Revision tummy tuck is generally more complex than the initial surgery due to the presence of old incision lines and scar tissue. Oftentimes, the patients also have some type of navel deformity, contour asymmetry, and residual excess skin, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted a series of Snapchat videos to demonstrate revision tummy tuck performed on a male patient.
A few years ago the patient underwent tummy tuck performed by a different surgeon. But instead of achieving a more masculine physique, the surgery left him with unnatural-looking navel (too big and round), visible asymmetry along his flanks, and high-riding and indented scars.
Aside from revision tummy tuck, the patient also asked for a simultaneous breast reduction to make his chest area congruent with the abdomen.
To conceal the high-riding tummy tuck scar beneath the patient’s underwear, Dr. Smiley created a new incision line (hip to hip) that was positioned very low that it settled within the groin and pubic hairline.
Through the new incision placement, he was also able to eliminate the appearance of indented scar by removing the residual loose skin. Furthermore, he removed more skin along the right flank to eliminate the contour irregularity.
Meanwhile, the celebrity plastic surgeon also performed navel repair, particularly with the intent to reduce its size and change its shape. He said that a natural-looking belly button has a more vertically oriented contour, as opposed to having a perfectly circular shape.
During navel repair, he placed the incision inside the belly button’s rim so the scar will remain imperceptible.
Afterwards, all the incisions were closed by multiple rows of stitches to promote the best scar possible. The skin, meanwhile, was not picked up by any suture and instead a surgical tape held its edges together to reduce superficial tension.
“The key to faded and favorable scar is to eliminate most of the tension on the skin,” says Dr. Smiley.
Dr. Smiley also injected Exparel directly into the abdominal muscle; this is a long-acting numbing medication that works for up to four days, thus allowing the patient to avoid or at least limit his use of narcotic pain relief.
Tummy tuck final shape: Can every patient enjoy a more hourglass figure?
It depends, says leading Orange County plastic surgeon Dr. Tarick Smiley who has about 7,000 tummy tuck surgeries under his belt.
Recently, Dr. Smiley performed tummy tuck on a female patient with loose skin and lots of stretch marks that extended above her navel due to previous pregnancies. However, she had very little fat thanks to her commitment to healthy and active lifestyle.
(Note: Her surgery was recently shown on Dr. Smiley’s Snapchat.)
The celebrity plastic surgeon was able to remove up to 90 percent of stretch marks with meticulous skin incision in which the resulting hip-to-hip scar was hidden beneath the patient’s underwear.
Meanwhile, some Snapchat followers wrote to the surgeon asking why he was not able to deliver “curvier results” as compared to his previous patients with remarkably defined waist line following their surgery.
“While I make every effort to reshape the midsection and adhere to the classic hourglass figure, we cannot simply go past the muscle and bone,” he said.
“We have to put in fillers on the side to give her a more S shape curve,” he further explained.
Fillers, which can be in the form of fat grafts or Sculptra (a type of dermal filler), can help reshape the hips to achieve a more hourglass figure, which is traditionally believed to be the hallmark of female fecundity and beauty.
In general, Dr. Smiley prefers fat graft or fat injection because of the additional contouring effects provided by liposuction, which is the method to collect fats from multiple donor sites.
Despite some limitations in term of the tummy tuck final shape, the surgery nonetheless created significant improvement over the patient’s previous appearance. Aside from removing the loose skin and eliminating about 90 percent of the stretch marks, Dr. Smiley also repaired the enlarged navel.
Navel repair was done by making an incision around its inner rim to conceal the scar. Afterwards, the surgeon reduced its size and made its shape slightly vertically oriented, leading to a more athletic appearance of the abdomen.
Tummy tuck is one of the most popular body contouring surgeries after massive weight loss. This involves removal of loose skin and fat that hangs from the abdomen; oftentimes, it also combines some type of muscle repair (tightening) to further contour and narrow the waistline.
The tummy tuck incision, which typically runs from hip to hip and is beneath the undergarment, generally takes 3-4 weeks to heal—i.e., all the scabs are gone and so there is no longer risk of wound irritation and infection. At this point, patients can start using scar treatments such as silicone sheets and gels.
TUMMY TUCK RECOVERY PHOTOS
While most of the swelling and bruising are already gone by 2-3 weeks, tummy tuck scars take longer time to “stabilize” or reach its maturity. Oftentimes, they look worst at 4-6 weeks postop due to the reddish color stemming from new blood vessels growing beneath their surface.
And after about six weeks following tummy tuck, the scar appearance starts to improve. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says most scars fade gradually over a period of 12-18 months until they leave a white or silver mark that is barely visible.
Meanwhile, a few patients end up with a less than optimal scar appearance (due to keloids or hyperpigmentation in which the scar is noticeably darker than the surrounding tissue). Laser treatments, medical-grade chemical peels, steroid injections, and scar revision are some of the options that can help improve its appearance.
Two months postop.
While certain risk factors of scar are beyond the surgeon and the patient’s control (e.g., genetic propensity to keloids), some methods remain useful in promoting faded scars; these include the use of scar treatments such as silicone patch or gel, sun protection, and scar massage.
In general, tummy tuck scar should never be exposed to the sun for a minimum of six months to prevent hyperpigmentation.
Scar barely detectable after two years.
Tummy tuck recovery with Exparel injection has completely revolutionized postop pain management.
