In this day and age of non-invasive the Tummy Tuck, no-pain, no downtime cosmetic procedures, you might wonder – would anyone still want to go under the knife? Believe it or not, the answer is a resounding yes.
Nothing beats the real, tangible, and more significant outcomes plastic surgery can bring such as a tummy tuck. In fact, it is making quite a comeback, with almost 130,000 operations performed in 2017, boasting an increase of 2 percent from the preceding year. [^1]
According to one survey conducted in the UK, body contouring via a tummy tuck emerged as the most desired treatment of British adults among all other surgical procedures. [^2] After all, a trim and tight abdomen is something that may not be possible under the circumstances even with strict diet and exercise.
Tummy tuck in the spotlight
So what is a tummy tuck? The medical term is abdominoplasty, which is the removal of extra skin alongside tightening of muscles in the abdominal area. [^3] It involves surgery, which helps the body reclaim its normal waistline. [^4] This truncal rejuvenation as it is called, aims to achieve the ideal waist-to-hip ratio in women, which is normally affected by estrogen levels.
A narrow waist is considered as one of the important features of an attractive feminine body given their increased reproductive capacity and youthful appearance. [^5]
Several factors such as age, pregnancy, weight fluctuations contribute to redundant skin, excess subcutaneous fat and flaccid muscles. A tummy tuck is a proven treatment that can actually be catered to meet individual goals and needs. It can dramatically transform the body by regaining the abdominal tone, especially those who have lost a tremendous amount of weight, or have been pregnant.
To put things in perspective however, a tummy tuck is not to be mistaken as a weight loss method, but a way to achieve an aesthetically pleasing stomach area.
Early tummy tuck
Abdominoplasty is an operation which has evolved over many decades from being originally developed for medical purposes to cosmetic improvements enjoyed today.
Back in the late 1800s, repurposing excess skin was more important than the aesthetic value a tummy tuck can bring to the individual. It was used to conceal open wounds of those who were critically injured during World War I rather than being simply bothered by overhanging skin. At the time, patient selection was confined to extreme, “only if you must” situations. [^6]
In 1870 when the surgical era started, it was limited to a dermolipectomy, which involved minor resectioning of the abdominal wall in order to repair umbilical hernias, or protrusion of the belly button. [^7] Such medical issue was associated with excess skin in the abdomen.
The first recorded procedure of this nature was in 1890, which performed in France by doctors Demars and Marx. [^8] They found that removing the extra skin and fat will give them easy access to the herniated tissue, which in the process of doing so, improved body contour as well.
In 1899, H.A. Kelly had a similar operation conducted at the John Hopkins Hospital in Baltimore, Maryland. Dr. Kelly referred to it as a transverse abdominal lipectomy procedure. While he was able to perform a resection, it meant sacrificing the belly button. [^6]
Another surgery performed in 1905 by Dr F. Gaudet and Dr H. Morestin was reported in France, where this time, the outward appearance of the umbilicus was retained. [^7] Succeeding advances followed where they began to preserve the internal structure of the belly button. By 1924, Dr M. Thorek introduced the placement of incision below the navel using a transverse method, calling it plastic adipectomy. [^6]
Given the early improvements, such weren’t enough to promote the overall aesthetic because of the resulting scar on patients. A host of complications needed to be addressed, as well such as necrosis, hematoma, infections, and delayed wound healing. [^8]
Throughout the 1960s and 1970s, suturing techniques have been enhanced that minimize scar visibility as well as refine body contouring. It was during this time that excess skin and laxity of the abdominal muscles were concluded as natural outcomes of pregnancies.
It was then established that abdominoplasties are not only confined to hernias, but can be used for cosmetic enhancements. Dr Ivo Pitanguy was at the forefront, with his placement of incisions in the lower abdomen and groin. He also promoted muscle tightening and compression dressing. [^7]
In 1972, Dr. P. Regnault used the W incision method which he revised in 1975 by placing the incisions a few centimeters within the pubic hair line that can minimize unsightly scarring. [^7] Other techniques are employed, all geared towards improving the incision scars of the preceding methods such as the “vest over pants” technique, belt lipectomy, etc.
The integration of liposuction in the 80s, which by itself was performed in 1977 by Dr. Yves Gerard Illouz, [^3] allowed more pronounced body transformations, addressing more patient needs. Its combination with abdominoplasty (lipoabdominoplasty) revolutionized the concept of body contouring in leaps and bounds.
In the 2000s, tummy tucks have even become more popular with the surge of bariatric surgeries which resulted in the patient’s interest in skin rehabilitation. [^9]
The procedure continues to bring more innovations which are geared towards making abdominoplasty as safe and effective as it is today.
Abdominoplasty is designed to rejuvenate truncal aesthetics which considers the central trunk as one aesthetic unit. [^10] According to Dr. Lockwood, tummy tuck is not just a two-dimensional procedure but a three-dimensional one. He stresses that the excess skin post pregnancy is both vertical and circumferential.
Dr Lockwood devised a different method in terms of scar placement, dissection and direction of tension, and recognition of the superficial facial system or SFS. [^6] This procedure began to put more emphasis on seeking an aesthetically pleasing abdomen and not just to be relieved from the weight burden of the surplus skin.
As such, abdominal contouring via a tummy tuck targets the following aesthetic elements:
- Tight and firm abdominal surface without visible scars and stretch marks
- Good muscle tone
- Upper abdomen contour
- “Six-pack” look
- Taut belly button
- Smooth lower abdomen and pubic mound
- A curvier frontal silhouette that extends to the hip region [^7]
Reasons for tummy tuck
Tummy tuck could only be the solution to those who are self conscious about loosely hanging skin from their midsection, which diet and exercise may have failed to address completely. You cannot lose weight by abdominoplasty, but it can refine your abdomen by sculpting it.
From an aesthetic point of view, the goals of abdominoplasty are:
- A defined waistline
- Flattened and tightened abdomen
- Minimal scarring
- Normalized belly button placement and appearance [^3]
An effective tummy tuck surgery should be able to eliminate redundant skin and subcutaneous tissue, restore abdominal wall muscles, contour to the desired shape, reduce striae or skin ridges, and elevate the pubic mound. [^3]
Here are the possible causes of excess skin and fat from the body which are solid reasons that would prompt an individual to seek a tummy tuck procedure.
