Tag Archives: ABDOMINOPLASTY

Tummy tuck scars

Abdominoplasty tummy tuck scars in wrong location

Often a picture is worth a thousand words.

Look here;

High abdominoplasty scar

 

This young patient came to see me after having had an abdominoplasty – tummy tuck surgery by another plastic surgeon. It’s not the first time I see this type of scar after a tummy tuck on a patient. Unfortunately it is far too common and worst of all, in many situations little can be done to fix it by any cosmetic plastic surgeon. The scar is just too high and the plastic surgery patient cannot cover it up even with larger style of panties.

 

Abdominoplasty scar too high

 

 

Reasons why tummy tuck scars are too high

  1. Easier surgery for surgeon

The sad fact is that some board certified plastic surgeons are lazy and do not wish to have any headaches with their surgical procedures even at the cost of a shoddy surgical result.

Placement of the tummy tuck scar high on the abdomen means that the surgeon has

  • less work to do,
  • the work he does perform is easier,
  • the risk of any wound opening or scar disruption is less
  • the patient will have less pain as there is less tension in the abdomen.

It also means that the patient will have

  • a lesser result
  • an unsightly scar forever.

       2.  Easier for the plastic surgery patient

The high scar means there is less tension on the wound and  also a better blood supply. Unfortunately trying to get away with an easy surgery, less pain, and less risk, though something we all want, is not going to give you the result you want. In fact it will give you a result you will hate and regret. Not what we want plastic surgery to do for you!

Many plastic surgery patients who have been to doctors in other countries to have surgery will return with these types of tummy tuck scars. I cannot blame them. They have a medical tourist who is going to be around for a short period of time and who wants a quick fix.  The plastic surgeon will not be there to give post-operative care and does not want any headaches- so, a high scar solves his problem. By the time the plastic surgery patient realizes where the scar is and that it cannot be hidden by normal panties, it is too late and the patient has long left the country.

In summary, for the best surgical results after a tummy tuck the scar should be as low as possible just above the pubic area. Though this may mean that scars may have some small disruption in the early post operative period, they can always be fixed later. The high abdominal scar can rarely be fixed if ever.

 

Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!

 

Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look

 

Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;  http://www.youtube.com/watch?v=HCqqri8Yt5M&list=UUGHAP0wTkrkJuRo1yN1CFjg

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

Decreased swelling after tummy tuck

How to decrease swelling after Tummy tuck

Tummy tuck or abdominoplasty is a common cosmetic surgery procedure. The cosmetic plastic surgeon tightens muscles of the abdomen, remove extra tummy skin,  and liposuction of the flank for fat removal.

Here are a few previous blogs on the topic.

 https://www.tavmd.com/2013/02/17/full-or-mini-abdominoplasty/

https://www.tavmd.com/2011/03/13/abdominoplasty-after-care-part-1/

https://www.tavmd.com/2011/03/17/abdominoplasty-after-care-2/

Healing after an abdominoplasty or tummy tuck is dependent on a number of factors

1. Amount of fat and thickness of skin

2. Patient genetics and lymphatic tree

3. Movement of the body

 

Skin and fat

The more skin and fat a patient has the greater the amount of “water” (swelling)  that is trapped within the abdomen . This will prolong the time for the swelling to decrease. Thinner patients will have a faster recovery from swelling after a tummy tuck. There is not much a patient can do about that after the surgery, but it’s important  for you to know.

 Lymphatic vessels

The lymphatic vessels are responsible for removal of the swelling from the tissues and taking it back to the blood circulation. The lymphatics mirror the blood vessels throughout the body. Any damage to the lymphatics,( surgery can be considered an injury), will decrease lymphatic flow.  Decreased lymphatic flow causes more swelling. With time lymphatic vessels reform and start their function again. Until this time, massage of skin by lymphatic massage, will help to decrease swelling in skin.

https://www.tavmd.com/2013/03/17/lymphatic-drainage-after-cosmetic-surgery/

 Movement

Another way to decrease swelling after a tummy tuck is for the cosmetic plastic surgery patient to move. Walking or even standing are better than sitting. Sitting will increase swelling in the lower abdomen which needs even more time for healing.  Even movement of the limbs will help decrease swelling in the abdomen also as the lymphatic system is a closed system.

 https://www.tavmd.com/2010/10/22/blood-clots-and-tummy-tucks/

Morad Tavallali, M.D., FACS

Cosmetic Surgery Scheduled at 7 am?