Dr. Tarick Smiley, one of the most prominent Beverly Hills plastic surgeons, uses Exparel in most of his tummy tucks. This drug is injected directly into the abdominal muscle right after surgery while the patient is still on the operating table.
Exparel is a type of local anesthetic (bupivacaine) that is slowly released into the surrounding tissue; its effects can last up to four days. According to studies, patients who had this medication took less pain relievers and were less likely to use narcotics than non-Exparel patients; they also recovered quicker because they breathe better, experienced less stress, and moved more freely.
(Note: Some patients require additional [oral] painkillers, while others may avoid them altogether; it really depends on their pain threshold.)
In addition, Exparel is a non-opioid medication and thus it is not addictive. According to recent studies, patients who use opioid/narcotics for more than three days postop face an increased risk of addiction.
This injectable drug lasts 3-4 days, which is the worst period of the post-surgical discomfort. Afterwards, patients might take non-narcotic pain relief for a few more days until they are able to tolerate the [slight] discomfort.
In the past, narcotic medications were the only option to minimize discomfort following tummy tuck or other surgeries. Aside from risk of addiction, they also have unfavorable side effects that include drowsiness, constipation, abdominal cramps, nausea, and vomiting.
Then came pain pump, which is a small balloon-like device attached with a tube to slowly deliver numbing medications into the surgical site for three days. While it manages the pain quite well, due to its tubes and straps (worn by the patient that goes around the neck) it can restrict one’s movement.
To avoid any cumbersome device, Dr. Smiley now recommends Exparel injection to his patients.
You might be surprised to hear that the benefits of tummy tuck surgery transcend cosmetic improvements. For instance, several studies have found that it can reduce appetite-inducing hormones, which could help patients sustain their weight loss.
Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained some surprising health benefits of the surgery.
After massive weight loss, patients are generally left with apron-like skin and fat hanging from their abdomen. Hence, tummy tuck typically involves a hip-to-hip incision to remove this excess soft tissue.
According to a 2013 study, tummy tuck could help sustain weight loss because it removes copious amounts of fat cells from the abdomen. Researchers have concluded that these cells affect appetite and thus after surgery patients might improve their satiety.
Other studies, meanwhile, have pointed out that sustained weight loss is more likely caused by “tangible” cosmetic improvements that may encourage people to keep a healthy weight.
- Relief from skin-related problems
Sagging skin can trap perspiration, which can lead to non-healing rash and tissue breakdown. In fact, it is not uncommon in MWL patients to use powder, cornstarch, and fabric to minimize the risk of rashes and yeast infections in their skin folds.
The trapped perspiration and moisture not only lead to skin irritations, but also to poor hygiene and foul odor.
- Increased physical activities
Some MWL patients have large redundant skin hanging from their abdomen that weighs as much as 40 lbs. Others even have difficulty moving around due to skin lesions and pain.
Removing the large redundant skin can help improve mobility, which of course is the key to sustained weight loss and physical fitness.
The large apron-like skin and fat may upset a person’s center of gravity, leading to postural problem. Hence, some tummy tuck patients who were previously obese have reported improved posture after surgery.
Tummy tuck also tightens the weak muscle with the use of internal sutures. Consequently, some patients have reported improved posture (and possibly relief from lower back pain) since the stronger abdominal muscle provides better support to the spine.
Tummy tuck with muscle repair ensures a flatter, more athletic abdomen after surgery. Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has demonstrated this technique on Snapchat as part of his patient awareness campaign.
The patient shown in the photos had extensive stretch marks, loose skin, and bulging tummy prior to surgery.
Tummy tuck is more commonly known as a surgery that removes the excess skin and fat hanging from the abdomen. However, this technique alone may not be enough to deliver optimal results unless complemented by muscle repair.
The excessive protrusion of her abdomen, according to Dr. Smiley, was caused by “weakness or poor integrity of the abdominal muscles.”
While the abdominal muscles are elastic, the fascia that holds them together is relatively inelastic; hence, some women with flat tummy may end up with barrel-shaped contour after pregnancy or large weight fluctuations.
Compared to most patients, the woman had a more severe case of abdominal wall weakness, which fittingly required additional suturing and tightening during surgery.
Dr. Smiley started the surgery with the creation of a hip-to-hip incision placed very low—i.e., a few centimeters below the pubic hairline. This incision placement would allow him to remove the excess skin and elevate the sagging mons pubis at the same time.
This is the suture pattern used to repair the loose rectus abdominis muscle. However, the patient’s oblique muscles are included as well due to the extent of her muscle weakness.
After the creation of the hip-to-hip incision, Dr. Smiley separated and lifted off the skin, revealing the loose abdominal muscles.
The celebrity plastic surgeon first worked on the rectus abdominis muscles. This is a pair of vertical muscles that is attached between the ribs and the pubis in the center of the abdomen. It should be noted that this anatomy is commonly repaired during standard tummy tuck.
But due to the extent of her abdominal wall weakness, she required additional muscle repair, particularly of the oblique muscles found on the more lateral side of the tummy.
By tightening the oblique muscles, Dr. Smiley says the patient “can expect more tightening effect and less bulging of the tummy every time she sits down.”
To complement her flatter abdomen, Dr. Smiley reduced the size of her navel with the use of an incision made inside its rim to hide the scar.