Tummy Tuck

Tummy tuck and waist size: Can this body contouring surgery result in a dramatic improvement in the size and contour of the patient’s abdomen?


Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says the vast majority of tummy tuck patients can expect drastic narrowing of their waistline with the right combination of surgical maneuvers.


tummy tuck and waist size

The patient is ecstatic after seeing the results of her tummy tuck.


(Note: The only tummy tuck patients who would experience limited contouring effects are those who have lost large amounts of weight but still remain overweight, and those with diabetes and other conditions that compromise their healing. Since the large apron-like skin causes pain and tissue breakdown, their doctors are more focused on improving their quality of life than refining their physique.)


Traditional tummy tuck uses a hip-to-hip incision to remove the excess skin from the lower abdomen; the skin above the navel is then pulled downward to close the wound in a way that the scar settles very low and is concealed beneath the underwear. However, this method alone is not enough to narrow the girth.


Prior to the creation of hip-to-hip scar, Dr. Smiley occasionally performs liposuction of the flanks to remove the excess fat. In his recent Snapchat post, he said this allows him to tighten and pull more skin centrally during tummy tuck, further contributing to the tapered waist appearance.


To further reduce the waist size and correct the barrel-shaped appearance of the abdomen, Dr. Smiley also incorporates tummy tuck with muscle repair.


Prior to pregnancy or large weight fluctuation, the pair of abdominal muscles is positioned immediately side-by-side right and runs below the sternum and above the pubic hairline.


However, the abdominal wall becomes separated due to the stretching of fascia layer (connective tissue) during pregnancy or large weight fluctuations. Hence, the once flat and athletic-looking abdomen is turned into something that resembles a “barrel.”


To correct the barrel-shaped abdomen, Dr. Smiley uses permanent sutures to bring the abdominal muscles closer to each other, back to their original configuration. He said that he prefers the “individual suturing technique” to the “running stitch” due to the former’s stronger support.


“The individual suturing technique means that each stitch is as strong as the next one,” Dr. Smiley said in his previous Snapchat post.


On average, patients can expect to lose 2-6 inches off their waist following tummy tuck surgery. Nonetheless, the celebrity plastic surgeon said that its long-term success still boils down to the patient’s commitment to healthy lifestyle—i.e., sustainable weight management.

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The appearance of six pack after tummy tuck might be possible with the right surgical maneuvers. Nonetheless, some factors are beyond the surgeon’s control and thus the right candidate for the surgery should understand that to some extent their results are determined by their underlying anatomies and lifestyle.


The appearance of six pack primarily stems from two factors: a well-developed abdominal muscle, and a thin layer of fat between the muscle and skin.


The “after” photo shows more athletic “grooves.”


During tummy tuck, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the hanging skin and excess fat is removed. However, this is not enough to deliver the appearance of six pack and so other surgical maneuvers are utilized as well.


In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had tummy tuck, which resulted in an athletic appearance. This has been possible with a combination of techniques: performing muscle repair, thinning out the fat above the muscle, and placing enough tension during wound closure.


  • Muscle repair


During surgery, Dr. Smiley performed muscle repair in which the pair of vertical muscles between the upper and lower abdomen were tightened in the midline with the use of permanent sutures, which were individually stitched to promote additional support.


By incorporating muscle repair with skin excision tummy tuck, the anterior abdomen appears narrower and there is no or very little bulge every time the patient sits down.


  • Thinning out the fat


A well-developed abdominal muscle will not show through a thick fat. Hence, the fatty tissue beneath the skin must be thinned out, but not completely obliterated.


It is important to preserve some fats between the skin and the muscle to ensure smooth and natural results.


  • Tension


To further ensure the appearance of six pack after tummy tuck, it is important to use the right amount of tension during muscle repair and wound closure.


  • Diet and exercise


The patients are in control of some factors such as their diet and exercise. Hence, the right candidates for tummy tuck or any other forms of body contouring surgery understand the importance of healthy lifestyle to maintain the results long term.

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Tummy tuck surgery removes the hanging skin and excess fat often with the use of a hip-to-hip incision placed very low within the “bikini area” so the resulting scar is well concealed.


Aside from skin excision, the surgery also typically incorporates muscle repair, navel repair, and liposuction of the flanks to further create natural curves and contours.


Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a “special case” of tummy tuck: The female patient previously had appendectomy, resulting in a scar on the right side of the abdomen that was causing asymmetric skin folds [see the “before” picture below].


tummy tuck


Dr. Smiley said the skin fold must be released during tummy tuck to achieve smooth results.


