The appearance of navel after tummy tuck can make or break the results. The goal is to avoid surgical stigmata such as misaligned belly button, visible scar around it, or perfectly round shape, as suggested by renowned Beverly Hills plastic surgeon Dr. Tarick Smiley who has performed more than 7,000 surgeries to date.
Most people think that tummy tuck simply removes the pannus, an apron-like skin that can sometimes reach the pubis, leading to skin irritation, foul odor, and poor hygiene. However, Dr. Smiley says that the surgery is more than that.
Aside from pannus removal, tummy tuck also typically incorporates muscle tightening, liposuction of the flanks, navel repair, and sometimes even hernia repair.
The correct anatomic position of the navel must be determined to achieve the most natural results possible. Hence, surgeons generally do not detach the belly button from its stalk and main blood supply during the entire surgery.
After removing the excess skin in the lower abdomen with a hip-to-hip incision, the skin in the upper abdomen is pulled down to close the wound and a new hole is cut out to inset the navel. Meanwhile, the scar lies inside the rim of the belly button for its optimal concealment.
Simply put, the navel remains in its original placement, although it may appear a bit higher or lower after removing the loose skin around it.
Meanwhile, the hip-to-hip scar is made very low that even the lowest “low rise” jeans and underwear can cover it. Over time and possibly with the use proactive scar treatments (e.g., silicone sheets and scar massage), it is expected to fade into the background.
Dr. Smiley says that a good number of tummy tuck patients need some type of navel repair, e.g., reducing its size and/or width or turning an outie into an innie. It is also critical to preserve its natural shape—i.e., with a small hooding at around 2 o’clock or 10 o’clock, and it should be somewhat vertically oriented.
The effects of hourglass tummy tuck will depend on many factors such as the surgeon’s skills, ancillary procedures (e.g., liposuction and muscle repair), and patient’s anatomy.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the fundamental factors affecting the final results of hourglass tummy tuck, which he regularly demonstrates on his Snapchat account.
Generally speaking, the more distance between the lowest rib and the pelvic bone the more definition one can achieve from tummy tuck.
Meanwhile, women with a markedly short distance between these two points could not get the same amount of definition achieved by individuals with a “great distance” between them, with or without hourglass tummy tuck.
- Adjunct procedure/s of tummy tuck
Dr. Smiley almost always incorporates muscle repair in his tummy tucks. This rather critical component of the surgery involves tying the pair of loose muscle that extends from the breastbone to the pubic region. Aside from creating a flatter frontal abdomen, he says the procedure makes the results less susceptible to the effects of “unplanned” pregnancy or even mild to moderate weight gain.
Meanwhile, the standard tummy tuck (hip to hip incision) cannot address the appearance of love handles (fat rolls along the flanks) or any excess skin on the sides.
Liposuction can further define the waist and hips by removing the excess fat beneath the skin, while extending the tummy tuck incision into the flanks can help the surgeon remove the excess tissue on the side.
- Surgeon’s technical and artistic skills
Tummy tuck, as with any body contouring surgery, combines art and science. The goal is to remove a precise amount of skin and fat without causing surgical telltale signs such as unacceptable scarring, contour irregularities, navel deformity, and skin asymmetries.
Dr. Smiley, who has performed over 7,000 tummy tucks to date, says that experience allows him to determine the ideal tension during muscle repair and the exact amount of skin removal and fat without destroying the natural curves and contours of the frontal abdomen and waistline.
Will a tummy tuck strengthen my core? Some patients ask this question in the hope of finding some relief or improvement in their back pain.
It is important to note that for most patients, tummy tuck surgery not just removes the apron-like skin hanging from their abdomen; muscle repair is also an important component to achieve a smoother, flatter appearance. To some extent this procedure also results in increased efficiency of the abdominal muscle.
While the surgery does not actually strengthen the core, it can restore the normal function of the abdominal muscle, said leading Beverly Hills plastic surgeon Dr. Tarick Smiley who has performed more than 7,000 tummy tucks.
