One of the most common concerns of patients seeking plastic surgery to remove the redundant skin in their abdomen is that pregnancy after tummy tuck may be risky or might completely reverse its results.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who performs over hundreds of tummy tucks every year, says the surgery does not affect conception or safety of mothers, nor automatically reverse the contouring effects of the procedure.
In his recent Snapchat video post, Dr. Smiley is seen suturing the pair of loose abdominal muscle along the midline between the breastbone and the pubic region to achieve a flatter, more feminine waistline. He says that permanent sutures can limit the effects of “unexpected” pregnancy or even mild to moderate weight gain in the future.
While pregnancy after tummy tuck is safe, Dr. Smiley says it remains best to postpone the surgery until the patient is done having children to ensure near permanent results, or at least does not plan getting pregnant in the near future.
Dr. Smiley says that muscle repair, which he almost always incorporates with tummy tuck, will still allow the body to stretch to accommodate the growing body.
(Note: Some women think that pregnancy after tummy tuck can increase the risk of prematurity. However, one patient who had twins about two years after her surgery says she went full term and had less loose skin afterward as compared to her “pre-tummy tuck” pregnancy.)
Should the patients become pregnant years after their tummy tuck, Dr. Smiley recommends avoiding unnecessary weight gain, which can have more detrimental effects on the surgery’s result than the pregnancy itself.
Because the celebrity plastic surgeon uses permanent sutures during muscle repair, he says the vast majority of his patients who became “unexpectedly pregnant” did not require any type of touch-up and remain happy with their results.
The tummy tuck incision healing time may differ from patient to patient, although most can expect their wound “clinically” healed about two weeks postop, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
In standard tummy tuck, the incision goes from hip to hip positioned very low that it is concealed by the underwear. Due to the natural tension in the area, some patients who are not careful may end up with small wound separations, which can take a long time to heal.
Some doctors suggest their patients to walk slightly flexed at their waist in the first few days postop. After about a week, most of them can walk straight without any problem or some “awkward” tightness.
Furthermore, sleeping in a recliner or “beach chair” position (i.e., the head and upper torso and legs are propped up by large pillows) can also prevent unnecessary strain on the incision.
It is important to avoid anything that can put strain on the incision. For this reason, patients are generally advised to avoid heavy lifting, rigorous exercise, and bending over for a minimum of three weeks.
To promote healing by keeping swelling to a minimum, Dr. Smiley uses drainage tubes, which are typically removed a few days or about a week postop. These grenade-like bulbs, which prevent seroma (fluid buildup), are emptied by patients 2-3 times a day.
Abdominal compression garments, which are typically worn in the first few weeks postop, can also promote healing by preventing large seromas. To some extent they can also encourage smooth results by allowing the skin to heal closer to the body.
The “quality” of postop care is not the only thing that will determine the tummy tuck incision healing time. As with any surgery, it requires advance planning to achieve one’s optimal health and reduce risk of wound healing problems and other types of complications.
A good rule of thumb is to avoid aspirin, non-steroidal anti-inflammatory drugs, herbal supplements, tobacco products, and pretty much anything with blood thinning properties. Furthermore, the patient must achieve her optimal health through superb diet, regular exercise, and stress management prior to surgery.
Travel for tummy tuck requires advance planning to avoid risk of complications, particularly relating to deep vein thrombosis. The problem with long travels (by plane or car) is the prolonged immobility, which could lead to blood clot in legs and more serious problems such as pulmonary embolism.
Inland Empire plastic surgery experts explain the basic guidelines to make travel for tummy tuck a safe endeavor.
- Wait at least a month before traveling by plane.
Many surgeons suggest postponing long flights for at least four weeks to avoid blood clots. Furthermore, staying within the immediate vicinity of the doctor’s office will allow him to monitor and ensure that his patient is healing nicely.
- Possible use of low-dose blood thinner.
Should the patient need to travel by plane sooner than ideal, some doctors recommend a low dose of blood thinner (aspirin) to reduce risk of deep vein thrombosis. “Waiting” nonetheless remains to be the best option.
- Perform light activities such as walking.
Most out of town patients can travel by car around two weeks postop. However, certain precautions are needed to prevent or at least reduce the risk of deep vein thrombosis. The general rule of thumb is to take several stopovers to stretch and walk around.
Good blood circulation through light exercise is one of the best defenses to prevent deep vein thrombosis. Furthermore, it can minimize the effects of narcotic painkillers such as constipation and lethargy.
- A capable adult must always accompany the patient.
Travel by plane means rushing from one airport to the next with a heavy luggage in tow. It is important to avoid strenuous activities, bending from the waist, and over exertion for 3-4 weeks to prevent complications. For this reason, it always makes a sense to bring a friend or family member along when traveling for plastic surgery.
Also, driving is inadvisable when under narcotic painkillers, which cause poor coordination and drowsiness. Just to be safe, patients must have someone to drive them home.
- The patient should build good rapport with a local primary care physician.
Travel for tummy tuck requires advance planning, which typically includes finding a local primary care physician ideally before to the operation. He may be the one to order a pre-op physical exam and fax its results to the plastic surgeon to rule out any medical condition.
The local primary care doctor will also monitor the patient for up to 2-3 months to ensure the latter is healing nicely.
Combining tummy tuck and breast reduction is one of the most popular mommy makeover surgeries. While this has been a routine procedure, theoretically it results in increased bleeding and higher surgical trauma, and ultimately higher risk of complications.
To minimize risk of complications from multiple surgeries, the consensus is to complete combo surgeries in less than 6-7 hours. For this reason, some patients may need a team of surgeons operating simultaneously to limit the operative time.
