Downtime for tummy tuck may differ from person to person, although the general rule of thumb is to take things slow for at least 2-3 weeks. Ideally, patients should take a time off from work during this time so they can focus on rest and avoid stressors, which have been known to delay healing.
As expected, the first few days are the most challenging period; patients need help getting up from a reclined position, and when going to the bathroom as well. Despite decreased mobility, it is highly advisable to walk as frequent as possible to prevent blood clot formation (deep vein thrombosis), to keep swelling to a minimum, and to ultimately promote recovery.
Due to the pulling sensation and discomfort around the midsection, it is not uncommon to walk slightly bent at the waist for about a week postop. But after this period most patients can resume their normal posture.
After 2-3 weeks, patients can gradually increase their physical activities, although anything that involves straining the abdominal muscles and doing rigorous exercise are best avoided for one to three months. People heal differently and so each patient may receive a slightly different postop instructions from his/her surgeon.
Pain and Discomfort
The pain mostly stems from muscle repair in which the pair of abdominal muscles is stitched together to achieve a flatter appearance. However, the amount of tightness and discomfort greatly diminishes by one week.
Because pain is one of the most common concerns of patients, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has started using a new way to control pain: Exparel injection. This drug is injected directly into the muscle during surgery and is expected to provide numbing effects for up to four days.
Exparel has eliminated the need for pain pump, a somewhat cumbersome device that is worn underneath the clothes. It is similar to a balloon with tubes where local anesthetics slowly drip into the surgical site.
Going Back to Work
The ideal time depends on factors such as the patient’s type of work (office vs. physically demanding job), pain threshold, and individual healing. In general, a two-week off will suffice, whereas a three-week vacation is considered as a nice luxury.
At three weeks postop, most patients are back on their feet although it is not uncommon to tire easily or to feel like going to bed earlier than their usual routine. This is expected as their body is still in the process of healing.
Tummy tuck healing complications can be prevented or at least minimized with strict patient selection, preparation, meticulous surgical techniques, patient commitment, and follow-up care, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley shares his core principles to minimize tummy tuck healing complications and ultimately promote the best results possible.
- Identify patients with risk factors for delayed wound healing
Dr. Smiley requires all his patients to pass lab screening and disclose their drug use and medical history to ensure that they can handle the surgery. The idea is to identify risk factors such as bleeding problems, diabetes, weak immune system, and other chronic medical condition; ideally, any elective surgery must be postponed until these are well under control through medication and/or lifestyle changes.
Dr. Smiley says that the success and safety of tummy tuck also boils down to patient candidness during consultation. They must fully disclose their drug and supplement use, previous surgeries, medical condition, results of previous tests, and other health-related information.
By knowing this information, surgeons can help their patients eliminate or at least control risk factors through right preparation.
Furthermore, patients are often instructed to avoid aspirin and other blood-thinners, too much alcohol consumption, and large weight loss a few weeks in advance of their surgery.
- Performing good wound closure
Each doctor has his own preferred wound closure technique, although there are generally agreed upon guidelines such as closing the hip-to-hip tummy tuck incision in multiple rows of sutures, and placing most of the tension on the deepest structures and progressively reducing it as one reaches the superficial layers and skin.
- Taking it slow during recovery
Over-exertion should be avoided for a minimum of three weeks, although most patients can safely return to work within two weeks provided that they are not doing rigorous activities.
Any activity that causes pain, discomfort, and persistent swelling might be a sign of over-exertion or over-straining. Hence, women taking care of small children are typically advised to arrange for childcare for at least 10 days.
A common advice is to stop smoking one month before and after tummy tuck, which typically involves large skin excision. It is important to mention the detrimental effects of nicotine on healing and blood supply, causing it to become constricted and thus increasing the wound complication rate.
Dog ears tummy tuck refers to skin puckering and/or excessive fullness at one or both ends of a scar. While there are ways to prevent or reduce the chance of this minor complication, certain types of patients remain susceptible.
For instance, massive weight loss patients—i.e., those who had lost more than 50 percent of their excess weight—have large redundant skin and markedly poor skin tone that makes them prone to dog ears tummy tuck, with medical literature suggesting that 15-20 percent will even require some type of revision to improve the appearance of their tummy tuck scar.
The first and most critical step to prevent dog ears tummy tuck is to use the right incision technique during surgery.
Nonetheless, there is one potent technique to avoid or at least minimize the risk of dog ears tummy tuck and other surgical “stigmata”: Use the right incision length, placement and shape during surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the vast majority of patients need the standard hip-to-hip incision pattern due to the natural diffusion of loose skin. Meanwhile, the mini tummy tuck in which the scar runs just a few inches below the navel is rarely beneficial.
Using a tummy tuck incision that is too short—i.e., it does not cover the entire span of redundant skin along the abdomen and flanks—is the primary cause of large dog ears, surface irregularities, and less than optimal contour of the waistline.
In order to prevent dog ears tummy tuck, achieve smooth results, and ultimately promote faded and well-healed scars, Dr. Smiley says that massive weight loss patients may even have to accept a longer scar that reaches their posterior flanks.
Despite the longer scar resulting from extended tummy tuck technique, Dr. Smiley says all efforts are made to position it very low that it goes within the groin and pubic hairline. Furthermore, suturing the surgical wound in which there is no or very little tension on the skin surface can help promote the best scar possible (i.e., almost as thin as a human hair and so it blends into the background after 6-18 months).
