Abdominoplasty ('Tummy Tuck')
You’ve lost weight, toned your ab muscles, and no matter what you do, that same roll of skin is still perched on your lower stomach. Unfortunately, the excess skin left over from pregnancy, weight loss¸or the passage of time won’t go away.
Abdominoplasty, or “tummy tuck”, is the removal of excess skin and the reshaping of the abdominal wall. Abdominal muscles, stretched over time, are stitched to create a more “cut” waist Excess skin is removed to flatten the contour of the abdomen, allowing clothes to fit better.
Am I a candidate for Abdominoplasty?
The best candidates have a lot of extra skin, have lost most of their extra weight, and may have a degree of bulging of their abdominal wall from the stretching of pregnancy or previous obesity. The doctor can advise you at the consultation about your specific situation, but if you have a lot of extra skin that won’t go away with exercise and diet, you are probably a candidate. Patients must have quit smoking at least two months before surgery.
Where are the incisions and how is it done?
The incision usually goes from hip to hip across the lower abdomen like a bikini line. The extra skin is lifted up off the muscles up to the rib cage and just below the breast bone. The loose muscles are sewn together, and then the extra skin is trimmed off. A new opening is created for the belly button.
Some people only need the skin from below the belly button removed, this is called a “mini-abdominoplasty.” Some patients require skin removed from all around their body, called a “Belt lipectomy”, or “body lift.” Doctors Grosso and Muskett will advise you regarding the best procedure for you.
Where is the surgery performed?
We use only fully accredited surgical facilities, whether it is our own new state-of-the-art operating room or the local surgery center. An overnight stay is available, although most procedures are outpatient same day visits. We use only board-certified MD anesthesiologists for your safety and comfort.
What about after the surgery?
We use devices called Experel pumps that deliver pain-killing medicine through tiny catheters placed under the incisions. With the addition of oral pain medications, pain control should be good. The first week, honestly, can be sore and tight. It is important to keep moving, and soon the benefit of your vastly improved tummy soothes the postoperative discomforts. You will have a drain under the incision for a few days, the output of which we ask you to record. Once the output is less than 20 cc per day we can remove it. We feel that wearing a girdle-like compression garment afterward provides support for the incision and reduces swelling. Return to work depends on lifting. If you have a desk job, 7-10 days may be enough. We ask you not to lift anything over 10 pounds for month, or twenty pounds for two months. We will work with you and your employer on activity restrictions.
What are the risks?
Problems are unusual with abdominoplasty, and if they occur, tend to be easily treated. Occasionally bleeding will occur that will require a second operation to fix. Infections can result in redness or drainage that require antibiotics or minor surgery. Areas of slow healing might need to be treated with dressings. Major complications such as blood clots, pneumonia, severe infections, or death are exceedingly rare.
Scars are unpredictable. Typically they fade and patients don’t notice them. Usually they are concealed, even under a bikini. Some people get thick scars. Usually, after a year, they are thin and white. Most people find the tradeoff between a tummy roll and a scar to be a good one.
Liposuction is a highly effective technique for the removal of localized areas of fatty deposit that won’t go away with diet and exercise. Unfortunately is it not effective as a technique for losing a lot of weight, and it won’t remove excess skin. With the right circumstances and reasonable expectations, liposuction can lead to satisfying and durable results.
How is it done?
The initial examination will determine if you are a good candidate for liposuction, and what areas might be addressed. Commons areas are the flanks, lower abdomen, thighs, arms, and the neck. Any area with fat can be suctioned if done carefully. On the day of surgery, markings are performed with your input. After the administration of anesthesia (local for small areas, general anesthesia for larger), the areas are filled up with a solution that reduces pain and bleeding. Suctioning is performed with a series of tubes, or cannulae of different sizes. The procedure is continued until the excess has been removed. The incisions for the cannulae are about a quarter of an inch in size and usually heal well. They are hidden in inconspicuous areas. A compression garment is used afterward to reduce swelling.
What about recovery?
Recovery is not significant. Discomfort may last a day or two. Bruising is variable. Some clear drainage may last a day or two. Normal activity can be resumed when comfortable. Final results take about two to three months, once the swelling is completely gone.
What about risks?
Irregularities can be seen under the skin, but being both well-trained and careful we rarely have this problem. Infection and bleeding are rare. Severe complications are usually related to very large volume liposuctions, which we don’t do as we feel they are inappropriate.
Arm Lift (Brachioplasty)
Brachioplasty, commonly known as an arm lift, attempts to procure a more natural and youthful look by removing the fat and excess skin hanging down from the underarms. This is most commonly requested by aging women, but some men opt to have this procedure as well. An arm lift is often performed on post-bariatric surgery patients who have lost huge amounts of weight in a short amount of time. The procedure helps to relieve patients’ self consciousness in wearing short sleeves or otherwise showing their arms.
During the arm lift procedure, the incision is made beneath the arm and can extend from the elbow to the armpit, varying upon how much skin must be removed. The skin is then cut away from the rest of the arm and pulled taut around the extremity.
This procedure is very likely to leave a scar that could be noticeable. Most doctors can adjust where they make their incision so that the cut runs either underneath the arm or on the inside surface. These are less visible in normal poses and can improve over time as the scar fades. However, most patients need to be firmly aware that they are essentially trading “skin for scars” with this procedure.
Body Lift (Belt Lipectomy)
Also called belt lipectomy, torsoplasty and panniculectomy, the circumferential body lift is performed to remove excess skin from the torso and upper legs.
Candidates for body lifts typically suffer from loose (inelastic) skin on many or most areas of the body as a result of age, childbearing or significant weight loss due to diet, exercise or bariatric surgery. Because of this, the procedure is often combined with others such as breast lifts, arm lifts and liposuction to retain a proper body proportion. Body lifts tighten and tone the abdomen, back, buttocks, hips and thighs.
During the procedure, skin is lifted from underlying tissue, muscles are tightened and stitched, fat is removed where necessary, and the skin is sutured closed. The navel is often removed and replaced in its new position. Surgical tubes may be needed for a few days to drain any fluid, and patients may need to wear compression garments for a few weeks to facilitate faster healing.
After surgery, patients are encouraged to walk as soon as they are able to, although strenuous activities must be limited for about a month. Results are visible immediately.
A thigh lift is performed to remove excess skin and fat from the upper legs. Candidates typically suffer from loose, inelastic skin after extreme weight loss due to diet, exercise or bariatric surgery. Because of this, the procedure is often combined with others such as breast lifts, facelifts and arm lifts to retain an attractive body proportion.
In a medial thigh lift (inner thigh lift), the surgical incision is made in the inner thigh along the line where the leg meets the groin. In a lateral thigh lift (outer thigh lift), the incision is made from the groin around the back of the body, so that the buttocks are lifted along with the thigh.