Tummy Tuck

Tummy tuck with Exparel results in less pain and discomfort during the initial stage of recovery. Exparel is a long-acting local anesthetic (Marcaine) that is injected into the abdominal muscle right before closing the incisions with sutures.


Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, says Exparel can numb the treated area for up to four days, allowing his patients to rely less on postoperative narcotics that may cause vomiting, lethargy, nausea, and constipation.


tummy tuck with exparel

This drug is injected into the abdominal wall, numbing the surgical site for up to four days.

Exparel is also more convenient than using pain pumps, which are external devices (resembling a small balloon) that slowly release numbing medications into the surgical site.


It makes sense to control the postoperative pain as studies have suggested that when patients feel less pain, they breathe and move easier, which is the key to quicker recovery. Nonetheless, they should remain cautious about their postoperative activities to prevent tear sutures and wound breakdown.


The general rule of thumb is to avoid rigorous exercise and heavy lifting for three weeks. After this period, most patients may gradually increase the intensity of their activities provided they do not experience pain or discomfort, and their surgeons give their go signal.


Exparel can also help control postoperative pain after breast enhancement surgery. It can be injected into the surrounding soft tissue or muscle layer or simply released into the implant pocket.


The only downside to the use of tummy tuck with Exparel is the additional cost, although most patients wouldn’t mind it as long as they have a comfortable recovery.

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Male tummy tuck technique has a subtle degree of difference compared when the surgery is performed in women. For instance, men rarely experience diastasis recti, or more commonly referred to as muscle separation, that is commonly linked to pregnancy.


Hence, male tummy tuck technique in general does not incorporate muscle repair, which is almost always warranted by female patients. Thus, men may experience less postop pain and discomfort and ultimately shorter recovery than most women.


male tummy tuck technique

The patient seeks tummy tuck to remove his large apron-like skin hanging from the abdomen.


But compared to women, male patients tend to have larger redundant skin that follows massive weight loss. It should be noted that the more skin removed, the higher the risk of compromising the existing blood supply. Increased bleeding and higher surgical trauma may also become an issue.


To promote patient safety, leading Beverly Hills plastic surgeon Dr. Tarick Smiley employs a series of surgical methods to minimize bleeding, with the most notable of these is epinephrine. Before creating the tummy tuck incision, which typically runs from hip to hip, he injects the abdomen with this drug that constricts the blood vessels and thus keeps bleeding well under control.


To further ensure patient safety, in all Dr. Smiley’s surgeries he is accompanied by a board-certified anesthesiologist who keeps the patients’ blood pressure relatively low to control bleeding. Meanwhile, the anesthesiologist also monitors the oxygen level, breathing, heart rate, and other critical life functions.


Recently, Dr. Smiley has performed male tummy tuck in a patient who had lost a significant amount of weight, resulting in a large apron-like skin. The surgery has been documented on his Snapchat as part of his patient safety awareness campaign.


To create gender-appropriate results, Dr. Smiley said the rolls of fat and skin along the flanks should be eliminated together with the apron-like skin hanging from the anterior abdomen. But unlike female patients who require cinching of their waistline, the surgeon said his waist should appear relatively straight, which can be achieved with precise skin excision.


Because men are more reticent about their plastic surgery than women, Dr. Smiley said it becomes more critical to eliminate surgical stigmata such as unnatural navel position and shape, dog ear appearance (skin puckering at one or both ends of the scar), and high riding scar.


During surgery, Dr. Smiley positioned the scar very close to the pubic hairline and so the surgical stigmata would lie beneath the “bikini area.” Furthermore, he closed the wound in which the skin received very little tension, allowing the scar to fade well.

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Pubic lift with tummy tuck creates a smooth transition between the abdomen and the mons pubis, which is the soft mound located over the pubic bone that may sag after large weight loss and pregnancy.


The primary goal of tummy tuck is to remove the redundant skin and fat, leading to a flatter and more streamlined appearance of the anterior abdomen, specifically its four quadrants. But to create natural results and to preserve the natural feminine curves, the adjacent areas such as the mons pubis and flanks should also receive a great deal of attention, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.


pubic lift with tummy tuck

The patient receives pubic lift with tummy tuck as part of her mommy makeover surgery.


The standard tummy tuck technique uses an incision that goes from hip to hip to remove the loose skin and excess fat, and to tighten the abdominal muscle with the use of internal sutures. This results in a curved scar that is concealed by the patient’s underwear.


Nonetheless, incorporating pubic lift often entails lowering further the incision pattern in order to elevate the sagging mons pubis and thus create a smooth transition between the lower abdomen and the area just above the female genitalia.


Pubic lift with tummy tuck requires very precise elevation of tissue as over-correction can lead to unusually high and visible “pubic hairline,” which of course is a telltale sign of plastic surgery. It should be noted that great surgeons make every effort to prevent or at least hide surgical stigmata.


Occasionally, the pubic area is further enhanced by a concomitant liposuction, which reduces the fullness by removing the excess fat. However, over-correction or removing too much fat should be avoided like a plague because it can interfere with sexual enjoyment. It is important to note that some fat should remain after surgery to serve as a “cushion” during an intercourse.


Liposuction can also be used to contour the flanks, further highlighting the feminine curves.

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Tummy tuck recovery takes three to eight weeks and during this period the internal scar tissue that holds the “new contour” is not yet as flexible as the normal tissue. Hence, coughing and sneezing may cause feeling of tightness or pain, or in rare instances even result in suture break along the abdominal wall.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a video on Snapchat to show how permanent sutures are used to “tighten” the rectus muscle. The pair of muscle between the lower and upper abdomen becomes separated due to pregnancy or large weight fluctuations, and thus suturing them together in a side-by-side configuration is one critical component to achieve flatter results from surgery.