Tummy tucks are perfect for moms who want to reclaim their pre-pregnancy body after having children. There are those who can hardly fit into their jeans with a wider midsection.
Pregnancy may stretch the skin to the point where it cannot retract after giving birth, at least not in the next six months or even longer. It can also tear abdominal muscles such that many women experience sagging in the lower abdomen as a result.
Worse, diastasis recti may also become a problem. This is when the left and right compartments are markedly separated. Basically, people are born with some gap between the sides of the rectus, also commonly called the “six-pack”.
As the baby grows inside, the connecting tissue between the ab muscles is stretched. Hormones can also affect the tissue integrity, making it softer, thinner, and looser, which leaves your abdominal skin looking like an undone corset.
While a considerable separation along this ab line is quite normal, having a gap that is 2 centimeters wide isn’t. This usually happens either during the second half of the gestation period or, after childbirth. With a slackened abdominal wall, you may have the appearance of a pot belly.
A tummy tuck targets such issues in order to transform the abdominal region practically from flap to flat. In this particular case, the surgery will be more extensive and therefore require a longer recovery time. Patients may expect to return to their usual grind after 4 weeks at the fastest.
Meanwhile, it is recommended to have a minimum lead time of 6 months after giving birth or breastfeeding before one considers a tummy tuck. This allows sufficient healing from the childbirth procedure and elimination of any active pregnancy hormones. Besides that, mothers will be most often carrying their babies during the first few months, which can affect a tummy tuck negatively.
Many are surprised to find celebrities bounce back so fast after a pregnancy, and one can only surmise if it’s possible they may have had tummy tuck alongside their c-section delivery. After all, it might be an opportune time because instead of having 2 surgeries, you can just have one. Or can you?
While it may sound ideal, many doctors will discourage this as it may bring about more problems than a patient can anticipate. For one, you may have disappointing results. You defeat the purpose of looking your best after a tummy tuck when you do it simultaneously with a C-section.
By virtue, the tummy tuck candidate should be in good physical condition going into the surgery. And after you’ve just carried a baby for nine months, it surely does not abide by this guideline. Your abdominal skin may have been fully stretched at this point which may still retract after months of recovery from pregnancy. As such, it may be difficult for the surgeon to accurately gauge the amount of tightening you actually need.
Extreme weight loss
After losing a significant amount of weight either naturally, or with the help of bariatric surgery, you may find most of your fat gone except for the hanging skin left behind where it was used to be stored.
Extra skin tends to linger in many different areas, [^11] but may be more prominent in the abdominal area. How your body looks will largely depend on the ability of your skin to hug its new foundation, which refers to skin elasticity. The more you lose weight, the less elasticity your skin will have.
The excess flap that will not shrink back may make one uncomfortable in spite of his weight reduction. It may even serve as a daily reminder of a previous obesity that can affect self-confidence.
Just like with pregnancy, stretched skin may lose its natural elasticity such that it will not conform to the new and smaller body shape. Skin elasticity also decreases with advanced aging, frequent sun exposure, cigarette smoking and genetics. One good indicator is below the belly button which may form a paunch, or an overhanging apron called panniculus.
The weight loss journey may not be as fulfilling if you still need to hide skin folds under loose clothing. Doing so can bring about skin irritation and rash which can be aggravated by hot climates. This loose skin can even interfere with exercise and physical routine, not to mention that it may cause some embarrassment. This is why a tummy tuck is a great way to resolve this problem. [^12]
However, it should be noted that while abdominoplasty will tighten the problem area, it will not able to restore skin elasticity, especially on those who were extremely overweight prior.
In other words, the surgery alone will not transform an overly stretched out tummy into washboard abs that have better elasticity. Instead, it can make a huge difference in the general appearance, which should also be maintained to continuously enjoy the pleasing results.
If you want to know how to check for your skin laxity, you can pinch your skin with your thumb and forefinger, and hold it for a few seconds. Upon release, take notice of how long the pinched skin snaps back to its original state. As such, the longer it takes to do so, the less elastic your skin is.
Tightening the area improves the appearance, but again, it will not do anything with its elasticity. In case you gain weight after a tummy tuck, the lax skin may show again.
People can expect to lose the natural elasticity of their skin and find that their muscles gradually weaken as they age. Their impact is more pronounced in the abdomen, which takes a flabby appearance. A tummy tuck can rejuvenate this area, the effect of which can also improve the entire body.
There is a large percentage of female patients with an average age of 42 years who underwent abdominoplasty during the period of 2008 to 2013. [^13] While many believe that surgical procedures pose a higher risk among those who are older, one study found no significant difference in terms of complications between the young and the elderly groups. [^14]
Major complications, if at all, are likely to occur when simultaneously combining tummy tuck with other body enhancement procedures in obese males who are 55 years in age or older. [^13]
We know that individuals are unique in their own right, and this extends to where their fat tends to accumulate, or situates itself stubbornly. For many, they typically store fat in the stomach, which can be bothersome and frustrating.
There is sufficient evidence that the distribution of body fat is controlled by one’s genes. [^15] Under extreme scenarios, the inheritance of abdominal obesity alongside its metabolic consequences, may lead to diabetes and cardiovascular disease. [^16]
Because of genetic predisposition, the body does not reflect the true lifestyle of eating proper food and exercising regularly. Simply put, a young adult may have that round tummy no matter what. Thankfully, this can be addressed by surgery such as an abdominoplasty.
Tummy tuck quick facts
Abdominoplasty can provide more than just cosmetic advantages.
Aside from aesthetics, a tummy tuck can improve overall quality of life, self-esteem, sexual functioning and mental health. It also seems to lessen the incidence of bulimia and other eating disorders. [^17]
Abdominoplasty is not a weight loss procedure
As many doctors would recommend, a tummy tuck should be performed only when an ideal weight has already been reached, or approaching towards it. It is a contouring surgery, pulling the lower abdominal skin downward, which can also improve stretch marks in the process.
