My goal is not simply to make the belly flat or to remove extra skin, but to sculpt a torso that not only looks youthful and healthy, but offers the added benefits of muscle repair.”
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What patients need to know about Abdominoplasty…
- In general there are three main issues that must be addressed to fully functionally and aesthetically rejuvenate the abdominal area.
- Liposuction alone is not a viable substitute for patients who need a tummy tuck.
- Scars are a big concern for most patients seeking a tummy tuck or abdominoplasty.
- A rejuvenated abdomen can only look better when adjacent areas that are not ideal are considered for treatment as well.
- The advent of Ulthera® has provided an excellent opportunity for those patients who are in between liposuction and abdominoplasty.
- The notion that a “mini” abdominoplasty has special benefits is a misconception.
- Endoscopic techniques just address muscle laxity—not skin and will not address a bulging belly.
- The benefits of an abdominoplasty go beyond cosmetic improvement
In general there are three main issues that must be addressed to fully functionally and aesthetically rejuvenate the abdominal area—extra skin (upper abdomen, lower abdomen or both), extra fat and lax muscles. The correction of muscle laxity can reduce back pain caused by imbalance between the back and abdominal musculature. Post partum moms or men and women who have lost significant weight are the most common candidates for an abdominoplasty—also known as a “tummy tuck.” Often, two areas of the abdomen are affected. One is the rectus abdominus (sit-up) muscles and the other is the oblique muscles. The former are two vertical muscles from pubic bone to sternum that should touch in the midline and the latter is low and to the side by the hip, to the outside of the sit up muscles. Together with the abdominal fascial layers, they help hold back the intra abdominal contents and diet sensitive fat. Pregnancy or significant weight gain leads to both the muscles and the skin stretching, usually resulting in stretch marks. These conditions cannot be treated by weight loss and exercise alone. Muscles do not shrink and skin can only be expected to minimally recoil after weight loss. Surgically tightening the sit up muscles and the oblique muscles essentially acts as an internal girdle and resembles what one might see in the mirror when sucking in the belly.
Liposuction alone is not a viable substitute for patients who need a tummy tuck. Liposuction removes fat and contours the area treated. A tummy tuck removes excess skin and addresses the underlying muscles. One cannot be exchanged for the other. They are mutually exclusive procedures and are dictated by what is discovered during your physical exam. During a detailed examination, the abdominal contour will be evaluated relative to the surrounding trunkal structures. This will help determine what procedure is in the patient’s best interest. Oftentimes patients seen in consultation either ask or are hoping that liposuction alone will resolve their aesthetic issues; however the degree of laxity of the abdominal musculature is the determining factor.
Scars are a big concern for most patients seeking a tummy tuck or abdominoplasty. Classic abdominoplasty results in a scar in the bikini line and within the umbilicus (belly button). It focuses on lower abdominal skin excess. In general, the more skin you have the wider the resultant scar. Reverse abdominoplasty places the scar at the crease under the breast, deals more effectively with upper abdominal skin laxity and is much more powerful at creating a waist as it pulls in skin excess around the waist (270 degrees of the torso circumference.) Ventral and/or umbilical hernias may also be corrected without scars during abdominoplasty
A rejuvenated abdomen can only look better when adjacent areas that are not ideal are considered for treatment as well. Liposuction is often part of an abdominoplasty giving the patient the benefit of a more aesthetic contour. Often, women who are not anticipating additional pregnancies will get their “pre baby” body back by addressing their breasts during the same surgery—either an augmentation with implants, or fat or a combination breast lift and augmentation. This approach allows the entire torso to appear more youthful and age as one unit.
The advent of Ulthera® has provided an excellent opportunity for those patients who are in between liposuction and abdominoplasty. Until recently there has been no liposuction technique that significantly or reliably enhances skin shrinkage (including Smart Lipo®) above and beyond conventional and superficial liposuction where the fat on the back of the skin is thinned out significantly so skin is pliable and has the ability to contract. The advent of Ulthera® has provided an excellent opportunity for those patients who are in between liposuction and abdominoplasty. Those with localized skin excess around their belly button or directly above their pubic region may be good candidates for Ultherapy or liposuction.
The notion that a “mini” abdominoplasty has special benefits is a misconception. The request for this “abbreviated” procedure is usually driven by the desire for a smaller scar. No patient would purposely seek a longer scar; however scar length is determined by the amount of skin excess. Understand that making the scar length the priority can lead to an inferior contour. Patients who choose optimal contouring along with a well placed finely healed albeit longer abdominal scar are the happiest with their results.
Endoscopic techniques just address muscle laxity—not skin and will not address a bulging belly. Some patients who have sit up muscle (rectus abdominus) laxity alone are candidates for endoscopic abdominoplasty. I feel it is safer and more reliable to accomplish the same objective through a small incision about the width of the pubic area.
The benefits of an abdominoplasty go beyond cosmetic improvement. Muscle repair can save patients years of chronic back pain. In addition, future intestinal entrapment and subsequent emergency surgery can be avoided for those whose pregnancy and weight gain have led to hernias around the belly button since these are easily addressed and repaired during a tummy tuck.