Another possible way to prevent dog ears is to perform a simultaneous liposuction of the flanks and hips. In Dr. Smiley’s previous posts on Snapchat, he says that with this ancillary procedure he is able to pull and tighten more skin, ultimately resulting in smoother and flatter contour.
Despite best efforts from the surgeon, dog ears tummy tuck may still occur in patients with a markedly poor skin tone. Fortunately, most will only require minor revisions that are performed in-office.
Dog ears revision is usually performed by slightly extending the scar, which allows the surgeon to remove the loose skin. Occasionally, liposuction is used as well to further eliminate the “fullness” at the edge of the scar.
Tummy tuck for men typically deals with large pannus or redundant skin that resembles an apron that hangs down from their lower abdomen. Unlike women who often seek the procedure following pregnancies, male patients request for it after losing large amounts of weight.
Due to the extent of their pannus, tummy tuck for men rarely involves the short-incision technique (mini tummy tuck) in which the resulting scar below the navel only runs a few inches.
To achieve smooth results, Inland Empire plastic surgery expert Dr. Tarick Smiley says the incision must cover the entire span of pannus lest the abdomen and flanks would have unsightly bulges and “skin puckering,” or more commonly referred to as dog ears.
Dr. Smiley says the vast majority of male tummy tucks are done through the standard technique in which the resulting scar goes from hipbone to hipbone; it has a curved shape and runs very low, just above the patient’s pubic hairline for optimal scar concealment.
The incision not just allows the surgeon to remove the pannus. Before excising the redundant skin, they are able to access the pair of vertical muscles, which goes between the sternum and the lower abdomen, and repair it with sutures. The idea is to further tighten the anterior aspect of the abdomen, leading to a more athletic physique.
In some cases the incision is extended into the posterior flanks to reach more redundant skin, a technique aptly referred to as extended tummy tuck. While the scar is longer than that of the standard pattern, at least it remains beneath the patient’s underwear.
For additional contouring effect, Dr. Smiley performs liposuction of the flanks before proceeding to tummy tuck. With this complementary procedure, he is able to tighten more skin and create flatter abdomen.
A good number of male patients seek tummy tuck to address skin breakdown and non-healing irritation caused by the large pannus; hence, some may qualify for health insurance provided that they have presented adequate medical documentations suggesting that their surgery can improve the quality of their life.
What causes dog ears tummy tuck? This is arguably the most common concern of people who want to get rid of their apron-like skin and fat that hangs from their lower abdomen.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos to explain dog ears, which refer to puckering of skin usually at the end of a scar. This is not uncommon after tummy tuck and other body contouring surgeries that rely on skin tightening.
But should dog ears appear after tummy tuck, Dr. Smiley says about 90 percent of the time they go away on their own within a year postop.
In the event that dog ears persist after one year, Dr. Smiley says a small revision (office procedure under local anesthesia) is generally enough to eliminate the puckering or fullness at one or both ends of the tummy tuck scar.
A revision typically entails slightly extending the scar laterally to remove a small amount of skin; however, a few patients may need minor liposuction to further eliminate the fullness.
Dr. Smiley says one way to prevent or at least minimize the risk of dog ears after tummy tuck is extending the scar laterally; the idea is to use an incision pattern that reaches all the redundant skin and fat.
Recently, Dr. Smiley performed tummy tuck on a patient who did not care so much about the length of scar, provided that it would not result in dog ears appearance. Hence, during surgery the surgeon extended the incision line more laterally that it reached her flanks.
Nonetheless, Dr. Smiley placed the tummy tuck incision line within the groin and pubic hairline so the patient’s underwear or two-piece bikini could hide it with ease.
Aside from strategic placement of the incision line, the celebrity plastic surgeon says the use of meticulous suturing techniques also ensures the most favorable scar—i.e., flat, symmetric, and faded line.
The key to achieve the “best” tummy tuck scar is to close the wound in multiple layers without picking up the skin so that no excessive tension can pull its surface, which might cause the scar to migrate higher or thicken.
Tummy tuck pre op markings can play a significant role in the final result. Not only they indicate where the tummy tuck incisions and the resulting scar should lie, they also highlight any pre-existing asymmetry, the center of the torso, and the position of the navel.
In a recent Snapchat video post, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he always marks his patients in a standing position to allow the gravity reveal the “imperfections” and cosmetic issues that need to be addressed. After all, people generally look at themselves in the mirror upright.
Thank to meticulous tummy tuck pre op markings and detailed surgical techniques, the patient enjoys natural looking results and hidden tummy tuck scars.
Meanwhile, tummy tuck is done in a supine position, causing the loose skin and fat to shift. But with meticulous markings, doctors nonetheless will have ease identifying the tissue that needs to be removed and reshaped.
Should the patient require a simultaneous liposuction, the treatment areas are also marked. Dr. Smiley says he often uses it as a complementary procedure to sculpt the flanks, allowing him to further narrow the waistline, which is the hallmark of a pleasing feminine physique.
Most patients will need the standard tummy tuck technique in which the resulting scar goes from hip to hip and is positioned very low that most swimwear designs and panties can hide it with ease. However, massive weight loss patients may have to accept a longer scar that extends into their posterior flanks, allowing their surgeons to remove more loose skin and fat and to sculpt their sides.
Another incision around the navel, specifically inside its rim to hide the scar, is created during tummy tuck so the surgeon can remove the loose skin above. Then, the upper abdominal skin is brought down (like a Roman window shade) so the wound/scar settles beneath the “bikini line.”
Occasionally, the mons pubis is lifted as well to create a smooth, natural transition between the pubic region and abdomen.