Bikini body after tummy tuck. This has always been the proverbial request of patients who ask for this type of body contouring surgery in which the apron-like hanging skin and fat from the abdomen is removed, typically with a hip-to-hip incision pattern.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently performed a tummy tuck in a female patient with barrel-shaped abdomen, redundant skin, lots of stretch marks, sagging pubis area, and “boxy” flanks. (Note: The surgery was recently shown on his Snapchat.)
Dr. Smiley places the incision below the pubic hairline so the scar is perfectly concealed by the patient’s underwear or bikini.
During surgery, Dr. Smiley placed the incision “very low and hidden” so the “resulting scar will not show when the patient wears an underwear or a bikini.”
“I place the incision way below the hairline [of the pubic region] to hide the scar and to slightly elevate the sagging mons pubis,” Dr. Smiley says in the video.
Conservative elevation of the mons pubis without excessive tension also ensures a smooth transition between the pubic area and the lower abdomen, further contributing to natural-looking results.
After the creation of tummy tuck incision, Dr. Smiley lifted the skin to reveal the pair of separated or splayed abdominal muscles, which he tied in a side-by-side configuration to help improve the patient’s barrel-shaped abdomen. This was done with the use of permanent sutures known for their additional support.
“By tightening the muscle with internal sutures and paying more attention to the area right above the belly button, we can prevent the appearance of unsightly bulges that tend to be more pronounced when a person is sitting,” says Dr. Smiley.
The celebrity plastic surgeon then removed the hanging skin before closing the wound in which a curved hip-to-hip scar would lie low “beneath the bikini area” for its optimal concealment.
To further improve the shape of the waist, Dr. Smiley tightened the skin with the “right amount of tension” so that a degree of muscle definition would show through. He also pulled the skin “more centrally” for additional “feminine curves.”
Dr. Smiley says that meticulous cutting and excision techniques, in addition to precise suturing methods, “have a significant impact on the healing and the final scar appearance.”
“When cutting the skin, the blade should be held at a 90 degrees angle and it should be moved in one direction. This paves way for meticulous suturing technique in which the goal is to close the wound edges just like you’re arranging puzzle pieces,” he says.
Patients seeking tummy tuck want to have a flatter, more athletic abdomen without any surgical stigmata such as “high-riding” scar, unnatural navel shape or placement, overly tight appearance, and residual fullness of the flanks or upper abdomen.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that fake tummy tuck results can be avoided with meticulous surgical methods specifically created for the patient’s underlying anatomy and cosmetic issues.
The after photo depicts impressive tummy tuck results; there is no visible scar, the feminine curves have been preserved, and the new navel size complements the flatter abdomen.
The incisional placement used in tummy tuck can make or break the results. All efforts are made to ensure that the scar lies very low to the point that it is covered by the patient’s underwear. Also, it should encompass the loose skin to prevent residual fullness and dog ears appearance in which the skin around the scar appears “puckered.”
Due to the natural diffusion of loose abdominal skin caused by pregnancy or massive weight loss, Dr. Smiley says the vast majority of patients will have to accept the hip-to-hip incision pattern to achieve the most natural contouring effects. The short-scar or mini tummy tuck technique, meanwhile, rarely works because it removes just a minimal amount of skin—i.e., only one-third of the anterior abdomen.
Aside from visible or high-riding scar, another common insignia of a fake tummy tuck result is the overly tight transition between the navel and the mons pubis. First and foremost, there should be a gentle curve between these two “points” to ensure natural-looking results.
Overly tight navel-mons junction often stems from over-correction; either too much skin has been removed or the mons pubis has been lifted too much, resulting not just in unnatural tightness but also in pubic hairline “riding higher” and poking out the edges of the underwear.
Nonetheless, some patients need a conservative elevation of their mons pubis, which has the tendency to sag following massive weight loss and pregnancy.
Unnatural belly button also leads to the appearance of fake tummy tuck results. Hence, all efforts are made to preserve its original position, which is done by removing the excess skin around it without cutting it off completely from its stalk (and main blood supply). After excising the redundant skin and fat, the skin above the belly button is pulled down and a small round incision is created in order to expose it.
Furthermore, the scar should be made inside the navel’s rim to prevent visible “stitch lines.” Oftentimes, its size is also reduced to complement the patient’s flatter and more athletic abdomen.
Complementing tummy tuck with liposuction of the flanks and/or muscle repair is another sure way to keep the results as natural as possible. The idea is to create smooth “transitions” between the lower and upper abdomen, and between the anterior abdomen and flanks.
Tummy tuck with Exparel results in less pain and discomfort during the initial stage of recovery. Exparel is a long-acting local anesthetic (Marcaine) that is injected into the abdominal muscle right before closing the incisions with sutures.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, says Exparel can numb the treated area for up to four days, allowing his patients to rely less on postoperative narcotics that may cause vomiting, lethargy, nausea, and constipation.
This drug is injected into the abdominal wall, numbing the surgical site for up to four days.
Exparel is also more convenient than using pain pumps, which are external devices (resembling a small balloon) that slowly release numbing medications into the surgical site.
It makes sense to control the postoperative pain as studies have suggested that when patients feel less pain, they breathe and move easier, which is the key to quicker recovery. Nonetheless, they should remain cautious about their postoperative activities to prevent tear sutures and wound breakdown.
The general rule of thumb is to avoid rigorous exercise and heavy lifting for three weeks. After this period, most patients may gradually increase the intensity of their activities provided they do not experience pain or discomfort, and their surgeons give their go signal.
Exparel can also help control postoperative pain after breast enhancement surgery. It can be injected into the surrounding soft tissue or muscle layer or simply released into the implant pocket.