Individuals who are overweight are typically denied the procedure as they counselled to lose their pounds first. [^18]
Abdominoplasty will be optimal if the patient is at a stable weight
The individual considering a tummy tuck should be at his target weight, if not close to it, which has been maintained for at least 6 months or 1 year prior to the surgery. Any weight fluctuation can practically undo the contouring achieved through the tummy tuck, which may then require a revision procedure later on.
Abdominoplasty has a down time
Tummy tucks are major operations that will require some time for recovery. Depending on the type of tummy tuck surgery performed, patients can return to work after 2 weeks. The operation itself may last up to 4 hours.
Abdominoplasty has different scar types
The size and location of your scar will depend on the type of tummy tuck that will be performed on you. For the conventional type, the scar usually runs from hip to hip that’s hidden below the bikini line. It will fade and flatten anywhere between three and twenty-four months.
Abdominoplasty will not be likely covered by insurance
As tummy tucks are considered cosmetic, its price cost is not absorbed by your insurance company. In case you are having an hernia repaired, or some other medical issue, the insurance will probably cover a portion of the surgery fee.
Abdominoplasty is not only for women, but men, too
While a high percentage of tummy tuck patients are female, males can also have issues with loose abdominal muscles and sagging skin themselves. Especially men who have been morbidly obese in the past will benefit from a tummy tuck just the same.
Abdominoplasty should be performed by a qualified surgeon
Finding the right doctor can be tricky. You should choose a plastic surgeon, not a cosmetic practitioner, who is certified by the American Board of Plastic Surgery (ABPS) or the American Board of Surgery, or whichever legitimate organization is in your country of residence.
Abdominoplasty may not be sufficient for your concern
Your doctor may recommend liposuction on top of your tummy tuck. Depending on the problem, an adjuvant procedure such as liposuction helps achieve more desirable results. There are times that a tummy tuck alone can lead to an unsightly bulge on the hips, which can be resolved via liposuction.
Abdominoplasty results are technically permanent
Yes, you can expect your newly tight abs to last. In some patients, they even lose weight after the surgery given the new tautness of their abdominal region. In any case, you should employ maintenance such as the right food intake and physical activity to sustain it long term.
Tummy tuck qualifications
Several factors such as a dramatic weight loss, pregnancy, etc. can decrease skin and muscle elasticity, which can be addressed by abdominoplasty. In addition to having any of these issues, the following qualities should ideally be present in the corresponding individual when considering the procedure.
- Desired weight has been maintained for at least 6 months
- In generally good health
- With preop clearance from physical examination
- Has no intention to get pregnant in the future
- Has withdrawn from smoking at least six weeks preoperative
- Possesses realistic expectations
- Committed to maintaining the results with the appropriate diet and exercise
- Can tolerate general anesthesia
As with any major surgical procedure, it is essential that the patient is healthy overall. The prospective patient should come clean with any history of heart, lung, kidney or any major illness for his own safety. Having one does not automatically disqualify the individual, but it will be assessed by the surgeon depending on the case.
A person who has internal or external scars from a previous abdominal surgery may affect his eligibility for the surgery.
Aside from weight, It has been noted that the lower the BMI of the patient is, the better the results of your abdominoplasty will be. [^19] In case you still have a significant amount of abdominal fat surrounding your internal organs, you will be asked to slim down first before you are admitted to the surgery.
Many patients who undergo abdominoplasty are relatively older at 40 years and above after being done with having children. While you can still get pregnant after a tummy tuck, it will affect the abdominoplasty results. As such, you will likely get another surgery just to correct it.
Tummy tuck vs liposuction
Many people desire to have that quintessential 6-pack, but there is quite a confusion on how to achieve it – is it via a tummy tuck or liposuction? Both procedures may sound like they are addressing the same problems in the midsection, but they don’t. Although both aim for the smaller, flatter, and tighter stomach, these procedures are done differently.
Tummy tuck targets loose skin and weakened muscles on the abdomen through surgical manipulation. Liposuction on the other hand, uses a blunt metal tube or cannula to remove fat in tight skin areas such as the flanks, back, hips, thighs, among others.
While technically you can still use liposuction to remove fat from the abdominal region, it will do nothing on the ensuing loose skin unlike an abdominoplasty. And besides, reducing fat in the abdominal wall via liposuction alone may induce fibrosis, which will make any subsequent tummy tucks very difficult. [^18]
As such, tummy tucks are recommended for the stomach as it can get rid of both extra skin and some remaining fat for as long as you are at your ideal weight, or at least, close to it.
There are those who would prefer liposuction because it is a much shorter operation and results in a much smaller scar. Ultimately, it boils down to one’s body goals and what is deemed appropriate to achieve them. An individual may get the most optimal results by having a liposuction and tummy tuck, which can be performed in conjunction with one another.
A doctor may do liposuction of the lateral flanks and backside to complement the results of a tummy tuck. [^19] With ever-increasing advanced technologies available, a lipoabdominoplasty or LABP is now performed more frequently and safely in the abdominal region.
Back then, no doctor will do both procedures in the abdomen simultaneously, as this would impact blood supply, which can further delay healing. In other words, it was considered risky, especially with the reports of increased complication rates. [^20]
However, the evolution of lipoabdominoplasty has made the combination possible given the right technique. It can now accommodate obese patients under categories I and II with thicker abdominal walls, which are usually denied a tummy tuck procedure.
Tummy tuck vs panniculectomy
Abdominoplasty is frequently used interchangeably to label all tummy tucks, hence it covers the abdominal region. Panniculectomy is a surgical procedure that targets the hanging skin and fat from the lower abdomen, or pannus.
While panniculectomy can be considered a partial tummy tuck, it differs from a conventional abdominoplasty by the limited amount of skin and fat excised. [^21] It does not involve plication of the abdominal wall muscles, which is also fixed during a tummy tuck.
Panniculectomy is not cosmetic by itself, but performed for medical reasons and therefore a necessary one. This is because the excess lower abdominal fat called panniculus can cause health problems such as, skin rashes, irritation, and odor, which can impact daily activities.
The procedure is simply designed to alleviate these issues because a large panniculus can be so severe to the point of affecting the mobility of the individual. [^22]
In order to qualify for panniculectomy, the panniculus must be hanging extremely that it falls below the pubic area. [^21] It usually complements a bariatric surgical weight loss, which can leave a massive amount of redundant skin afterwards. Recovery time is longer than a tummy tuck, which can take an upwards of 8 weeks.
