TUMMY TUCK (Abdominoplasty) NEW JERSEY
What Is A Tummy Tuck?
"A tummy tuck eliminates excess skin and fat, narrows the waistline, gets rid of stretch marks on the lower abdomen and improves the appearance of the navel."
Abdominoplasty, commonly known as a "tummy tuck," is a body contouring technique to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The waistline also becomes better defined and a large floppy navel or one that has the appearance of a frown can be converted into a small elliptical navel. Stretch marks and old scars that are located below the navel can be eliminated as they are part of the abdominal wall tissue that is discarded.
The best candidates for a tummy tuck are patients who are in relatively good shape, with loose abdominal skin. If there is a large fat accumulation on the abdominal wall, especially along the upper part, liposuction may be required at a second stage after an abdominoplasty removes loose skin and tightens muscles. Liposuction can also be performed as a primary procedure before abdominoplasty to debulk the fatty layer.
Women whose abdominal muscles and skin have been stretched out from multiple pregnancies, as well as older women who have a loss of skin elasticity due to age or weight fluctuations, are excellent candidates for abdominoplasty. Women who are planning future pregnancies may be advised to wait, as the vertical muscles in the abdomen that are tightened during surgery will tend to separate again during pregnancy. Men are also candidates for abdominoplasty following massive weight loss or due to aging and lack of exercise. If your fat deposits and loose skin are all located below the navel, a less complex procedure called a mini-tummy tuck or partial abdominoplasty may be recommended. Both a partial and complete abdominoplasty may be performed in conjunction with limited liposuction to remove fat deposits from the hips, waist or thighs for a better contour. Extensive liposuction or multiple areas of treatment should be avoided at the time of tummy tuck as the surgical risks increase when these procedures are combined.
Following the initial consultation, we may suggest other treatments or procedures that will more effectively meet your ultimate appearance goals. For instance, liposuction of the abdomen may be all that is needed or perhaps a more limited procedure such as a mini-abdominoplasty would be more beneficial than a full tummy tuck. Previous surgery with scarring above the level of the navel, a heavy smoking history, cardiovascular disease and morbid obesity may predispose a patient to impaired skin circulation and are therefore relative contraindications to abdominoplasty.
How We Do It
There are basically three different approaches to contouring your abdomen, depending on your goals and the amount of skin, fat and muscle that needs to be addressed. For some patients, we can use liposuction alone to achieve a slimmer contour of the abdomen, flank and hip region. For people who have more skin laxity or excess skin, a traditional tummy tuck is the best method to produce a flat abdominal contour. For some patients who have a small degree of excess skin below their navel, a mini tummy tuck may be all that is needed.
A tummy tuck is nearly always performed under general anesthesia, but under special circumstances may be performed under other types of anesthesia. We usually perform abdominoplasties in our surgicenter, but some people may prefer a hospital setting where they can stay overnight for recovery.
The most common technique involves an incision made across the lower abdomen, just above the pubic area, extending to the hip on each side. This incision can be angled higher or lower to make it easier to conceal, depending on whether low rise pants or high cut bikinis are more desirable. A second incision is usually made to free the navel from surrounding tissue.
We then separate the skin from the abdominal wall all the way up to your ribs and lift a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. The skin flap is then stretched down and the extra skin and attached fat is removed. A new opening is made for your navel that has remained in the same position. The incisions are closed with dissolvable sutures, and surgical tape is placed over the incisions followed by a gauze dressing.
In partial or modified tummy tuck, the incision is much shorter and the navel may not need to be moved. The skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.
There are only a limited number of patients who qualify for mini-plasty. Most post-pregnancy bellies have stretched out muscle and excess skin above the navel. Unfortunately, a common mistake is made by patients who choose a mini-plasty who would be better candidates for full abdominoplasty. Most do so in an effort to avoid what they perceive to be a more invasive procedure. In fact, a more complete procedure will be the most satisfying for them; repair of the abdominal wall muscles and removal of excess skin above the navel. The incision site usually winds up being the same for both procedures, although the proponents of mini-plasty will propose limited incisions. Unfortunately, limited incision mini-plasties usually leave excess skin on either end of the incision site which gives the appearance of what plastic surgeons refer to as "dog ears." Good mini-plasty candidates are usually those with excess skin only below the navel and with otherwise firm, flat abdominal muscles. This is an example once again of matching the right patient to the right procedure as the only way to achieve a satisfactory result. Sometimes doing less is more, but other times it may not be prudent.
The Recovery Period
After surgery, you will have soreness and discomfort that can be controlled with medication. You may need to retain a family member or friend for support for two to three days. The morning after surgery, the dressing will be replaced with an abdominal supporter that you will be instructed to wear for several weeks. Two or three drains are usually placed beneath the abdominal skin flap to collect small amounts of blood and serous fluid that may be secreted. The drains are easily removed in the office about 5 days after the surgery.
Bed rest is recommended with legs bent at the hips in order to reduce the strain on the abdominal area. You will be up and around the next day, but it is important to avoid heavy lifting or exercise for three or four weeks. Most people are able to return to work after 10-14 days. You will be given instructions for showering and changing your dressings.
At first you may not be able to stand up straight without feeling a tugging sensation, but you should start walking as soon as possible as your body accommodates to your newly tightened abdomen. Postoperative bruising is minimal, but swelling may take up to three months to settle. You may also experience a loss sensation of the abdominal skin that may take several months to return. Surface stitches, if used, will be removed in five to seven days, and deeper sutures will dissolve on their own. Lighter bandages will be applied that will be replaced with an abdominal support garment that is worn for several weeks.
If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Vigorous exercise should be avoided until you can do it comfortably, at about four to six weeks. It may take nine months to a year before the scars completely flatten, soften and lighten, but it may be sooner in fair skinned individuals. Avoidance or direct prolonged sun exposure and the use of liberal sunscreen is important for several months after a tummy tuck to decrease the chance of burning the abdominal skin that may have diminished sensation for a while and to minimize darkening of the healing scar.
What Are The Risks?
Possible complications include infection, bleeding, adverse scarring skin loss, asymmetries, and the need for a secondary procedure. This surgery does produce a permanent scar, which can extend from hip to hip but the scar is usually placed so that it will not show under most clothing, lingerie and bathing suits. Everyone heals differently, and in some cases, the scar may be thick, raised and irregular. Occasionally, a projection of bulging tissue on the ends of the scar called a "dog ear" can result which can be easily revised at a later date if necessary. Infections are rare, but when they occur are treated with drainage and antibiotics. The risk of blood clots can be minimized by moving around as soon as possible after surgery.
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