Tummy Tuck

Male breast reduction and tummy tuck performed at the same time offers advantages such as lower cost compared to having them separately. Furthermore, not everyone has the luxury to have two recovery periods.


Dr. Tarick Smiley, one of the leading Beverly Hills plastic surgeons, says that patient safety is the most important aspect of multiple-surgeries operations. Theoretically, the longer operative time under general anesthesia and the more incisions and cutting are made, the higher the risk of complication is.


male breast reduction and tummy tuck

The first and most critical step to make combo surgery reasonably safe is to conduct strict patient selection. In this respect, Dr. Smiley requires all his patients to pass lab screening to ensure that they can handle the “rigors” of any operation.


Lab screening typically includes blood work and EKG and cardiopulmonary tests.


After passing lab screening, the patients are instructed to “prepare” weeks or even months prior to surgery. The idea is to help them achieve their optimal health through superb diet and regular exercise.


Preparation for surgery also involves complete cessation from tobacco and smoking cessation products and discontinuation of all drugs and supplements with blood thinning properties. For clarity, Dr. Smiley provides his patients written materials that let them know all the things and activities they need to avoid before surgery and afterwards.


To further ensure patient safety, Dr. Smiley says in his recent Snapchat post that he only works with a board-certified anesthesiologist who requires a separate lab screening. Also, this specialist monitors the patient’s vital signs at the time of surgery.


Moreover, all efforts are made to complete the surgery in less than six hours to control the amount of surgical trauma and bleeding.


While combo procedures have a perceived higher risk of complications, Dr. Smiley says having separate surgeries also has problems—e.g., multiple recovery periods, higher cost, and “multiple” risks.


Because bleeding has a large effect on the recovery period and the risk of complications, Dr. Smiley uses different modalities to reduce blood loss. For instance, he injects epinephrine before making incisions.


Epinephrine is a drug that constricts the blood vessels, ultimately reducing the amount of bleeding. Furthermore, it “spreads” the effects of local anesthesia and so the patients rely less on oral narcotics to control their postop discomfort.

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The tummy tuck suture technique greatly varies from surgeon to surgeon, although all efforts are made to promote the best scar possible. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the “core principle” is to eliminate or at least reduce tension on the skin to prevent indentations, aggressive scarring (wide or thick appearance), and scar migration.


In his recent Snapchat videos, the celebrity plastic surgeon has explained the importance of meticulous tummy tuck suture technique in the final appearance of the scar.


tummy tuck suture technique



Dr. Smiley said the hip-to-hip incision must be closed in several layers to promote favorable scarring. In the video, he is seen closing the deeper tissue with permanent stitches known for their “additional strength.”


Dr. Smiley has further explained that as he goes nearer to the skin layer, he reduces the tension and at the same time uses finer absorbable sutures when closing the wound.


The actual skin, meanwhile, is just allowed to “kiss each other” (the edges of the skin wound) with only a few staples holding them together.


“This suturing technique prevents indentations. When there is no or very little tension on the skin, the scar will find it easier to fade into the background six to 18 months after surgery,” he said.


Once the wound is clinically healed, Dr. Smiley said he recommends the use of silicone gel and other topical scar treatments containing silicone, which hydrates the skin and so the scars remain flat and faded.


Aside from using the “right” tummy tuck suture technique, Dr. Smiley said the scar placement will also play a critical role in patient satisfaction.


He always positions the hip-to-hip scar very low—almost “touching” the pubic hairline—so the patient’s underwear can conceal the surgical stigmata. Over time, the scar is expected to fade into the background and “contract” as thin as a human hair.


Dr. Smiley said that patient cooperation also plays a crucial role in the final appearance of tummy tuck scars. He said a good rule of thumb is to avoid over-exertion for at least six weeks and stay away from the sun for about a year.

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The appearance of tummy tuck scarring is one of the major concerns of patients who want to eliminate their apron-like abdominal skin and/or improve their barrel-shaped waistline, as explained by Dr. Tarick Smiley on his recent Snapchat video post.