Tummy tuck vs lipectomy
Lipectomy is a much simpler procedure which refers to excising fat in areas not restricted to stomach, but also includes thighs, arms, and the like. Liposuction is therefore one form of lipectomy that uses a cannula to extract fat, and so is abdominoplasty but with more aesthetic corrections, which encompasses fat removal by extending to loose skin, muscle plication, and abdominal contouring.
Given the multi-layered issues of abdominal aesthetics, the majority of patients will benefit from a versatile approach such as a tummy tuck that targets more than just fat. Remember that obesity stretches the skin and damages its tissues along the way, affecting its laxity. Nonetheless, lipectomy may bring about limited results, but it can suffice for the right patient.
Different tummy tuck types and techniques
Abdominoplasty can take many forms, ranging from mere removal of the apron of skin, or pannus, to a complete abdominal contouring with muscle tightening and the relocation of the belly button. There may be those who are attracted to undergoing a mini tummy tuck operation because it has a shorter recovery period, and smaller incisions.
Although a “mini” can be a viable option for some, the person considering it must realize that because it’s much simpler, it may not be sufficient to address the problem. Needless to say, the tummy tuck technique that must be employed on the patient should match his needs and goals for it to be an optimal procedure.
A full or standard tummy tuck is the most frequently performed abdominal contouring surgery. It can remove up to four inches off one’s waistline by creating a horizontal incision from hip to hip, plus another around the navel area in order to move the belly button to its rightful position.
This procedure will remove loose skin and fat, and repair the fascia above the abdominal muscles using sutures. The remaining skin will be pulled together and stitched in place. This will enhance the final result of the rejuvenated upper and lower abdomen.
Patients with excessive skin laxity, subcutaneous tissue and weak abdominal musculatures are ideal candidates of a complete tummy tuck. [^19] Although drains may be required, there are latest methods which do away with their use, that can also minimize fluid buildup in the treatment site.
Sometimes, a complete tummy tuck will involve liposuction in order to remove stubborn fat buildup from the abdomen. LABP is a versatile operation that is said to have a low complication rate, being a procedure that’s been refined over a period of time since its first use. [^18] It is not simply combining liposuction and tummy tuck into one.
First, liposuction is done on the abdomen, flanks and hips, even down to the pubic mound if necessary, to sculpt the waist. The amount of fat suctioned from the abdomen alone can be as much as 4 liters in certain cases. Abdominoplasty and umbilicoplasty will follow to finish off the body contouring makeover.
Liposuction assisted abdominoplasty (LAA)
This technique is an evolved lipoabdominoplasty procedure that preserves flab mobility, which is considered the fundamental requirement of a safe and effective tummy tuck. It uses sound surgical maneuvers such as hydro dissection, lipo dissection, and separation of fat from deep fascia that is basically uncomplicated to perform. [^20] These processes ensure a rich blood supply to the abdominal flap which is often at risk when incorporating liposuction with a tummy tuck.
High superior tension abdominoplasty (HSTA)
Seroma, which is fluid buildup beneath the skin, is one of the complications of abdominoplasty. HSTA was conceived as an abdominoplasty technique that addresses this problem plus other side effects. It combines dissection of the epigastric tunnel and liposuction using two high tension sutures on the navel. [^23].
It is believed that this method is a great way of avoiding cell death and hiking up of the pubic scar thereby, providing more natural and reliable outcomes. Those with massive weight loss but have limited excess epigastric skin are good candidates.
Ultrasound assisted abdominoplasty
Truncal aesthetics may be achieved with less fat, loose skin, and laxity. However, many believe that a good and healthy abdominal contour is more than that. [^24] Being able to recreate the natural light and shadow of the skin surface that lies on the abdominal muscles should also be targeted by a tummy tuck. [^25]
VASER ultrasound technology has been widely tested and found to be highly effective in aiding fat extraction. The fat cells are broken down with the applied energy to the fat tissue. This makes for lesser trauma and blood loss, quicker recovery, and facilitates the surgery altogether. It also addresses the issue of unnatural surgical scar in order to improve the overall appearance of the abdomen.
This procedure covers a much larger area, removing fat and surplus skin not only in the abdomen, but also in the flanks commonly called love handles. As such, its incision extends behind the hips and is placed much lower that it doesn’t show when wearing low waisted jeans or clothing.
Practically all the components of a full tummy tuck are involved in the extended method. [^26] During the surgery, plication of the exposed muscles will be performed and a new belly button will be created in order to match the patient’s new shape. The surgeon may also employ a bit of liposuction to further enhance the body contours.
There may be women whose stretched abdominal skin is only in the infra umbilical or navel area, having a good tone on the upper abdomen. This may only entail a smaller incision on the site, eliminating the need to move the belly button, which can be operated on using the limited tummy tuck procedure. [^27]
It has evolved for many years, becoming applicable to patients who have a distorted abdominal wall along with a slightly hanging pannus. With fatty deposition, the use of liposuction has also become an essential part in a limited tummy tuck surgery. [^28]
Tummy Tuck Belt lipectomy
This method, which is also known as circumferential abdominoplasty and abdominal lipectomy, aims to enhance truncal contours with incisions located in natural junctions between the lower back and buttocks. [^29]
Performing traditional abdominoplasty on a patient with circumferential truncal excess will be insufficient to address the problem. First of all, the trunk should be viewed as a unit. [^30] With belt lipectomy, the surgeon will eliminate the fat that forms around the waist like a belt. However, a person with excessive fat and a higher BMI may have a higher risk of complication and unsatisfactory outcomes. [^31].
This type of tummy tuck, also has a learning curve so it is essential for the attending surgeon to be adept to this procedure to achieve the intended body contour. As such, it can be tailored to the patient by targeting the problem areas. Ultimately, those who have loose skin not only in the abdomen, but also stretches around the waist will be perfect for this procedure.
Extended belt lipectomy
This is an aggressive variation of a standard belt lipectomy by adding an incision on the vertical midline. It allows more significant improvements on the lower trunk and abdomen of patients who have shed a substantial amount of weight. Based on a study of cosmetic outcomes of this type of procedure, the patients rated their surgery results between good and excellent, [^32] which bolsters its efficacy in trimming truncal excess.
