Abdominoplasty/Tummy Tuck
*Please note that abdominoplasty scars always look worse in photographs than in real life. Also, most post operative photos are taken at four months when scars have not yet fully matured. Complaints about an abdominoplasty scar are uncommon.
Age 33: Abdominoplasty
This is a 33 year old female 5’9” and 175 pounds who was interested in body contouring procedures after a 100 pound weight loss. After a careful examination and history, I suggest she only “needs” an abdominoplasty. She is seen here after a full abdominoplasty without any liposuction. I felt her issue was mostly skin and not fat excess. I also felt that although she has some lax skin all over her body, it wasn’t terrible and an abdominoplasty alone would offer her treatment of the area that has fared most poorly after her weight loss. This result is quite nice—the loose skin of the abdomen is tighter, her overhanging skin is gone, and her abdomen is a lot flatter. She has scarred quite well in both the belly button and the long incision at the lower part of her abdomen. I arranged her photo panties so they actually were able to completely cover the existing scar.
Age 34: Abdominoplasty
This is a 34 year old 135 pound mother of three interested in abdominal improvements. She is seen here after a full abdominoplasty with fascial plication and scars around her belly button and hip to hip along the lower part of her abdomen. You can clearly see a flattening of the abdominal contour and a more muscular appearance to her abdomen. She had a small wound at the lower scar in the midline that healed by itself after surgery. It occurred because of a C section scar that she had in the mid to upper part of her pubic hair. She is seen here about one year after her abdominoplasty.
Lessons to take home:
- In the right patient, an abdominoplasty is a very powerful procedure to flatten the abdomen and tighten the skin. This comes at the expense of the associated scars. Scars are only a big deal if you are not someone who needs a tummy tuck. For those who do, it’s a small price to pay for a huge difference.
- Combining liposuction and an abdominoplasty is possible when the amount of liposuction is modest. It takes an experienced surgeon to know what “modest” is.
- Abdominoplasty is associated with DVT or deep vein thrombosis (clots in the legs that can be deadly). If you have a history of clots in your legs, I would not suggest an abdominoplasty procedure.
- Scars from previous surgery on the abdomen can affect the outcome from an abdominoplasty. These scars must be taken into consideration when planning for a safe procedure without undue risk.
- If you are overweight, I would not recommend an abdominoplasty. It puts you at risk for complications and the outcome can often look “weird” as your abdomen is smaller (and looks like a barrel) and the rest of you is larger. The appearance is unnatural.
- The scars take about two years to soften and look their best.
- Make sure that you tell your surgeon about any abdominal hernias that you may have.
- Long term compression garments worn over the lower scar for six or more months after your procedure helps the scar and flattens your lower abdomen.
Age 32: Abdominoplasty
This is a 32 year old mother of two who is 5’4” and 130 pounds interested in a tummy tuck. She told me she had really large babies. Her fascia was weak and stretched and her skin on the lower abdomen was rather loose.
She is seen here after a full abdominoplasty with a tightening of the stretched fascia, a resection of a football shaped area of skin on the lower abdomen, and the creating of a new belly button. Scars include a circular one around the belly button and a “smile” shaped scar on the lower abdomen. She has small “dog ears” on each side of the lower abdominal scar which isn’t uncommon after this procedure. This will be treated with some liposuction under local anesthesia in the near future. I offer this so that the result is as good as it gets. Her scar has done particularly well even though it’s only a year old. She is still using the silicone scar strips! It will look even better after two or three years’ time. She has been running marathons lately and has lost about ten pounds since her original procedure.
Age 47: Abdominoplasty
This is a 47 year old mother of two, who is 5’8” and 140 pounds who presented to me for abdominal work. Her main complaint is that she does not like to “hold her tummy in” all the time. She is relatively thin and she has a nice appearing abdomen with only a modest amount of loose skin on the lower part of the abdomen, most noted when she bends over.
I told her that I could not guarantee here that by performing an abdominoplasty with fascial tightening, that she wouldn’t have to still “hold it in”. I performed a modified type abdominoplasty ( a “floating tuck”) because I felt that the primary goal was fascial tightening and not the removal of a lot of loose skin. I wanted to keep the scars to a minimum and keep the scar as low as possible. I wanted to avoid a scar around the belly button if possible as this would be the most noticeable scar when she wears a bathing suit.
A “floating tuck” means that there is an incision very low on the abdomen, the fascia is tightened to the max, and the belly button is “floated” with the skin on the abdomen rather than cut out and moved. It’s not for all comers but is ideal in her case, with her anatomy. She is seen here about 8 months after her procedure. She lost 12 pounds that she didn’t need to lose, but this benefited her big time because she lost mostly fat from the inside of her abdomen (interesting that she didn’t lose any breast volume). This makes her abdomen even smaller and flatter. She told me she is several pant sizes smaller. Her scar has done well and is low and well covered in most clothing. I plan on performing a small amount of liposuction just above the scar under local anesthesia to make the results even better. She is considering a small breast augmentation mostly for superior breast fullness.
Age 43: Abdominoplasty
This is a 43 year old mother of three who is 5’’ and 140 pounds who was interested in body contouring options. You can see from her preoperative photos that she is not overweight, has only a modest amount of fat at best and has a very full abdomen that protrudes significantly.
She is seen here after a full abdominoplasty and a small amount of liposuction around her flanks and abdomen. A full abdominoplasty consists of compete elevation of the skin of the abdomen and tightening of the underlying abdominal fascia that is stretched by pregnancies. This is commonly referred to as “tightening the abdominal muscles”.