During surgery, Dr. Smiley placed a curved hip-to-hip incision very low that its mid aspect was at the same level as the pubic hairline; this allowed him to remove the loose skin along with the appendectomy scar.


The celebrity plastic surgeon said that prior to surgery he “marked” the patient standing up to assess more accurately how much skin must be removed.


“Marking should be done while the patient is standing since when one is lying down, everything shifts,” he said.


Aside from removing the large skin folds causing the unsightly “rolls,” the celebrity plastic surgeon also performed muscle repair with the use of permanent sutures.


The pair of vertical muscle, which runs between the lower and upper abdomen, is naturally placed side by side until pregnancy or large weight fluctuation causes it to become separated. Hence, Dr. Smiley tightens it with the use of individual permanent suturing technique known to provide additional support and narrowing effect on the waistline.


To further ensure a feminine contour, Dr. Smiley performed navel repair to reduce its size and make it more proportionate to the flatter, narrower waistline. Furthermore, he placed it at the same level as the “stable bone” of the iliac crest or hipbone for the most natural effect.


During navel repair, he placed the incision inside the rim of the belly button to ensure that the scar would remain hidden.

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Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat showing a case study of tummy tuck with lots of stretch marks.


The female patient shown in the videos has a significant amount of stretch marks above and below the navel due to previous pregnancies and weight fluctuations. Furthermore, there was a C-section scar below her belly button.

before tummy tuck


The patient received the standard tummy tuck technique in which the resulting scar went from hip to hip and was positioned very low so it would be well concealed by the underwear.


But before the actual tummy tuck surgery, Dr. Smiley performed liposuction of the flanks. The idea was to remove the excess fat along the lateral trunk so he could “pull the skin better” and ultimately deliver a smoother, more feminine contour.


In the video, Dr. Smiley said he used the tumescent liposuction technique in which the fatty area is infiltrated with a solution that contains epinephrine to control bleeding, and lidocaine, which is a type of local anesthesia to numb the treated site.


After sculpting the flanks with liposuction, he proceeded to the creation of tummy tuck incisions, allowing him to remove the loose skin, together with the stretch marks, in the lower abdomen.


While some of the stretch marks along the upper abdomen were not removed during surgery, there is a significant improvement nonetheless (about 90 percent reduction). It is important to preserve enough skin to allow good wound closure and to ensure a well-concealed tummy tuck scar and “unremarkable” healing.

tummy tuck with lots of stretch marks


Before closing the curved tummy tuck incision, Dr. Smiley tied the separated abdominal muscle that runs between the sternum and the area just above the pubis. He used permanent sutures that were created one at a time to ensure that each stitch was as strong as the next.


Furthermore, Dr. Smiley corrected the supra-umbilical hernia right above the navel, a common issue among tummy tuck patients, he said.


A hernia is a tear in the abdominal fascia, which is a sheet of connective tissue, and so the abdominal fat or intestine pokes through and thus it may lead to medical problems (e.g., blood flow blockage or organ “strangulation”). Hence, this “hole” must be reinforced with sutures or sometimes with the use of mesh by the surgeon performing the tummy tuck.

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Tummy tuck on large belly poses some unique challenges, which should be recognized prior to surgery to achieve the best results possible and to avoid or at least minimize the incidence of complication.


To shed light on the effects of tummy tuck on large belly, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted videos and photos of a female patient who had this anatomy.


tummy tuck on large belly

Before and after photos of a patient with large redundant abdominal skin and fat rolls along her flanks and back—“cosmetic” issues addressed during surgery.


Aside from the apron-like abdominal skin, the patient also had “bra and back rolls” caused by excess superficial fat, which sits close to the skin. This is different from the deeper visceral or intra-abdominal fat that is linked to obesity and so the only way to eliminate it is through weight loss.


To eliminate the fat rolls along the flanks and upper and lower back, Dr. Smiley performed liposuction prior to the creation of tummy tuck incision.


“I always perform liposuction along the flanks first so I would know how much skin to pull and tighten during tummy tuck,” he said.


During liposuction, Dr. Smiley created several small puncture wounds where a hollowed tube called cannula was inserted and used to break up and remove the superficial fats responsible for the “unsightly rolls” that are more apparent in tight clothing.