Floating abdominoplasty (FAB)
One of the newest procedures to emerge in the tummy tuck line, floating abdominoplasty allows a smaller incision placement in the lower abdomen, sparing the belly button area. This procedure will elevate the umbilicus from the inside such that it will “float” on top of the muscles.
Meanwhile, these abdominal muscles will then be tightened from the sternum down to the pubic region with the help of an endoscope and place the belly button back in its position. This body contouring technique can be further enhanced by using liposuction at the same time depending on the case.
In spite of the less trauma from its smaller incision, one study found that there is no significant difference in its complications compared to other procedures entailing large incisions. [^33]
This approach caters to patients who aside from requiring tightening of their tummy which results in vertically hanging skin, also has it in a horizontal direction. [^34] Also known as vertical abdominoplasty, fleur-de-lis tummy tucks are safe and effective in correcting redundant skin in vertical and horizontal orientations. [^35]
The operation will pull your skin downward to make it taut and pulled inwards to the center of your abdomen at the same time. This makes for an incision with a shape of the water lily which this technique is named after. It would mean a long, vertical scar starting from the lower breastbone to the upper portion of the pubic region, which would look like a fleur-de-lis or inverted T.
Such ensuing scar can be a major disadvantage, but if the patient’s body calls for extensive contouring, this procedure may still be more beneficial nonetheless. [^36]
A body contouring procedure such as oblique flankplasty is a great way to redefine a female waistline as well as eliminate large flanks and flank distortions for males. [^37] It is considered an alternative to a lower body lift, which can provide satisfying results given the focus on the lower traverse tummy tuck.
Ideally for a woman, the trunk and thighs should form and hourglass shape and cinches towards the waist, while leaving smooth curves on the outer thighs. A single but larger incision will be placed low on the torso, from the flank bulge to the twelfth rib and spine. [^38] In several cases, flankplasty is done alongside a butt lift, liposuction, or both to achieve the desired outcome.
For those who are considered thin or average-sized yet, has that bulge on the lower abdomen, you may find yourself wanting to do a mini tummy tuck. This pooch problem is also common for women after a C-section delivery. The upper abdomen is typically in good shape with no lax or excess skin.
As its name can tell, mini tummy tuck is less invasive than other abdominoplasty techniques as only a small to moderate amount of hanging skin needs to be addressed. The procedure begins with a single incision above the pubic bone. Excess skin is trimmed, which will leave a few inches of thin horizontal scar.
It must be known that even with a smaller incision, muscle plication and simultaneous liposuction are possible as necessary. [^39] The umbilical scar is usually non-existent, with minimal changes in the vertical position of the belly button. This method is also adopted when performed in delicate cases in order to minimize wound complications and cosmetic deformities. [^40]
The reverse tummy tuck has its focus on the lax skin in the upper abdomen. It can be one’s next course of action when a previous liposuction procedure failed to correct residual skin in the upper portion of the tummy.
While visibility of scars can be an issue with traditional tummy tucks, the incision with a reverse abdominoplasty can be strategically placed in the inframammary, or breast crease which is easily hidden. This also helps avoid tension in the resulting scar. [^41]
One study found that this method can provide better reconstruction results following an oncological resectioning from tumor ablation. [^42] As such, it can be used alongside skin grafting, or as coverage for a prosthetic mesh.
Complete revision abdominoplasty
This procedure is done to correct and optimize the results of a previous tummy tuck or body contouring surgery. [^43] It involves total dissection and elevation of the abdominal apron or panniculus that can address weak muscles and loose skin.
The revision tummy tuck may also include revision and repositioning of a previous scar, relocation of the belly button, and liposuction in the abdominal region. There may be some dissatisfaction with the thick scar from a previous surgery, and overall abdominal appearance given the inappropriate technique or less extensive procedure that was initially used.
For example, a woman who has very lax skin opted to do a standard tummy tuck, leaving her with residual skin on the flanks and back. As such, an extended or circumferential abdominoplasty will be used during the revision.
Modified Brazilian abdominoplasty (MBA)
This relatively new technique was conceived in 2008 by Dr. Joao Erfon Ramos, a Brazilian plastic surgeon, in order to trim the pannus, tighten the fascia on the transverse abdominal muscles, and reduce bulge on the pubic mound for a youthful V shape. [^44] It promises lower rates of complications with minimal dissection and dead space where fluid buildup can accumulate.
The scarpa fascia, which is the layer attached to the front abdominal wall, is medially advanced along with lipomobilization and repair of the rectus muscles. This may include liposuction in order to define the waist contour.
Named after the surgeon Dr Juarez Avelar who pioneered it, the Avelar tummy tuck incorporates liposuction to trim skin and fat. This in turn, releases the skin which can then be removed and pulled down. His technique often does not involve transposing the belly button and less undermining of the abdominal flap. Instead, he adds the skin excision along the breast fold in some cases. [^45] As a result, there is a low incidence of sensation loss, fluid accumulation, and poor blood flow.
This is another technique that can be done in patients with significant skin laxity, but have existing abdominal wall scars [^46] The surgeon makes the incision in the center of the abdomen, pulling on the skin like a corset in order to provide an hourglass silhouette.
In any case, it can be tailor-fitted to both men and women such that, it is flexible enough by adjusting the length and position of the transverse incisions. The middle scar can be a setback, but it is a compromise other patients may be willing to take under the circumstances. This incision has the biggest impact on the front and back waist, which results in a 360-degree reduction and improvement.
Consultation/ questions to ask
Prospective abdominoplasty patients would always want minimal scarring and recovery while enhancing their truncal aesthetics at the same time. The individual is required to consult with a board-certified plastic surgeon in order to choose the appropriate type of tummy tuck procedure.
Here are a number of questions to throw at the doctor in order to gain more confidence and knowledge on the topic:
- What is your experience with this type of surgery?
- How many similar procedures have you performed?
- Can you explain the methodology that is appropriate for my case?
- Are you board-certified?
- Are you trained in this particular field of plastic surgery?
- Where will you perform the procedure?
- Am I qualified for the procedure I intend to undergo?
- How much recovery period will I expect?
- What special prepping do I need?