The only downside to the use of tummy tuck with Exparel is the additional cost, although most patients wouldn’t mind it as long as they have a comfortable recovery.
Male tummy tuck technique has a subtle degree of difference compared when the surgery is performed in women. For instance, men rarely experience diastasis recti, or more commonly referred to as muscle separation, that is commonly linked to pregnancy.
Hence, male tummy tuck technique in general does not incorporate muscle repair, which is almost always warranted by female patients. Thus, men may experience less postop pain and discomfort and ultimately shorter recovery than most women.
The patient seeks tummy tuck to remove his large apron-like skin hanging from the abdomen.
But compared to women, male patients tend to have larger redundant skin that follows massive weight loss. It should be noted that the more skin removed, the higher the risk of compromising the existing blood supply. Increased bleeding and higher surgical trauma may also become an issue.
To promote patient safety, leading Beverly Hills plastic surgeon Dr. Tarick Smiley employs a series of surgical methods to minimize bleeding, with the most notable of these is epinephrine. Before creating the tummy tuck incision, which typically runs from hip to hip, he injects the abdomen with this drug that constricts the blood vessels and thus keeps bleeding well under control.
To further ensure patient safety, in all Dr. Smiley’s surgeries he is accompanied by a board-certified anesthesiologist who keeps the patients’ blood pressure relatively low to control bleeding. Meanwhile, the anesthesiologist also monitors the oxygen level, breathing, heart rate, and other critical life functions.
Recently, Dr. Smiley has performed male tummy tuck in a patient who had lost a significant amount of weight, resulting in a large apron-like skin. The surgery has been documented on his Snapchat as part of his patient safety awareness campaign.
To create gender-appropriate results, Dr. Smiley said the rolls of fat and skin along the flanks should be eliminated together with the apron-like skin hanging from the anterior abdomen. But unlike female patients who require cinching of their waistline, the surgeon said his waist should appear relatively straight, which can be achieved with precise skin excision.
Because men are more reticent about their plastic surgery than women, Dr. Smiley said it becomes more critical to eliminate surgical stigmata such as unnatural navel position and shape, dog ear appearance (skin puckering at one or both ends of the scar), and high riding scar.
During surgery, Dr. Smiley positioned the scar very close to the pubic hairline and so the surgical stigmata would lie beneath the “bikini area.” Furthermore, he closed the wound in which the skin received very little tension, allowing the scar to fade well.
Pubic lift with tummy tuck creates a smooth transition between the abdomen and the mons pubis, which is the soft mound located over the pubic bone that may sag after large weight loss and pregnancy.
The primary goal of tummy tuck is to remove the redundant skin and fat, leading to a flatter and more streamlined appearance of the anterior abdomen, specifically its four quadrants. But to create natural results and to preserve the natural feminine curves, the adjacent areas such as the mons pubis and flanks should also receive a great deal of attention, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.
The patient receives pubic lift with tummy tuck as part of her mommy makeover surgery.
The standard tummy tuck technique uses an incision that goes from hip to hip to remove the loose skin and excess fat, and to tighten the abdominal muscle with the use of internal sutures. This results in a curved scar that is concealed by the patient’s underwear.
Nonetheless, incorporating pubic lift often entails lowering further the incision pattern in order to elevate the sagging mons pubis and thus create a smooth transition between the lower abdomen and the area just above the female genitalia.
Pubic lift with tummy tuck requires very precise elevation of tissue as over-correction can lead to unusually high and visible “pubic hairline,” which of course is a telltale sign of plastic surgery. It should be noted that great surgeons make every effort to prevent or at least hide surgical stigmata.
Occasionally, the pubic area is further enhanced by a concomitant liposuction, which reduces the fullness by removing the excess fat. However, over-correction or removing too much fat should be avoided like a plague because it can interfere with sexual enjoyment. It is important to note that some fat should remain after surgery to serve as a “cushion” during an intercourse.
Liposuction can also be used to contour the flanks, further highlighting the feminine curves.
Tummy tuck recovery takes three to eight weeks and during this period the internal scar tissue that holds the “new contour” is not yet as flexible as the normal tissue. Hence, coughing and sneezing may cause feeling of tightness or pain, or in rare instances even result in suture break along the abdominal wall.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a video on Snapchat to show how permanent sutures are used to “tighten” the rectus muscle. The pair of muscle between the lower and upper abdomen becomes separated due to pregnancy or large weight fluctuations, and thus suturing them together in a side-by-side configuration is one critical component to achieve flatter results from surgery.
Permanent sutures are used to tighten the abdominal wall, leading to flatter appearance and less bunching while sitting.
In the video, Dr. Smiley said the stitch right above the belly button is the most important aspect of muscle repair and may sometimes experience suture break due to abrupt force generated by a “strong” sneeze or an incessant cough.
To prevent too much tightness, pain, and accidental suture break during the critical period of tummy tuck recovery, Dr. Smiley recommends his patients to press a pillow against their abdomen when they feel that a sneeze or cough is imminent. The idea is to minimize the abdominal movement and ultimately the stress on the sutures and scar tissue.
Sneezing and coughing is not the only thing that can put stress on the healing tissue and sutures. Any activity that results in sudden tensing of the abdominal wall should be avoided for a minimum of eight weeks; hence, all patients are advised to postpone rigorous exercise until their scar tissue becomes more flexible.
In general, patients should wait eight weeks before they can gradually resume core body exercises. Nonetheless, light activity (walking and other light aerobics exercises) can be started sooner provided that the patient does not feel any pulling or discomfort.
Most of the tautness and discomfort following tummy tuck stems from muscle repair. Thus, many patients feel more comfortable when they are slightly bent at the waist within the first 10 days, but after this period most can stand up straight without any issue.