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.
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.
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.
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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.
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.
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.
Breast lift with tummy tuck is a common mommy makeover combo surgery. Because of the operation’s extent, this is only reserved for healthy patients who can handle the ensuing recovery, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted on his Snapchat account a case study involving a female patient who requested breast lift with tummy tuck.
The patient flew from Hawaii to have her surgery conducted by the celebrity plastic surgeon who performs over a hundred mommy makeover surgeries every year. (In one Snapchat video post, he revealed that he has already operated on more than 7,000 tummy tuck patients.)
The patient had large areola that aggravated the appearance of her drooping breasts. For this reason, Dr. Smiley recommended reducing her areolar complex to achieve a more proportionate, youthful result.
Using a cookie-cutter device, he delineated the new smaller areola by removing some of the dark-pigmented skin from its border.
After reducing the areola—ensuring that the resulting scar lies precisely at the dark-light skin junction to make it undetectable—Dr. Smiley then used vertical incisions between the nipple area and the breast crease to elevate the tissue, leading to a perkier appearance.
To further achieve impressive breast contour, Dr. Smiley placed incisions parallel to the breast crease; hence, the resulting scar lies precisely at the natural skin fold for its optimal concealment.
(Note: The overall shape of the scar resembles a nautical anchor, thus most surgeons call this breast lift technique as anchor lift.)
While the vertical scar of the anchor lift is in a more obvious location, Dr. Smiley says it generally heals and blends nicely into the background after 6-12 months. However, this is only possible with proper wound closure technique in which there is no or very little tension on the skin surface.
Aside from closing the wound in several rows to eliminate superficial tension, Dr. Smiley says he prefers absorbable sutures, which are known to promote favorable scars and are less likely to cause the appearance of “railroad tracks.”
After breast lift, Dr. Smiley proceeded to tummy tuck in which he used a hip-to-hip incision to remove the sagging skin and repair the abdominal muscle that had become separated due to pregnancy. The resulting scar has been made very low that the patient can wear a scanty two-piece bikini without any problem.
Overtime, the hip-to-hip tummy tuck is expected to fade and shrink almost to the width of a human hair.
Once the incisions from mommy makeover surgery are fully healed, Dr. Smiley recommends the use of silicone sheet and gel; the goal is to hydrate the scar and allow it to fade into the background.
Modified mini tummy tuck could mean a lot of things as each doctor may adjust the name or terminology of the technique they are using. To avoid confusion, a prudent patient should ask for the specific details of her surgery, says renowned Beverly Hills plastic surgeon Dr. Tarick Smiley.
Despite the varying terms, Dr. Smiley says there are generally agreed upon guidelines. For instance, mini tummy tucks use a shorter incision below the navel than the standard technique (or hip-to-hip scar method) entails.
Furthermore, mini tummy tucks do not involve repositioning or improving the appearance of the belly button, which is only achieved by the standard technique as it also involves an incision that goes around the navel.
However, even the length of mini tummy tuck scar varies from patient to patient since the amount of loose skin below the navel is the primary factor determining the extent of incisions. Nonetheless, most of them can expect that their scar is about the size of a C-section cut.
Despite the appeal of mini tummy tucks, particularly relating to their shorter scar as compared to the standard technique, Dr. Smiley says that the vast majority of patients are poor candidates for these modified methods.
The main caveat of mini tummy tuck is that it can only remove a small piece of excess skin below the navel. The technique cannot address any laxity above and around the belly button. And due to the natural diffusion of excess skin following pregnancy and weight loss, the standard tummy tuck remains the most helpful incision method, he explains.
Aside from removing more loose skin, the standard tummy tuck also allows for muscle repair known for its additional contouring effect.
Dr. Smiley says the pair of muscle between the breastbone and the pubic region becomes separated after pregnancy or drastic weight loss, making it necessary to tie them in the midline. The problem with modified mini tummy tuck is that only the area below the navel can be tightened; there is no way to access the upper aspect unless the hip-to-hip standard incision technique is used.
Because of the limitations of modified mini tummy tuck, anecdotal reports suggest that only 2 percent of patients can actually benefit from this technique.
Regardless of the incision length, Dr. Smiley says all efforts are made to ensure that the scar is positioned very low—i.e., just a few centimeters from the external genitalia—so the patients can wear the lowest “low-ride” jeans or shorts available.
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.