Early morning cosmetic surgery

 

It’s 7 a.m. and I am waiting for my cosmetic plastic surgery patient to arrive at the surgery center for a gynecomastia surgery and a tummy tuck procedure. a cosmetic surgery scheduled weeks ago.  He may still be sleeping, but hopefully he is just late because of traffic.

I have written about pre-operative preparation for cosmetic plastic surgery in the past;

https://tavmd.com/2013/07/19/eatingdrinking-dangerous-before-cosmetic-surgery/

https://tavmd.com/2011/10/30/preparing-for-plastic-surgery-the-day-before/

Why surgery starts early

There are several reasons why surgery of all types, including cosmetic surgery, traditionally starts early in the morning. These include medical reasons and non-medical ones.

 

Medical reasons for early morning cosmetic surgery

1. Hormonal cycle

Perhaps the most important medical reason for starting surgery early in the morning is the body’s normal cycle of contra-stress hormones.

Cortisol is the major anti-stress hormone in our bodies. It has a “diurnal” rhythm of its levels. It is at its lowest level at around midnight and rises sharply to its maximum between 6 a.m. and 9 a.m. It falls during the afternoon.

High cortisol levels protect the body against stress, psychological or physical. In the early morning, the associated high cortisol levels provide a little extra protection against surgery stress. Other hormones also play a similar role in stress reduction, but cortisol is the most important.

 

2. Blood sugar levels

Before any surgery requiring general anesthesia, cosmetic plastic surgery patients are required to fast for eight hours. This is important in preventing having any food in the stomach and decreases the risk of aspiration of stomach contents into the lungs—a condition that can be fatal!

The fast makes sure that your blood sugar levels are low in the morning. If surgery takes place later in the day, it’s like not eating breakfast. The low and decreasing blood sugar levels cause fainting, weakness and headaches, in addition to adding extra physical stress to the body.

3. Hydration

Having an early surgery means there is less chance for your body to become dehydrated. Not drinking water is part of the fasting process. Dehydration has obvious physical consequences and sets off its own series of stress responses that are not good for cosmetic surgery patients.

 

Non-medical reasons

 

1. Cosmetic plastic surgeons

Starting early in the day with cosmetic surgery allows the cosmetic plastic surgeon to have some time to see post-operative and pre-operative patients in the afternoon. Some plastic surgeons will operate all day long on certain days, but in general I like to break my days up and not operate for more than five hours a day.

Also, surgery is unpredictable in terms of timing. Though most plastic surgeons know how long their surgery takes, unforeseen circumstances like extra bleeding can occur and cause delays. This can have a domino effect and cause a string of delays extending into the evening.

 

2. Hospital staff

The workday at hospitals also starts early for nurses and staff. Hospitals are busy places, and the full day is needed to get all the work done; much medical care continues straight into the night! However, as in any workplace, hospitals are not fully staffed at night. The minimum number of staff required to take care of emergencies is usually what’s available. Most of the staff is at home, sleeping like normal humans! At 7:30 a.m., most hospital staff and nurses are at work.

 

3. Surgery complications

As with any other form of surgery, sometimes a complication arises after cosmetic plastic surgery. The complication of the surgery may require the patient to be taken back to the operating room.  Starting early in the morning means there is more time to deal with this possibility with the full complement of hospital nursing and support staff. It’s safer!

These are some of the reasons why cosmetic plastic surgery is started early in the morning. It’s  better for the cosmetic patient, better for the plastic surgeon and better for all the nurses and hospital staff.

 

 

Morad Tavallali, M.D., FACS

Tummy Tucks for Men

 Abdominoplasty in male cosmetic plastic surgery patients

 

Abdominoplasty, or tummy tucks for men, is a procedure that is often performed on women, and most of my blogs have talked about female cosmetic plastic surgery patients having these procedures.

https://tavmd.com/2013/02/17/full-or-mini-abdominoplasty/

https://tavmd.com/2011/07/02/new-technique-for-tummy-tuck/

Tummy tucks can also be performed on males, and though the number of male cosmetic plastic surgery patients who need an abdominoplasty is significantly less than female patients, there is no substitution for this surgical procedure when it’s necessary.

 david chubby photo    tavmdphoto1_ezg_1

Tummy tucks for men

Reasons for a male to have an abdominoplasty differ from abdominoplasty in female cosmetic patients.