By repositioning the loose abdominal muscle, its efficiency is improved and thus for some patients the surgery not just gives cosmetic enhancements, but functional-related improvements as well, he explained.
To access and repair the abdominal muscle, the celebrity plastic surgeon uses a hip-to-hip incision made very low so the resulting scar is well concealed by the patient’s underwear. Afterwards, he will separate and lift off the skin to reveal the pair of muscle that goes from the breastbone to the pubic region.
In his recent Snapchat video post, he explained his preferred suturing technique.
“I prefer using the individual stitch technique, as opposed to one continuous stitch, to ensure that the next stitch is as strong as the previous one,” he said.
For additional strength, Dr. Smiley said he also used permanent sutures to tighten and support the separated or splayed muscle in the midline, thus it is less susceptible to aging or even unplanned pregnancy and mild to moderate weight gain.
After tying the abdominal muscle in the midline, Dr. Smiley then removed the excess skin from the lower abdomen before pulling down the skin above in order to close the wound.
The skin removal aspect of the surgery involves high precision to allow for proper wound closure and favorable scarring in which the scar is positioned very low that the patients can wear a two-piece bikini without having to worry about visible surgical stigmata, Dr. Smiley said.
Meanwhile, Dr. Smiley said that recovery after tummy tuck entails avoiding rigorous activities, particularly if they involve strengthening and resistance exercise, for 3-4 months to avoid healing problems.
However, most patients can resume light exercise (walking and other low-impact aerobics) at 2-3 weeks postop, he added.
Out of town tummy tuck can be safely done as long as the patient practices due diligence, which all boils down to choosing a board-certified plastic surgeon. In the US, the only board-certifying body recognized by health authorities is the American Board of Plastic Surgery (ABPS).
Aside from board certification, “judicious” doctor selection should also include his experience. A good rule of thumb is to find a surgeon who performs over a hundred tummy tuck procedures every year and a long list of before-and-after photos of his actual patients to back it up.
Take note that body contouring plastic surgery encompasses many procedures; hence, a surgeon great at breast augmentation may not always be the perfect choice for someone seeking tummy tuck.
Out of town tummy tuck requires advance planning. In general, lab screening (e.g., blood and urine exam) is generally conducted 10-14 days before surgery to rule out chronic medical condition and risk factors (use of tobacco and aspirin and aspirin-like products) that can impede healing or optimal results.
Lab screening might be done in the patient’s state (or country) or in the surgeon’s vicinity.
Out of town patients will be given preliminary information by the surgeon’s staff. This typically includes the estimated cost, travel arrangements, recovery facility, ideal length of stay, and list of preparations (e.g., foods, drinks, and drugs to avoid).
Should they find the “arrangements” reasonable, they may speak with their surgeons via Skype, or they may arrive a few days before their scheduled surgery to discuss the surgical plans and their cosmetic goals and expectations with their doctors.
Meanwhile, world-renowned plastic surgeon Dr. Tarick Smiley typically requires his patients to stay within the vicinity for about two weeks to make follow-up visit convenient. Furthermore, long travels (by car or plane) are best postponed for at least 10 days to prevent deep vein thrombosis, a serious complication in which blood clots form in a vein located deep inside the body (usually affecting the pelvis, arms, or legs).
Ideally, the surgeon’s staff should help out of town tummy tuck patients arrange their travels, especially in terms of booking a hotel room and finding an airport shuttle service. The goal is to make the whole experience less stressful and so they can focus more on their recovery and ultimately put their mind at ease.
In the ideal scenario, out of town patients should be accompanied by at least one relative or friend to help them move around during the first few days postop. If this is not possible, the clinic staff may recommend a private nurse or they might be required to stay at a hospital or recovery facility until they can walk without risk of fainting, and their pain has dissipated significantly.