Dr. Smiley said all his patients’ tummy tuck scar is made very low that they have no problem wearing the “lowest cut” two-piece bikini.


tummy tuck scarring

Most tummy tuck surgeries involve a hip-to-hip incision to remove a wedge-shaped excess skin in the lower abdomen (between the navel and the pubic region). Then, the upper edge of the incision is pulled down to close the curved wound, which lies very low. Of course, a hole is made through the stretched over skin where the navel is set.


In his recent Snapchat post, Dr. Smiley has shown an image of a patient who had her surgery 11 years ago. The scar has faded significantly into the background, which generally happens when someone has a fair complexion.


Nonetheless, many dark-skinned patients can also expect having a barely visible tummy tuck scarring years after their surgery.


The first and most critical step to promote favorable tummy tuck scarring is to use proper wound closure. The idea is to prevent excessive tension and migration, which can lead to scars becoming thick or riding up higher.


To prevent scar migration, Dr. Smiley said the incision site must be secured and anchored to the lower abdominal fascia (strong connective tissue beneath the skin). Furthermore, it is critical to take as much tension off the final layer of wound closure as possible, which is done with the use of deep sutures.


However, patient cooperation is also critical to promote favorable tummy tuck scarring. Aside from using silicone sheets and other similar scar treatments, Dr. Smiley said the scar should not be exposed to the sun for about a year to prevent hyperpigmentation or permanent darkening.


Moreover, the patient must avoid over-straining (e.g., heavy lifting and strenuous physical activities) in the first few weeks following their surgery to prevent wound breakdown and less than optimal scars, said Dr. Smiley.

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Extensive tummy tuck does not only rely on skin removal. It is important to note that after pregnancy or massive weight loss, the apron-like abdominal skin is not the only “factor” that contributes to the sagging or barrel-shaped appearance of the waistline.


The splayed or separated abdominal muscle, excess fats, and hernia (weak spot in the muscle or connective tissue that causes the intestine to squeeze through) also contribute to the unattractive appearance of the waistline.


extensive tummy tuck


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted educational videos on his Snapchat account to demonstrate surgeries involving extensive tummy tuck. It is important to note that each surgery is highly customized due to varying anatomies of the patients.


One female patient has received extensive tummy tuck that involved muscle repair, navel repair, liposuction of the flanks and lower back, and mons pubis lift.


Liposuction was first conducted to remove the excess fat along the flanks and lower back before the actual components of the tummy tuck were performed.


The patient then received a hip-to-hip incision made very low so that her underwear can easily cover the resulting scar. Over time, the scar is expected to fade into the background.


The hip-to-hip incision has allowed Dr. Smiley to lift the skin off and expose the pair of vertical muscle between the breastbone and the pubic region. Using the permanent “individual” suturing technique, he was able to tighten the muscle in the midline, leading to a flatter abdomen in frontal view.


After muscle repair, he injected Exparel into the muscle; this is a long-acting numbing medication that can significantly reduce the amount of pain for about four days.


Then, he removed a wedge-shaped excess skin before closing and tightening (centrally) the remaining skin in order to achieve an hourglass figure effect.


Of course, the enlarged navel has also been repaired so it will not detract from the narrower, more feminine waistline.


Because the female patient had lost a lot of weight, she also had sagging of the mons pubis, which has been lifted and re-anchored to achieve a smooth transition between the pubic region and the lower abdomen.

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One critical aspect of your tummy tuck preparation is being near your ideal weight. Hence, you should be committed to healthy eating and regular exercise, which can help you maintain a stable weight long term and thus preserve the surgery’s results.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley warns that large weight fluctuations that often happen when the patient lacks commitment to healthy living can affect, if not, reverse the results of tummy tuck.

tummy tuck preparation

Photo Credit: imagerymajestic at FreeDigitalPhotos.net

However, the general rule of thumb is to avoid strenuous exercise—particularly involving your core—within a week of your surgery to prevent additional postop soreness and injuries. Also in the event that you sustain any type of injury, you may need to reschedule your surgery.