Typically females will have abdominoplasty for:

  • Excess loose skin
  • Excess fat
  • Separation and weakness of abdominal muscles

 

Males obviously do not have the sequelae of pregnancy to deal with and so do not have the separation of abdominal muscles that is a major reason for female abdominoplasty. They can, however, have extra fat and skin looseness.

Significant weight loss is the main reason for male tummy tucks.

 

Surgery techniques for abdominoplasty in men

Techniques for abdominoplasty in general include:

  • Excision of extra skin in the abdomen
  • Liposuction of fat from the abdomen, flanks and love handles
  • Suturing of abdominal rectus muscles

 

In male tummy tucks, liposuction and the excision of skin between the umbilicus, belly button, and pubic areas is performed in the same way as in female abdominoplasty.

The main difference is in the type of abdominal rectus muscle plication performed.

For female patients, I tighten the abdominal muscles in a diamond shape to bring the waist line in to a pre-pregnancy form and emphasize a small waist.

When men have tummy tucks, the idea is to tighten the muscles, if necessary, into a V shape, not to give them a small waist. This tightening of muscles is performed in a vertical manner.

The recovery from an abdominoplasty/tummy tuck  for men tends to be less difficult than for women because less tightening of the abdominal muscles is required. Men are typically able to resume work after 7-10 days.

 Still, the great majority of men looking for improvement in their abdominal contour and tummy shape will benefit from just a liposuction, without any removal of extra skin or a tummy tuck.  Many male tummy tuck patients also benefit from liposuction of the chest to reduce gynecomastia.

 

 

 

Morad Tavallali, M.D., FACS

Bulges After Abdominoplasty-Tummy Tuck

Bulges after abdominoplasty-tummy tuck  or liposuction surgery,  is not unusual for the cosmetic plastic surgery patient . There are multiple reasons for these bulges; some can be improved and others are normal sequel of cosmetic surgery.

Here are some previous posts about tummy tucks:

https://tavmd.com/2010/10/26/tummy-tuck-abdominoplasty-or-liposuction/

https://tavmd.com/2010/10/27/how-is-a-tummy-tuck-done/

abdominoplasty

 

 

 

 

Swelling

Normal post-operative swelling after abdominoplasty and liposuction may take up to four months to improve. Though the swelling is initially all over the abdomen and hips, as the patient moves around, the swelling will settle down in the area just above the tummy tuck scar of the pubis and cause a bulge. Lymphatic massage can help remove the swelling bulge.

Abdominal scar

The way the cosmetic plastic surgeon closes the scar of the abdomen will also lead to temporary bulges of the skin.

For a tummy tuck, the incision over the pubis is usually smaller than the incision of the upper part of the abdominal skin that is removed. The relative excess of skin in the upper parts of the abdomen means that the skin needs to be folded into the lower incision of the abdomen, causing small bulges of skin. If a longer incision is made in the pubic area, the bulges can be eliminated at the time of surgery, but at the expense of a longer abdominal scar. However, with a little patience, the bulges will flatten out and a straight scar can be achieved without making it longer.

 

Abdominal hernias

Patients who have tummy tucks and abdominoplasty by definition have a weakness of the abdominal wall muscles. This is what causes the roundness of the shape of the abdomen. With tummy tuck surgery, the muscles are tightened to give a flat abdominal contour. In some patients, the muscles themselves may be very thin and not strong enough to hold the abdominal contents, leading to hernias. These hernias require a specific and separate procedure for closure. Sometimes it can be performed at the same time as an abdominoplasty, but at times it may only become apparent after abdominoplasty and liposuction remove the fat covering the belly.

Excess fat

Some surgeons, such as myself, routinely perform liposuction at the same time as abdominoplasty surgery to get more contoured results. Other cosmetic plastic surgeons do not perform any liposuction with abdominoplasty, and still others perform it as a second procedure 6 to 12 months after the tummy tuck surgery.

With any liposuction it is possible to leave a little extra fat on one side or the other that may require a touch up later. The reasons for this are that patients have different amounts of fat on either side of the body and the tumescent solution injected for the liposuction swells the area up and makes it difficult for plastic surgeons to achieve a symmetrical result.

 

Scoliosis

The curvature of the spine called scoliosis, which many of us have, leads to the appearance of bulges on the abdomen only because of the way we stand. There is the same amount of fat on the abdomen on the two sides, no hernias or skin fold, just a curvature of the spine that makes the body curve to one side and cause an apparent bulge!

The causes for bulges after abdominoplasty and liposuction are many but can be identified and corrected with a little patience.

Morad Tavallali, M.D., FACS