Patients can do their part to prevent or at least minimize their risk of tummy tuck wound breakdown. It all boils down their level of cooperation and commitment to achieve their optimal health and eliminate risk factors such as obesity, smoking, use of aspirin, and over-exertion during the initial healing stage.
Experts at the California Surgical Institute explain how the patients themselves can reduce risk of tummy tuck wound breakdown and ultimately achieve the best results possible from the surgery.
Obesity, diabetes, and other chronic medical conditions can impede healing. For this reason, tummy tuck or any other types of elective plastic surgeries are only reserved for patients with no medical issues that can increase the risk of wound separation and infection.
Some patients are required to postpone tummy tuck so they can shed the extra pounds, recover from malnutrition or anemia after massive weight loss, or control medical conditions before their surgery.
Moreover, “staying healthy” means eating more lean meat, healthy “carbs” (as opposed to processed carbs such as white pasta and bread), and fresh fruits and vegetables.
Smokers face an increased risk of poor healing, skin necrosis, infection, and pulmonary-related complications, just to name a few. For this reason, the general rule of thumb is to avoid tobacco products for a minimum of three weeks prior to surgery so the body will have sufficient time to flush out the nicotine and other harmful chemicals of smoking.
It is important to note that occasional or social smokers may face the same amount of risk as a chain-smoker. Simply put, even smoking one stick a day could compromise healing or even the entire result of tummy tuck.
- Never rush one’s recovery
As previously stated, patient commitment will also play a critical role in the success of tummy tuck or any type of body contouring.
The general rule of thumb is to avoid heavy lifting, bending from the waist, and strenuous activities for a minimum of three weeks postop. But even after this period, most patients are advised to begin with light exercise first before they gradually progress to a more rigorous regimen. Just to be on the safe side, they should never start any activity without their surgeon’s permission.
- Follow the surgeon’s postop instructions
Postop instructions typically include wound cleaning (it is important to practice good hygiene such as washing one’s hand before and after changing her dressing); use of prophylactic [preventive] antibiotics; diet; and activity limitations.
Tummy tuck skin removal is a highly precise body contouring surgery. The surgeon must strike the perfect balance between removing the hanging skin without creating too much tension or leading to over-resection that it destroys the natural valleys and contours of the waistline.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley regularly posts educational videos on his Snapchat account to demonstrate how he achieves good results from tummy tuck skin removal surgery, which is almost always combined with muscle repair, umbilicoplasty (navel repair), and/or mons pubis lift to achieve proportionate results.
In his recent Snapchat video post, the celebrity plastic surgeon says “having artistic eyes” is the key to achieve natural-looking, smooth results from tummy tuck surgery; hence, he highlights the importance of doctor’s experience, which allows one to hone his skills.
“The amount of skin removal will primarily depend on the tension. We don’t want to over-resect the tissue because doing so does not allow for good wound closure, which of course precludes good scarring,” he says.
At the other end of the spectrum, removing too little skin could result in residual sagging and surface irregularities, Dr. Smiley warns.
Aside from the amount of excised skin, another key issue is the “shape.” Doctors typically remove a wedge-shaped skin on each side of the lower abdomen for natural but tight results. Nonetheless, all efforts are made to ensure that the resulting hip-to-hip scar will lie very low that the underwear can conceal it easily.
Wound closure is another critical aspect of tummy tuck skin removal. To ensure that the scar will fade into color and remain thin (almost the width of a hairline), Dr. Smiley sutures the wound in several deep layers so the skin surface will receive no or very little tension.
And with little “superficial” tension, “the scar is encouraged to heal and fade to the best of its ability,” he says.
Aside from skin removal, Dr. Smiley almost always tightens the pair of vertical muscle that runs between the breastbone and the pubic area with the use of permanent sutures; this is a critical part of surgery that ensures flatter, smoother abdomen.
Tightening the abdominal muscle with permanent sutures could also minimize the effect of “unexpected” pregnancy and moderate weight gain, says Dr. Smiley.