After surgery, most patients are advised to avoid strenuous exercise for 6-8 weeks, although it is a case-to-case basis and so you must only stick to your doctor’s recommendations.


Meanwhile, some people resort to exercise in an attempt to correct diastasis recti, a condition in which the membrane holding the pair of abdominal muscle splits apart due to pregnancy, large weight fluctuations, or over-straining.


The consensus is that a gap of more than two-finger spaces is considered diastasis recti, which contributes to the less than optimal shape of the waistline.


Contrary to popular belief, crunches and intense core abdominal exercise can even aggravate diastasis recti, a condition that is easily addressed during tummy tuck surgery.


Dr. Tarick Smiley corrects diastasis recti with the use of permanent sutures through an individual stitch technique (as opposed to a running or one continuous stitch) known for its extra strength.


The splayed abdominal muscle is tightened and sutured starting from the breastbone and down to the pubic area, says the celebrity plastic surgeon.


While incorporating muscle repair at the same time as tummy tuck does not actually “strengthen” it, at least it allows it to regain its normal function. Furthermore, some patients have reported finding relief from back pain, postural problems, and recurrent bloating and constipation after surgery.


The aforementioned symptoms occur when the abdominal organs are supported by weak muscle and fascia.

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Tummy tuck and panniculectomy are two procedures commonly mentioned in body contouring surgery after massive weight loss. While they both address the apron-like skin that hangs from the abdomen, they are “fundamentally” different, says renowned Beverly Hills plastic surgeon Dr. Tarick Smiley.


Both tummy tuck and panniculectomy remove the apron-like skin that usually follows after dramatic weight loss, providing immediate relief from rashes, infections, hygiene issues, and back pain.


tummy tuck and panniculectomy

The left photo depicts the results of tummy tuck, while the right image is the patient’s preoperative figure.


But unlike tummy tuck which is generally labeled as a cosmetic plastic surgery, panniculectomy is viewed as a medically warranted procedure and thus often covered by health insurance provided that the patient presents proof that the apron-like skin is causing the aforementioned problems, says Dr. Smiley.


Nevertheless, tummy tuck provides more contouring effects than panniculectomy because the former not just removes the apron-like skin, but it also incorporates muscle and navel repair.


Simply put, tummy tuck focuses more on the aesthetic improvements, while panniculectomy aims to provide immediate relief from the symptoms of redundant skin.


Because panniculectomy is considered a medically necessary procedure, patients who are still losing weight may still opt for the surgery provided that they are experiencing significant discomfort caused by the redundant skin. And once they reach their ideal weight, they may proceed to tummy tuck for additional contouring effects.


Tummy tuck, meanwhile, being an elective body contouring surgery is quite strict when it comes to achieving one’s ideal weight.


Studies have suggested that panniculectomy could stimulate additional weight loss as the patients are able to increase their activity level after the removal of their pannus, which in some cases even reaches their pubic region and causes foul odor and non-healing skin irritation.


However, even tummy tuck that focuses on abdominal contouring can also help in long-term weight management. Previous studies have shown that the aesthetic improvements can serve as a strong motivator for patients to maintain a healthy lifestyle, which is the key to preserve their results, says Dr. Smiley.


During a tummy tuck surgery, the skin is lifted after the creation of a hip-to-hip incision to reveal the pair of muscle that runs between the breastbone and the pubic region. The idea is to suture them in the midline to further create a flatter, narrower waist.


Tummy tuck also re-insets the navel, which is done after tightening the muscle and removing the apron-like skin. The skin in the upper abdomen is then pulled down and a small hole is created for the belly button.


Tummy tuck and panniculectomy can only address the frontal aspect of the waist. However, it is important to note that due to the natural distribution of redundant skin that follows after massive weight loss, a good number of patients will require an incision that extends all the way around their back (resulting in a belt-like scar) so the back and sides will not detract from the smoother frontal abdomen.

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