- What are the recovery instructions?
- Will there be lifestyle limitations after the surgery?
- What options are available if I am dissatisfied with the cosmetic results?
- Where will the scars be?
- What are the risks and side effects?
- How will I manage any complications arising from the surgery?
- What is the cost?
On the other hand, your surgeon will also be asking questions, especially about your complete medical history which you have to answer truthfully.
- Have you had any surgery in the past?
- Do you have any existing medical condition?
- What medication do you take, or treatment/s are you receiving?
- Do you suffer from any type of allergy, particularly to medicines?
- Do you have any vices such as alcohol, cigarettes, and recreational drugs?
- Have you had non-invasive cosmetic procedures?
- Why do you want to undergo the surgery?
- What are your surgery expectations?
- Are you taking any vitamins or herbal supplements?
- Will you be able to set a time for recovery by getting off from work for a period of time?
During a consultation, you can pinpoint the areas in the abdominal trunk that you would like to change or improve. The plastic surgeon may have a computer imaging facility through which he can show you the projected results. He will also evaluate your skin elasticity as this is crucial in deciding if you are a good candidate for a tummy tuck.
It is possible that the doctor may suggest you to lose weight prior to taking on the surgery so that you are close to your desired weight. A female patient should also discuss any plans of future pregnancies as these may affect the tummy tuck result thereafter.
As for the financial aspect, your surgeon will be forthright on this matter and may even offer you options in case you have a specific budget in mind. Ultimately though, he will have your best interest and provide you with a tummy tuck procedure that’s right for you.
Tummy tuck preparations
Before you come in for a scheduled consultation several months ahead, it is best to make a head start by being closer to your fitness level and ideal weight. Not only is this required before going into the surgery, but also places you in a much better position to heal faster.
Once you meet the initial qualifications for the desired surgery and decide to fully commit to it, a physical exam and laboratory testing will be performed in order to confirm your suitability for the procedure. Your plastic surgeon will run you through the following guidelines in prepping:
- Eat a healthy and well-balanced diet.
This can improve the individual’s immunity to diseases leading up to the day of surgery.
- Do a blood work.
This is to check for your blood count that will ensure the absence of
anemia, or any infection days before the scheduled date.
- An ECG/EKG is required for patients over 50 years old.
- No aspirin intake or any anti-inflammatory drugs a week prior.
Taking this type of medication can increase bleeding.
- Proper hydration prior and after surgery is recommended.
- Complete cessation of alcohol, tobacco, and recreational drugs.
This will promote a faster healing process.
- Arrange for help with children and pet care. (if applicable)
- Have a person accompany you on the day of the surgery.
- Assign somebody to assist you post-surgery.
Your movements will be restricted during this period.
- Have ice packs handy.
These can help with soreness at the surgical site.
- Ensure your medications and first aid kit will be easy to access, or within reach during your treatment recovery.
- Place water, crackers, digital thermometer, and other important items beside or near your bed.
- Get plenty of pillows.
These will help prop you up while resting and sleeping.
- Have an antibacterial soap, laxative, comfortable clothing, form of entertainment such as books, TV, mobile tablet, and the like ready.
- Take a shower before your scheduled surgery.
This will not only refresh you, but also reduce your risk of bacterial infection.
- Schedule your vacation leave if employed by allocating at least two to three weeks.
Tummy tuck procedure
A tummy tuck surgery can be as short as less than two hours, or extend up to five hours based on the techniques and additional procedures used. Each patient’s case may have its own complexities, which will also determine if the procedure will be an outpatient, or require an overnight stay in the medical facility.
During an abdominoplasty, the doctor will create markings on the abdomen where the incisions will be made, demarcating the mid torso, and where the navel will be repositioned. The patient is administered with general anesthesia by an anesthesiologist, consisting of a lidocaine solution and epinephrine which is a vasoconstrictor.
A local anesthesia combined with sedation is sometimes used for mini tummy tucks because it’s shorter and less invasive. However, a general anesthesia is much preferred because the muscles become totally relaxed. This facilitates the procedure by being faster and without the distraction of a muscle movement.
For patient safety, there will be several monitors available to check your pulse, heart rate, oxygen and blood pressure. The surgeon must follow the planned procedure that was discussed with the patient beforehand.
However, he may make certain judgment calls during which he will be employing or adding a technique that he feels best for your case. It cannot be avoided that there may be issues that only present themselves while the surgery is already taking place.
The main incision will typically be placed above the pubic mound right along the bikini line. There is another one around the umbilicus when a full tummy tuck is to be performed.
For mini abdominoplasty, the incision is created below the navel while a longer incision that goes around the waistline applies for a circumferential tummy tuck. The plastic surgeon will then detach the skin from the abdominal wall to the rib cage. The fascia will be sutured as a way to repair weakened muscles. The separated skin flap is pulled over the newly tightened muscles to as the finishing touch.
Excess fat may be removed via liposuction otherwise, it will be cut away along with the skin by stretching it down to the incision line. This will also impact stretch marks if any, as they will be less prominent as a result. Thereafter, the navel may no longer where it used to be. It may be repositioned as necessary by cutting a hole in the redraped skin, which will be stitched around it.
As such, if you have a mole above your belly button, it may now be located below it. When closing incisions, the surgeon may use tissue glue, staples, sutures, or Steri strips.
During a full abdominoplasty, one or more drains may be inserted to prevent accumulation of fluid in the surgical area. Drains aid in quicker wound healing and alleviate pain. That’s because any fluid buildup causes pressure on the incision. A surgical drain, which is a transparent bulb-like plastic, is attached to the body via a very small incision just below the primary.
As its name suggests, this plastic device needs to be emptied by squeezing it to help drain the wound. It is typically removed about a week post surgery, before the stitches are taken out, which will be dealt with in stages for a period of two weeks from the operation.
Tummy tuck Recovery
Recovery experiences may differ across individuals. Following abdominoplasty, you will be wheeled off to a recovery room for a short while. You will receive your surgeon’s instructions for your aftercare and advise you the normal symptoms you will encounter.
Your companion should be able to assist you in terms of driving you home and making sure you have all the supplies needed such as compression clothing, bandage, pain medicines, and healthy yet convenient food. Better yet, it is recommended that this person will be able to help you during the next 48 hours, and act as your caregiver so that you won’t be stressed so much during your recovery.