Permanent sutures are used to tighten the abdominal wall, leading to flatter appearance and less bunching while sitting.

In the video, Dr. Smiley said the stitch right above the belly button is the most important aspect of muscle repair and may sometimes experience suture break due to abrupt force generated by a “strong” sneeze or an incessant cough.


To prevent too much tightness, pain, and accidental suture break during the critical period of tummy tuck recovery, Dr. Smiley recommends his patients to press a pillow against their abdomen when they feel that a sneeze or cough is imminent. The idea is to minimize the abdominal movement and ultimately the stress on the sutures and scar tissue.


Sneezing and coughing is not the only thing that can put stress on the healing tissue and sutures. Any activity that results in sudden tensing of the abdominal wall should be avoided for a minimum of eight weeks; hence, all patients are advised to postpone rigorous exercise until their scar tissue becomes more flexible.


In general, patients should wait eight weeks before they can gradually resume core body exercises. Nonetheless, light activity (walking and other light aerobics exercises) can be started sooner provided that the patient does not feel any pulling or discomfort.


Most of the tautness and discomfort following tummy tuck stems from muscle repair. Thus, many patients feel more comfortable when they are slightly bent at the waist within the first 10 days, but after this period most can stand up straight without any issue.

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Some plastic surgeons use the term bikini tummy tuck scar to describe an incision technique in which the resulting scar is concealed by the patient’s underwear. While this has become a standard approach nowadays, it is equally important to preserve the natural curves of the feminine physique.


Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley explains the surgical techniques and aesthetic tenets that help his patients get bikini ready for the summer.


bikini tummy tuck scar

Six months after her tummy tuck, the patient remains happy with her results, citing that the well concealed scar and the more streamlined waistline allow her to don a two-piece swimwear, which she hadn’t done for many years.


  • Scar placement


All efforts are made to place the curved hip-to-hip scar beneath the bikini area, very close to the pubic hairline. This allows the patients to wear a two-piece swimwear without having to worry about visible signs of tummy tuck.


Despite the media hype venerating the mini tummy tuck in which the scar is just a few centimeters (almost the same as a C-section scar), it rarely provides smooth results due to the natural distribution of excess abdominal skin. And paradoxically, it does not promote the best scar possible.


It is important to note that a longer scar that is faded and concealed by the patient’s underwear is much better than a shorter scar that rides higher than ideal and has a dog ear’s appearance (i.e., bunching of skin at one or both ends of the scar).


  • Suturing technique


The goal is to allow the incisions to fade into a thin, barely perceptible scar. This is achieved by suturing the wound in deep rows, with the skin surface receiving no or very little tension.


  • Concomitant liposuction of the flanks


Before the actual tummy tuck—i.e., removal of loose skin—a large percentage of Dr. Smiley’s patients receive liposuction of the flanks, allowing him to tighten more skin towards the center, leading to smoother and more athletic looking results.


  • Muscle repair


Muscle repair is one critical element in tummy tuck that further flattens the anterior abdomen. The idea is to “tighten suture” the fascia or connective tissue so the pair of vertical muscles is returned to its side-by-side configuration.


  • Navel repair


Pregnancy and large weight fluctuations can have some detrimental effects on the appearance of navel, turning the once innie into an outie. The belly button may also appear larger or distorted.

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Tummy tuck improves the appearance of the abdomen, which is not an ethnically “sensitive” area (unlike the face, particularly the nose and eyes). Nonetheless, ethnic skin or darker complexion is known to have an increased risk of hyperpigmentation and keloid scar.


Tummy tuck traditionally uses a hip-to-hip incision to remove the skin and fat rolls. Most patients can also benefit from muscle repair in which the two vertical muscles along the midline are sutured closer together, resulting in a flatter appearance.


ethnic tummy tuck

With muscle repair and the removal of excess skin and fat, a good number of patients can expect a more athletic appearance of their anterior abdomen (because of the small grooves caused by the two vertical muscles positioned in a side-by-side orientation).


While there is no ethnic tummy tuck per se, patients with darker complexion may entail a more proactive scar prevention and treatment due to the perceived higher risk of keloids. The use of silicone gel sheets over the [healed] incisions for several months is known to reduce the incidence of aggressive scarring, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


Occasionally, the concomitant use of bleaching agents and/or laser could help prevent or reduce risk of hyperpigmentation of the scars.


Meanwhile, the inconspicuous placement of tummy tuck scar—it should be very low that it is easily concealed by the patient’s underwear—remains important regardless of one’s predisposition to keloids.


As with any body contouring surgery, the success of tummy tuck boils down to meticulous physical analysis and consultation. Another thing to keep in mind is that women of Hispanic and African descent often desire for fuller curves, while Caucasians usually prefer a more petite figure.


By being sensitive to culture-based beauty ideals and the patient’s cosmetic goals, doctors offering tummy tuck surgery typically achieve high patient satisfaction. After all, the purpose of any aesthetic surgery is to elicit a smile from patients.


To achieve fuller curves, some patients ask for a simultaneous Brazilian buttock lift, i.e., buttock augmentation via fat injection. In reality, this is not always a deviation from tummy tuck, which often entails liposuction of the flanks to remove the “fat rolls.”


Instead of discarding the fats collected during liposuction, these are purified and injected into the buttocks to improve their shape and projection. Of course, this additional procedure results in longer operative time and more cost.

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