and she never thought she would feel comfortable wearing a bikini again!
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.
Update: Our patient is now seen 18 months after surgery. The sculpted definition of the abdomen is more visible and she continues to have an excellent contour of the abdomen despite mild weight gain. Scars have continued to fade.