When your anesthesia wears off, you may find yourself somewhat nauseated, which should disappear within a couple of hours. Your prescribed oral pain relievers will help, although their side effect may include dizziness.
The first few days may be very uncomfortable, but you can walk a day after, albeit you have to do it slowly. The stomach will feel tight for a number of days as it adjusts to the smaller size. You can expect muscle spasms as well. However, you should be able to switch to over-the-counter pain medication after several days.
Walking is encouraged to prevent blood clotting in your legs and enhance blood circulation. But you will not be able to do your usual exercises or physical activities up until the sixth week. Your abdomen is expected to be very sore hence a bed rest will be suggested for a few days.
Your surgical incisions will be covered with a dressing. It is possible that you will be required to wear elastic compression garments to help reduce swelling and provide tightening support to the skin.
There will be an extensive downtime, at least two weeks after the operation. Generally speaking, patients who are younger, have excellent physical health, and observe their surgeon’s instructions before and after the surgery, are able to bounce back much quicker. They will tend to have a less incidence of complications.
However, this is not to say that older patients don’t have a shot at a good recovery after a tummy tuck. In any case, it’s essential to know what one can realistically expect from a typical surgery scenario.
You should expect to sleep with a slightly elevated torso using your extra pillows. Drains may be attached to you, which you need to empty out several times a day.
You should also monitor the amount of fluid it collects and advise your surgeon about anything out of the ordinary. Also, you need to let him know if you have other lingering or unanticipated symptoms such as vomiting, chest pains, irregular heartbeat, etc.
Your bandages also need replacing every now and then. Taking a shower using slightly cold water is also allowed at least 2 days after the operation, or as instructed by your surgeon, during which time your incisions are closed completely. Your sutures (if traditional is used) will be removed within a week or two post surgery. Doctor checkups will be done after one week and a few more times thereafter.
Tummy Tuck Results
They may have been obscured by swelling and restricted activity, but you can look forward to fully heal and relishing the tummy tuck results after 3 to 6 months. Your procedure will bring about a much flatter and tighter trunk that is in harmony with your body in general. It can be life changing which can improve the quality of your life, diminishes psychological distress and eating disorder symptoms. [^17]
Best of all, it is meant to last. You can be assured that the excess skin, which has been surgically trimmed will never return.
Tummy tuck before and after photos
Tummy tuck scarring
Scars from abdominoplasty may be inevitable, but with proper care, you can reduce their visibility such that they can be barely noticed. When your skin undergoes surgery, it’s practically broken by incision. Nonetheless, the body compensates for it by creating collagen fibers to close it, which takes place in three to four weeks post surgery.
The collagen protects the site and strengthens it at the same time. As a result, there is an increased blood supply to the area. However, it can become darker and thicker up to six months. Consequently, some of it will break down while its blood supply decreases. This will make the scar lighter, flatter and less prominent which will take place over the course of one to two years.
While the scars will improve over time, they’re still scars, which will look different from unscarred skin no matter what. Once a scar is born, it cannot be totally eliminated, only minimized. Here are some tips that will hopefully make their presence less conspicuous that it can fool one’s eye that they’re not there.
- Follow your aftercare routine to a T.
- Monitor your incision for any infection.
- Apply silicone-based topical treatments once the scabs have left your wound.
- Moisturize the site with vitamin E once the incisions are closed.
- Avoid sun exposure to the area.
- Refrain from using products or clothing that can cause irritation.
- You can use steroid application and injections.
- Laser treatment, surgical scar revision, and punch grafts can be good scar reduction options.
Safety and risks
Abdominoplasty has been a highly evolved procedure that is considered not only effective, but also generally safe. That is if patients are properly selected and under the care of a board-certified plastic surgeon. Being one of most popular cosmetic procedures, a tummy tuck possesses a high satisfaction rate on both the patient and the surgeon. [^47]
Meanwhile, this surgical procedure may come with risks just as other major surgeries do. The severity and impact of its complications may vary. [^48] Risk factors tend to fall on males, those who are 55 years or above in age, and are obese. [^49] Side effects do occur such as temporary discomfort, back pain, soreness, numbness and bruising. These can be resolved naturally, or through prescribed medication.
Complications on the other hand may pose a challenge for the surgeon and somehow endangers his relationship with the patient. An aesthetic surgery such as an abdominoplasty raises the expectations of the patient, which can be dashed by an adverse event following the procedure. Moreover, complications do not only deter medical recovery, but can also affect the outcomes.
This is a complication that frequently occurs after a tummy tuck. Seroma in abdominoplasty is fluid buildup below the abdominal flap. One study found that males have a higher risk when their abdominoplasty is performed with liposuction. [^50]
Whether lipoabdominoplasties are more susceptible than traditional tummy tucks is still a subject of debate. In any case, several strategies are employed during surgery that are believed to reduce this complication, one of them is the preservation of the scarpa fascia. [^51] It also includes the use of sutures to eliminate dead space. [^48]
This often refers to the inflammation of the surgical area which manifests itself through high body temperature, erythema, oedema, and tenderness. Infections are the next most common adverse event, its incidence is estimated at up to 3.8 percent in tummy tuck patients. [^52] A person who has been overweight, has diabetes, smokes, or even suffers from malnutrition is considered to be highly prone to infection.
Also referred to as cell death, necrosis shows itself with delayed filling of capillaries and having a lower local temperature. Using a limited dissection technique, its probability is placed up to 4.4 percent. [^52] Smoking can increase its occurrence, as well as having additional aesthetic procedures. [^48] To help avoid this, the use of hyperbaric oxygenation has been proposed after the surgery, which stimulates collagen formation and stem cell mobilization. [^53]
Although it happens less frequently compared to other complications, it can present itself as something small which is considered as asymptomatic, or large which is accompanied by swelling and localized pain during the first 24 hours from surgery. [^48]. It has been observed that those patients who have a higher BMI are likely to experience hematoma. [^54]
Other possible complications of abdominoplasty include anesthesia allergy, collapsed lung, prolonged or permanent sensory nerve damage, asymmetry, navel death, deep vein thrombosis, delayed healing, fat embolism, and unsatisfactory surgery outcome.
