About the Tummy Tuck (Abdominoplasty) ProcedureAbdominoplasty is the only effective option for improving the appearance of significantly loose skin in the abdominal area. Procedures that use the word “tuck” are exactly that. Meaning, in order to “tuck” the skin, the excess skin must be removed. As a result of “tucking” the skin, abdominoplasties have a scar in the lower abdomen, which can generally be placed within the area that would be covered by a bathing suit or underwear.
Who is a Candidate for Abdominoplasty (Tummy Tuck)?
After weight loss and depending on the elasticity of the skin, Abdominoplasty or the Tummy Tuck procedure may be performed to tighten lower abdominal skin. Liposuction
are each excellent options for reducing excess fat in the abdominal area. Depending on skin elasticity, removing fat alone may not adequately improve the overall appearance of the abdomen. Younger individuals typically have excellent elasticity, and the skin can be expected to “bounce back” following liposuction or CoolSculpting, which lends to an excellent overall result. However, factors such as history of pregnancies, significant fluctuations in weight, age, and genetics can all contribute to diminished skin elasticity. Unfortunately, non-invasive skin tightening techniques – including Ultherapy and Thermage – are on the whole, extremely poor in achieving meaningful tightening of lower abdominal skin. Dr. Rapaport does not recommend these procedures because over the years he has consistently seen disappointing results in patients who have undergone these treatments elsewhere. An abdominoplasty or tummy tuck may well be the procedure of choice for patients with poor skin elasticity.
Different Types of Tummy Tucks. Why Some Hurt and Some Don’t.
An abdominoplasty has two components: one is the skin and fat that you can easily pinch; the other is the muscle, whose front portion you can feel with your fingertips when you pinch the skin and fat of your abdomen.
As part of normal anatomy, there is a fine line (linea alba) between the two vertical rectus muscles in the front of the abdomen. These are the muscles which create a six-pack when well developed. As one of the natural changes that occur during pregnancy, the abdominal wall stretches. In some women, the linea alba between the two muscles stretches and does not return to normal. This is called diastasis recti. To repair diastasis recti through an abdominoplasty, the muscle edges are sutured together, thereby tucking in the loose abdominal wall. Sutures can also be placed at other portions of the abdominal wall to create further tightening and shaping of the muscle. While tightening the abdominal muscle during an abdominoplasty can provide substantial improvement for some of our patients, it is also causes significant discomfort for several days following the procedure. When a patient has abdominal muscle weakness, or abdominal wall laxity, they may be a candidate for abdominal muscle tightening during the abdominoplasty procedure.
In many patients, there is no real problem with the abdominal wall. For patients whose primary complaint is their loose skin and fat, there is no need to perform any suturing of the muscles. Typically, these patients will not complain of any abdominal pain following their surgery; however, they may experience some lower back pain during the six day recovery period when it is required to walk bent over. An abdominoplasty that removes loose skin but does not tighten the underlying abdominal muscles is called a skin-only abdominoplasty.
Skin Only Abdominoplasty: Mini vs. Full
As discussed above, abdominoplasties can either tighten skin alone, or both skin and underlying abdominal muscles. The distinction between a “mini” and “full” abdominoplasty has only to do with the amount of loose skin that needs to be removed.
There are two groups of patients who may qualify for a mini abdominoplasty. One group consists of patients who only have loose skin below their umbilicus (belly button). The second group contains patients who have a low horizontal scar, such as a c-section scar, and may have a bulge with fat and loose skin above the scar. In these cases, when only skin below the umbilicus is loose, only that skin needs to be removed. Therefore, there would be no need for a scar around the umbilicus, and the lower abdominal scar may be shorter in length, depending on the amount of skin needed to be removed. In these cases, because only the lower abdominal skin is being removed, the underlying abdominal muscles cannot be tightened.
In cases where there is loose skin above the umbilicus, a full abdominoplasty (with a scar around the belly button) will most likely be required to tighten the upper and lower abdominal skin as. During the patient consultation, Dr. Rapaport will discuss whether or not to tighten the muscles in addition to the skin.
The decision regarding which type of abdominoplasty is appropriate for any given patient is made at the time of a personal, one on one consultation with Dr. Rapaport, and will involve review of the patient’s concerns as well as an appropriate physical examination.
The scar from a full abdominoplasty must, by necessity, be a long scar in order to remove the large area of skin. Dr. Rapaport frequently likens this scar to a hem on clothing; the hem has to cover the length of the area to be reduced. In fact, Dr. Rapaport has seen some extremely unfavorable results when other, less experienced surgeons have tried to achieve the results of a full tummy tuck with a short scar. The amount of pulling in and crimping of the tissues, and/or excess of skin on the sides (dog ears), can be very disturbing. It is important to differentiate between a long scar and a wide scar. In the vast majority of cases, Dr. Rapaport’s abdominoplasty scars are narrow and fine because of the techniques employed in closure and the fact that tension in the closure is kept to an absolute minimum.
Post-Abdominoplasty Care and Downtime
A tummy tuck surgery is real surgery. Because of the skin removal, it is crucial that the area of closure be kept under minimal tension for the first several days after the operation. This is why all abdominoplasty patients are instructed to walk bent over whenever they are upright for the first 5-7 days. All of Dr. Rapaport’s full abdominoplasty patients are required to stay overnight in Manhattan under the supervision of a nurse, both for patient safety as well as comfort. The nurse ensures that the patient is resting in the proper position (back elevated 30-40 degrees, legs bent with pillows under the knees). The nurse monitors blood pressure, as well as discomfort and can medicate accordingly, as needed. The nurse also monitors drainage (drains are almost always used) and instructs the patient on drain care for the days following the abdominoplasty. Prior to the nurse’s departure on the morning after surgery, photographs of the abdomen area will be taken and sent to Dr. Rapaport to confirm good healing. Typically, between days 5 and 7 following surgery, drainage is low enough that the patient can come into the office and have her or his drains removed. At this point, the patient can stand upright again. The minimum downtime after abdominoplasty surgery is about 10 days. If surgery is performed on a Friday, one can generally expect drains to be removed the following Thursday or so, and one may return to very non-active work 10 days after surgery. However, it must be emphasized that even at 10 days after an abdominoplasty, activity must be kept at a minimum in order to ensure proper healing and to avoid complications.
A patient coming from another city or country should plan to arrive in New York at least 1 full day (preferably 2) prior to surgery and to stay in New York for a minimum of 14 days following surgery.
A complete tummy tuck surgery normally takes approximately 3 hours to perform. A mini tummy tuck, on average, takes between 1 and 2 hours to perform.
Anesthesia: General anesthesia is typically utilized for abdominoplasty surgery. Epidural anesthesia may be employed in selected cases
Risks of Smoking to Tummy Tuck Surgery
When one smokes cigarettes, there is a very significant disturbance of the blood flow within the skin. This abnormal blood flow can lead to major complications in surgeries where the skin is significantly manipulated, such as an abdominoplasty. These complications can include necrosis of the skin, which essentially means that the skin does not survive, and the patient subsequently would experience an open wound and poor scarring to follow. It is for this reason that Dr. Rapaport will not perform an abdominoplasty on people who are actively smoking. We require that our abdominoplasty patients stop all smoking for a minimum of six weeks in order to help reduce the risk of major complications.
For more information on Abdominoplasty / Tummy Tuck procedures, visit the ASPS website.