Furthermore, combining tummy tuck and breast reduction entails a strict patient selection process. The idea is to rule out any medical condition that can increase the risk of complications, particularly relating to wound healing and infection.
Hypertension, blood disorder, heart problem, obesity, and diabetes are just some of the roster of medical conditions that make any elective plastic surgery, particularly when it involves multiple procedures, imprudent.
If tummy tuck and breast reduction surgery is expected to take “too long,” or the patient has a medical condition that makes “combo surgery” inadvisable, the consensus is to have them separately. Nonetheless, procedures done in series also have their downsides such as multiple recovery periods and higher cost (i.e., the patient will pay for anesthesia and OR fees each time).
Increased bleeding is one of the caveats with combining tummy tuck and breast reduction or any other type of combo surgeries. Nevertheless, new techniques can minimize such risk. For instance, leading Beverly Hills plastic surgeon Dr. Tarick Smiley may elect the use of epinephrine injection before creating incisions.
Epinephrine is a drug that constricts the blood vessels thereby reducing the amount of bleeding. This is particularly helpful in tummy tuck, breast reduction, body lift for massive weight loss, and liposuction.
Furthermore, epinephrine can prolong or rather “spread” the numbing effects of local anesthesia, hence the patient could rely less on oral narcotic pain meds, which are linked to constipation, nausea, and lethargy.
The amount of postop pain is another issue with combining tummy tuck and breast reduction. But with proper pain management system, e.g., pain pumps or Exparel injection, most patients will find the initial healing stage (5-7 days) not too unpleasant.
Exparel injection is particularly ideal in combo surgeries. This is injected into the fascia and muscle right before the incision is closed with sutures.
Dr. Smiley says the numbing effects of Exparel can last up to four days without “disrupting” the normal functions of the body as their effects are limited to the surgical site. This is not the case with oral narcotic pain meds, which are known to cause nausea and vomiting.
Reducing tummy tuck bleeding at the time of surgery is one of the most critical steps to minimize risk of complications and promote quicker recovery, as suggested by leading Los Angeles plastic surgery expert Dr. Tarick Smiley.
In his recent Snapchat post, the celebrity plastic surgeon is seen injecting epinephrine before making a hip-to-hip curved incision, which is the standard tummy tuck technique.
(Note: This curved incision is positioned very low that the resulting scar is easily hidden by the patient’s underwear. Furthermore, it is almost always expected to fade significantly and blend in with the skin after about a year.)
By injecting epinephrine, Dr. Smiley can significantly reduce the amount of bleeding, as this drug works by constricting the blood vessels. Aside from tummy tuck, this medication is also helpful in reducing surgical trauma and blood loss during liposuction surgery.
Once the epinephrine takes effect, the surgeon creates a small circular or diamond shaped incision around the navel so it becomes separated from the surrounding skin, but still remains attached to the muscle. Then, he creates a hip-to-hip incision that will allow him to remove the excess skin and tighten the abdominal muscle.
When separating the skin and fat from the muscle, Dr. Smiley uses an electric cautery, which can further reduce bleeding by sealing off the blood vessels. The “separation” is performed up to the breastbone, allowing him to suture and tighten the pair of loose muscle.
Aside from epinephrine injection and meticulous tissue dissection, Dr. Smiley says certain preparations are also critical in reducing bleeding. For instance, in his practice he instructs his patients to avoid aspirin or any other medications that inhibit clotting and healing 2-3 weeks prior to tummy tuck.
Some herbal supplements, vitamins, and homeopathic remedies can also increase bleeding; hence, the patient must notify her doctor if she uses any of these.
Furthermore, patients with hypertension must control this condition through lifestyle change (e.g., weight loss, more exercise, healthier diet, etc.) or medications well in advance of the surgery to prevent bleeding and poor healing, warns Dr. Smiley.
Common ancillary tummy tuck techniques such as liposuction, umbilicoplasty, and muscle repair aim to create a smoother, more natural result, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Tummy tuck primarily aims to remove the apron-like skin that forms after massive weight loss and pregnancy. But for most patients this alone is not enough to provide natural-looking and balanced results.
Dr. Smiley almost always incorporates muscle repair when doing his tummy tuck. This rather critical step is believed to counteract the effects of inadvertent pregnancy and mild to moderate weight gain, in addition to the impressive contouring effects it provides.
During muscle repair, the loose or splayed abdominal muscle that starts below the breastbone and extends down into the pubic region is tightened with internal suture. But instead of the usual “one long running stich” technique, the celebrity plastic surgeon prefers using individual permanent sutures, which are believed to provide a stronger support.
To further achieve a smoother result, tummy tuck techniques may also involve liposuction in which small round incisions are created to remove excess fats via cannula, a flexible hollowed tube attached to a vacuum pump.
Tummy tuck in itself can remove the excess fat in the lower abdomen. However, it cannot eliminate the fat rolls along the flanks and upper abdomens, thus some patients require a simultaneous liposuction for smoother results.
Some patients can also benefit from liposuction of their mons pubis to reduce its fullness and ultimately create a smooth transition between the lower abdomen and the pubic region.
To prevent healing problems due to compromised blood supply, simultaneous liposuction is only ideal when treating areas far away from the hip-to-hip tummy tuck incision and the fat volume is rather small.
But when large volume liposuction is warranted, or the liposuction sites are quite near the tummy tuck incision, it is best to have liposuction at a later date.
Umbilicoplasty, or more commonly referred to as belly button surgery, is another common ancillary procedure of tummy tuck. The goal is to create a new navel that will not distract from the flatter, smoother abdomen.
The “ideal” navel appearance should have its shape vertically oriented with some small hooding on its side, rather than looking like a perfect circle. Furthermore, it should lie at the same level as the uppermost portion of the pelvis in order to appear natural.