Tummy tuck maintenance
Although it has been established that the tummy tuck result of a flat and toned stomach is permanent, poor lifestyle habits can still damage it. In fact, before you subject yourself to abdominoplasty, you should also commit yourself to maintaining the surgical outcome.
Even if you’ve had a tummy tuck doesn’t mean you can eat anything you want without the consequence of weight gain. It’s because of these pitfalls that you may find yourself right back to where you were pre-surgery. Needless to say that this is a waste of money, not to mention that it is also detrimental to your overall health.
It would be unwise to deal with another set of fat and loose skin by having a second tummy tuck, which may not guarantee the optimal results of your first one.
Becoming pregnant after a tummy tuck
It is always recommended that the female patient is done with pregnancies before embarking on a tummy tuck procedure. Interestingly, it can even be combined with a tubal ligation so that the patient will just go through one surgery instead of two separate procedures.
Being pregnant after a tummy tuck has effects that are pretty much the same with weight gain. Pregnancy can undo the abdominoplasty results by tearing the surgically tightened muscles of the abdomen. Despite that, It should be noted that there typically is no health risk to the pregnant woman when this happens.
Tummy tuck latest trends and developments
As abdominoplasties are continuing their popularity worldwide, there are even more developments using improved techniques for better results and quicker recovery. One of the things that needs constant enhancement is scarring.
Naturally, women would prefer to look as organic as possible, even with surgical enhancements, and scar is something that should be unnoticeable if not, almost non-existent. With the current methodologies, the scar is kept low in the middle, which makes for the most acceptable location thus far.
A subtle yet defined abdominal line is seen as both athletic and feminine. [^55] Using progressive tension sutures or PTS, the additional stitches that anchor the shallow fascia to the deep fascia helps in the alignment of skin edges. And with sutures placed on the side rectus sheath, the midline groove can be created.
Look ma, no drains
Although it serves an important purpose, a surgical drain can be a source of additional discomfort to the recovering patient. With a lipoabdominoplasty, the drain can be eliminated by using a layered suture technique. Also, the use of a long lasting anesthetic such as Exparel that’s combined with a particular suture method, also foregoes the use of drains.
A reinforcing mesh can be used to provide skin support for mothers whose abdominal walls have been substantially weakened due to frequent pregnancies. The makeover surgery may also enlist a breast lift using a Galaflex internal bra to provide better results overall.
Prolonged local anesthetics
Patients fear the pain that resurfaces when the anesthesia has worn off. Using liposomal bupivacaine can lower pain scores and reduce the need for opioid medication by targeting specific sensory nerves. [^55] Another option is the transversus abdominis plane or TAP block, which can last up to 3 days in the patient.
Tummy Tuck: How much does the procedure cost?
There are many types of tummy tucks that can range from a mini-abdominoplasty to a more complex circumferential technique. Hence, the cost will definitely vary. This tummy tuck price is also affected by the location and fees of your surgeon. A ballpark figure would be from $3,000 to $15,000 depending on how extensive the surgery will be.
Is there a right age when a tummy tuck should be done?
Technically, it is safe to perform a tummy tuck on individuals who are above 18 years old. However, other qualifications must be met like being in good health, among other things which are more important. The surgery will be most optimal for the patient when the guidelines are observed.
It should be noted that there is no definitive maximum age to undergo a plastic surgery such as an abdominoplasty. And besides, you may be 60 years young yet, but you’re clear of all contraindications and meet the prerequisites of the procedure. In the same manner, if you are old and not in the best condition, then it goes without saying that you should not proceed with a tummy tuck.
Will I lose weight after a tummy tuck?
As mentioned earlier in this article, abdominoplasty is not your ticket to weight loss. However, after one undergoes a tummy tuck, his tight and flat stomach will complement his body type more such that it may appear that he has lost a good amount of weight. At the same, having a firmer abdomen will somehow help you eat less given that it’s tighter and smaller than before.
What is the purpose of compression garments after the surgery?
This type of clothing can provide support and helps in swelling reduction and edema. It also hastens healing time, so that the patient can be back to his normal grind much sooner. The compression would aid the skin to hug its new contour which would help in the prevention of fluid buildup in the process.
Is it ok to cover scars with a tattoo?
Yes. It is a good and creative way to manage scarring from a tummy tuck procedure. Just make sure that your scars are fully healed before you take this action. Reversing the situation, a tummy tuck can definitely affect an existing tattoo on the abdomen given the pulling of skin over tightened muscles.
Depending on its location and size, it can even disappear altogether, which is something the patient should be willing to sacrifice under the circumstances.
How significant are the changes that are possible with a tummy tuck?
Many patients have been happy with their outcomes to a point that they have become life-changing. Visually, the changes can be very obvious from the get-go. Imagine if you were able to overcome obesity with a lifestyle change, but left with so much hanging skin.
You will be in for a big transformation once you undergo a tummy tuck. The results will match your new lifestyle and you’ll practically feel like a new person. For some, they find the change to be substantial even with just a few nips and tucks from a mini abdominoplasty.
How painful is the surgery?
Yes, it is painful postoperative and there are no two ways about it. It can be quite intense in the first couple of days, which is expected of a major procedure. Hence, pain medication is already prescribed to help deal with this side effect. After a week or so, you may be able to manage with lesser-strength painkillers that can be bought over the counter. You need not worry as this is generally a temporary situation.
How do I book an appointment?
As soon as you have narrowed down your list of preferred doctors, you should set an appointment to discuss every aspect of your intended tummy tuck in great detail. This will help you arrive at a final decision whether to proceed with it through that surgeon, or not. In any case, you can book your appointment by visiting VitalBar. You can make free consultation bookings through our city specific pages if you are in Vancouver or Calgary. Plastic surgery including tummy tucks are welcome.
Weighing the pros and cons of going for a tummy tuck, it is likely that one who needs it will benefit more from it, than without it. But of course, you should be a good candidate for the surgery first and follow the guidelines as discussed here.
An abdominoplasty could very well be the most wonderful gift you can give yourself after a successful weight loss, or the end of your childbearing years. Go ahead and check out VitalBar for your consultation today. The attending doctor will be more than happy to walk you through the details.
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