Afterwards, the celebrity plastic surgeon created a flank-to-flank tummy tuck incision that was made very low, slightly below the pubic hairline, so “the resulting scar is hidden by the patient’s underwear.”


Dr. Smiley said bleeding is one of the issues in tummy tuck and so all efforts are made to minimize it.


“I pre-treat the abdominal area. Epinephrine is injected prior to the creation of tummy tuck incision; this is a drug that constricts the blood vessels to reduce bleeding,” he explained.


Keeping the patient’s blood pressure relatively low, which is possible because of general anesthesia (administered by board-certified anesthesiologist), also contributes to less bleeding and reduced risk of large fluid imbalance, Dr. Smiley added.


Dr. Smiley measures the thickness of the apron-like skin he removes during tummy tuck surgery.

In his previous Snapchat posts, Dr. Smiley said he only works with board-certified anesthesiologist to ensure patient safety.


(Note: Anesthesiologists not just administer numbing medications and sedatives; they also monitor the patients’ vital signs such as blood pressure, oxygen level, and heart rate during surgery.)


Meanwhile, Dr. Smiley removed a chunk of excess skin and fat that almost reached the patient’s knee; it also had a thickness of about 2 inches.


After removing the excess skin and tightening the abdominal muscle, he closed the wound in several rows so the skin would receive no or very minimal tension, which is the key to “favorable” scar, he said.

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Honest discussion and good communications during tummy tuck consultation are the foundations of any successful result, which is generally defined as a postop appearance that satisfies both the patient and her surgeon.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley has explained the topics typically involved during the initial tummy tuck consultation.


tummy tuck consultation

  • Cosmetic goals and expectations


The patient must be able to explain in detail her cosmetic goals, allowing her surgeon to recommend ancillary procedures (such as liposuction of the flanks for a narrower waistline), adjust the incision pattern, and use the appropriate surgical maneuvers.


While a good surgeon respects and acknowledges his patient’s input, he must be able to explain certain limitations and caveats such as the appearance of the hip-to-hip scar, downtime, and risks associated with any surgery.


Meanwhile, patients who have unrealistic goals and expectations or cannot accept the ramifications that come with surgery are poor candidates for tummy tuck or any type of body contouring procedure.


  • Patient’s individual health


The patient’s candidness and commitment will play a critical role to the success and safety of her surgery. She must fully disclose her drug use (including supplements and recreational drugs), medical history and condition, previous surgeries, and drug allergies to her surgeon and anesthesiologist.


  • Incision pattern and other surgical maneuvers


During tummy tuck consultation, doctors conduct physical exam to determine the extent of pannus (loose abdominal skin), condition of the rectus muscle, navel appearance, shape of the flanks, and even the pubis. Not many patients realize that they will also need a pubic lift so the area will not detract from the smoother results.


After the physical exam, the surgeons will explain to their patients the length, shape, and position of their tummy tuck scar; all efforts are made to ensure that it will lie very low that it is easily concealed by the underwear.


  • Patient safety


A good surgeon must not only inform his patients about the benefits of tummy tuck, but also the potential risks. Nonetheless, he must be able to allay their concerns by explaining his contingency plan should problems arise during surgery or afterwards; and the preparation and surgical methods to prevent or at least minimize risk of complications.


Furthermore, reputable tummy tuck surgeons only conduct their operations in an accredited surgical facility and are always accompanied by board-certified anesthesiologists and highly trained medical staff during the operation.


  • Surgeon’s qualifications


Prudent patients can utilize tummy tuck consultation to their advantage. They must ask their plastic surgeons about their qualifications particularly relating to their board certifications (the American Board of Plastic Surgery is the gold standard), education, experience, and training.


Patients can evaluate the “artistic skills” of their surgeons through the before-and-after photos of their actual work and must insist to talk with at least two previous patients.


When looking for tummy tuck surgeons, it doesn’t hurt to seek second or third opinion until the patient has found the doctor she finds to be the “right fit.”


  • Patient’s responsibility and commitment


During tummy tuck consultation, the surgeons explain to their patients that the success of their surgery also boils down to their commitment. For instance, most known healing problems can be minimized by avoiding tobacco products, aspirin and other drugs/supplements with blood thinning effects, and poor lifestyle/diet well in advance of the surgery.


Furthermore, the patients should be committed to their recovery. The general rule of thumb is to avoid rigorous activities, smoking, certain drugs and supplements, and unhealthy diet (particularly foods high in sodium as they can lead to persistent swelling).

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