It’s easy to think that this is not the same person in her post-operative photos but it is. What we can learn from her case:
- The problem with her abdomen was not excess fat or terrible stretched skin—it was loose fascia. Her amount of fullness is simply a lot and is not the normal that would be seen in most women. She actually benefited from tightening of the muscles more than most patients with her anatomy. It’s not always easy to predict how “flat” an abdomen will become after an abdominoplasty but it is always flatter and often much flatter than it was before surgery.
- Fat on the inside of the abdomen cannot be treated with plastic surgery. This is a weight loss issue. Some patients have a tendency to accumulate fat on the inside of their abdomens more so than others and this has to be recognized by your surgeon. The “beer belly” abdomen is a classic—a large protuberant abdomen that has little fat on it and it’s actually hard. Spend any time at your local festival and you will see plenty in middle aged men. This is not as common in women but it does occur and it tends to run in families.
- Women hold in their abdomen almost universally. They subconsciously flex their abdominal muscles during the day so that it appears flat. Only about two percent of women don’t do this on a regular basis. Men don’t hold it in. The point of the matter is that your abdomen can be flatter with or without surgery if you hold it in. Abdominal muscle exercises will help the situation with a post pregnancy abdomen but it will unlikely result in abdomen that you prefer. You cannot exercise your abdominal wall to achieve the same results of an abdominoplasty. You cannot exercise your skin either for that matter.
Abdominoplasty/Tummy Tuck
These photographs illustrate some of the benefits of an abdominoplasty. Many women complain that when they bend over the skin of the abdomen hangs. In this case, you can clearly see the skin excess in the frontal view and the pooch seen on the lateral view. This has been corrected, in large part, with her abdominoplasty which tightens the fascia of the abdomen and reduces the skin excess.
Abdominoplasty/Tummy Tuck: Scar Improvement Over Time
The following three photos illustrate how the abdominal scars change over time. The first photo is the patient’s pre operative abdomen. The second was taken at four months, and the last was taken at 14 months after her abdominoplasty. It actually takes about 2 years or so for a scar to completely mature. During that time the redness deminishes, the scar flattens and minor skin irregularities improve. The scar is real, it goes from one hip to the other but it is rarely a source of concern.
Male Abdominoplasty/Male Tummy Tuck
This is a 24 year old male, 5’9” and 162 pounds who lost forty pounds with diet and exercise. He complained of fullness in the chest area and excess, loose skin of the abdominal area. He was chock full of misinformation that he learned from the Internet. We discussed options, and he elected to treat the gynecomastia/fullness of his chest with liposuction and the excision of dense breast tissue as well as a full abdominoplasty. The full abdominoplasty (defined as complete fascial/muscle suturing, and removal of excess skin) was recommended because he had loose fascia that made a bulge on his abdomen and his skin laxity was significant because of his large weight change.
He is seen here six months from surgery. The bulge on the lower abdomen is gone and excess skin has been removed. His gynecomastia is vastly improved. His scars are still red at this time as it takes about two years for them to become more skin colored. He has gained some weight because “life is good”, but I reminded him of the need to watch his weight. Abdominoplasty in men is most common in those who have had large weight reductions. Gynecomastia can be associated with obesity as fatty tissue accumulates in the breast as well as other areas (this is called pseudogynecomastia).
Age: 48 Abdominoplasty/Tummy Tuck
This woman, 5’8″ and 148 pounds had bariatric (weight loss) surgery performed and lost over 100 pounds. She was interested in body contouring options for her loose, saggy skin. We elected to focus initially on the “big picture” and opted to perform a bilateral breast enhancement as well as an extended abdominoplasty. She is seen here about four years after her procedures. The improvement is obvious, her excess skin has been removed and the fascia of her abdomen was tightened (sort of like taking in your pants after you lose weight). She had a thigh lift performed elsewhere (this is the scar on the upper part of her thighs).
There is a large spectrum of options available for weight loss patients. Personally, I perform procedures that can be done on an outpatient basis (procedure in my office and return home or to a recovery facility if you choose). Larger more complex procedures are best performed in the hospital setting. I always try to see the good aspects of every woman who has experienced massive weight loss and who has loose, saggy skin. In my opinion, the results don’t have to be perfect (in fact, it can’t be perfect), and I like to focus on those areas that patients benefit most from. Ultimately, “correcting” every area of loose or saggy skin will result in a “ragdoll” distribution of scarring which some patients may object to. Having said that, many bariatric patients don’t have concerns about scarring (“anything is better than what I have”). You can imagine that to some degree bariatric patients would naturally have some body image distortion because of the radical change that has occurred to them. This takes careful and thoughtful counseling to explore these issues and determine what is best for the individual patient. If you are planning complex procedures that require a long operation time and a lengthy recovery you must accept a higher complication rate. This is one of the prime reasons I prefer to stage your rejuvenation-I believe it is safer and more manageable to take it in bites rather than swallow the whole enchilada. You will sometimes pleasantly be surprised that less is more.
Age: 37 Abdominoplasty/Tummy Tuck
This mother of two children weighed 130 pounds and wanted to reduce her contour. She considered SmartLipo before coming to Westlake Plastic Surgery. She was fearful about a scar from a tummy tuck. We told her she would need both — a full tummy tuck and liposuction to achieve her goals. (Liposuction alone would not improve her abdominal area like a tummy tuck because she had only “fair” skin quality). We decided to perform a full tummy tuck and 2250cc liposuction of her hips, posterior waist and upper medial thighs.
Her “after” photos were taken at five months post-operatively. She weighs 122 pounds now and her dress size decreased from a 10 to a 4. Note that she is much smaller, even though she still has cellulite and some loose skin around her hips. She has no complaints about her abdominal scar. She is elated with her results.
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