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Abdominoplasty - Tummy Tuck

This is a procedure intended for women and men who have loose abdominal skin, and/or a significant amount of abdominal fat that is not improved by dieting or exercise.

You may be a good candidate for abdominoplasty if you have one or more of the following conditions:

  • Excess or loose sagging abdominal skin
  • An abdomen that protrudes or is out of proportion to the rest of the body
  • Abdominal muscles that have loosened through pregnancy or aging
  • Excess fat that is localized beneath the abdominal skin

If an individual plans to become pregnant or lose a significant amount of weight, this should be discussed prior to deciding on this procedure. Scars from previous abdominal surgeries that are below the belly button are typically removed during the procedure. This includes most cesarean section scars. Scars above the belly button may at times, be limit the results of the abdominoplasty.

Surgical Options

Typically, a horizontal incision is placed just above the pubic area. The length of the incision, which extends outward toward the hip bones, varies largely with the amount of skin to be removed. The more skin that needs to be removed, the longer the incision may be. For most cases the incision is kept within swimsuit lines. Dr Yousif tries very hard to keep the incision in hidden places. He actually asks you to bring the underwear of swim suit with you to the surgery so thay the pre operative markings can done with the garment in place. Working through the incision, underlying muscles are tightened, pulling them together and stitching them in place. Any excess skin from the lower abdomen is trimmed away. Skin that has stretch marks in the lower abdomen may also be removed. However, stretch marks in the upper abdomen may still remain, but will be moved down to the lower abdomen. In a "full abdominoplasty", a small incision concealed within the naval is also made. This allows the excess skin above the naval to be pulled down and removed. Although the navel's position remains unchanged, its appearance may be slightly different.

A "mini abdominoplasty" is a procedure that may benefit you if you are mainly dissatisfied with the appearance of the abdominal area below the naval. This procedure requires only a short, horizontal incision and no naval incision. A "mini abdominoplasty" will not correct loose skin above the naval.

During your consultation, Dr. Yousif will evaluate you to determine which procedure is right for you.

The Natural Tummy

Muscle tightening (Horizontal tightening of the muscles)

The standard tightening of the tummy muscles is done in a vertical direction. These are the rectus muscles or those muscles that give the "six pack abs". This form of tightening tends to hide the rectus muscles and give the tummy and un natural board like look. The youthful, attractive tummy still shows the shape of the underlying muscles and it is important to keep the shape of those muscles visible and place them back into their normal position. Dr. Yousif, in 2001 published a new way to tighten the rectus muscles that allows the beautiful shape of the tummy to remain visible. This is called horizontal plication(tightening) and tightens the rectus muscle regaining its youthful shape.

The Scars

The standard teaching for the placement of scars is 6 centimeters or 3 inches above the pubic bone. Dr. Yousif believes that this is much too high and is significantly above most of the bathing suits of the current day and fashion. Dr. Yousif maintains the scars at or slightly above the pubis. This allows the most scars to be easily hidden beneath most undergarments or bathing suits.

The Pubic drop

In some patients, after weight loss or pregnancies the pubic soft tissue tend to drop and this tissue need to be brought back into the youthful position. It is extremely important to bring this tissue to its appropriate position but not to allow this to be overly elevated. Over elevation can be unattractive and uncomfortable. Dr. Yousif positions evaluates and directly positions and sutures into its appropriate position.

Anesthesia and Surgery Facility

The abdominoplasty and its variations are most comfortably performed under general anesthesia in a surgery center or hospital setting. Occasionally, a mini-abdominoplasty can be performed under intravenous sedation with local anesthetic, however the tightening of the muscle layer may be uncomfortable.

Operative time for a mini-abdominoplasty is 1.5 hours whereas a full abdominoplasty may take up to 3 hours. Most patients are more comfortable in the hospital for at least one night following surgery. These decisions are based on the requirements of your specific procedure as well as patient and surgeon preference.

Side Effects

When surgery is complete, you will be taken to the recovery area. Small drainage tubes are placed beneath the skin to help prevent fluids from accumulating. Tightness and soreness in the abdomen may be felt, but can be controlled with pain medication, especially through the IV and then taken by mouth. Gauze dressings and tape will be applied to your abdomen and later an abdominal binder will be placed for support.

Although you may not be able to stand perfectly straight for the first days after surgery, you will be encouraged to get out of bed soon after surgery to promote circulation and prevent blood clots. While resting in bed, you are typically in a flexed position with your head and legs elevated on pillows.

Risk

Yearly, thousands of people undergo abdominoplasty and experience no major problems. However, this procedure is extensive and it is essential for you to be informed of the risks and benefits. As with any surgery, there is a risk of bleeding and infection, thought these are uncommon. Healing problems due to insufficient circulation may occur when the skin is stretched. To reduce this risk, we ask patients to refrain from smoking at least 3 weeks prior to surgery and 3 weeks afterwards. Second-hand smoke should also be avoided for 3 weeks postoperatively. The risk of blood clots in the legs may be greatly reduced by special compression garments that are placed during and after surgery, and by getting out of bed soon after surgery. Minor adjustments to the incisions line may, at times, need to be made in the office minor procedure room a few months later. Over-activity and not following the instructions after surgery could result in a weakening of the muscles that have been tightened.

Recovery

Typically, within the first week following surgery, surgical drainage tubes will be removed. Within the first week, any bruising and swelling will reach its peak. Although most sutures are dissolvable any stitches that need to be removed will be taken care of within the first two weeks. The abdominal support garment is usually worn for the first 6 weeks. This does aid in reducing the swelling and providing support with activity. In this early phase of healing, straining, bending and lifting should be avoided. However, at several weeks, you may gradually increase your activity and exercise. You will be given appropriate instructions as your recovery progresses. Most individuals may return to non-strenuous work, typically within the first 3 weeks. By 4-6 weeks, any bruising and swelling continue to subside and you will be able to see more of your results. After a few months, you will see a truer picture of the final result of your surgery. Feelings of numbness and tightness will disappear. The incision line will begin to fade from its pinkish color (although fading may take a year or more). In the months following surgery, it is important to treat your healing skin with additional care - that means avoiding sun exposure and not wearing dark colors when outdoors. Heat absorbed by dark colored clothing can actually burn the healing skin and complicate recovery.

Duration of Results

Abdominoplasty provides long-lasting results. Unless you gain or lose a significant amount of weight, you can expect to retain your new shape for many years. Over time, aging and gravity may cause your skin to become somewhat looser. If this occurs, the surgeon may suggest an additional, minor procedure for restoring a more youthful, abdominal contour.