Tummy tuck is one of the most popular body contouring surgeries after massive weight loss. This involves removal of loose skin and fat that hangs from the abdomen; oftentimes, it also combines some type of muscle repair (tightening) to further contour and narrow the waistline.
The tummy tuck incision, which typically runs from hip to hip and is beneath the undergarment, generally takes 3-4 weeks to heal—i.e., all the scabs are gone and so there is no longer risk of wound irritation and infection. At this point, patients can start using scar treatments such as silicone sheets and gels.
TUMMY TUCK RECOVERY PHOTOS
While most of the swelling and bruising are already gone by 2-3 weeks, tummy tuck scars take longer time to “stabilize” or reach its maturity. Oftentimes, they look worst at 4-6 weeks postop due to the reddish color stemming from new blood vessels growing beneath their surface.
And after about six weeks following tummy tuck, the scar appearance starts to improve. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says most scars fade gradually over a period of 12-18 months until they leave a white or silver mark that is barely visible.
Meanwhile, a few patients end up with a less than optimal scar appearance (due to keloids or hyperpigmentation in which the scar is noticeably darker than the surrounding tissue). Laser treatments, medical-grade chemical peels, steroid injections, and scar revision are some of the options that can help improve its appearance.
Two months postop.
While certain risk factors of scar are beyond the surgeon and the patient’s control (e.g., genetic propensity to keloids), some methods remain useful in promoting faded scars; these include the use of scar treatments such as silicone patch or gel, sun protection, and scar massage.
In general, tummy tuck scar should never be exposed to the sun for a minimum of six months to prevent hyperpigmentation.
Scar barely detectable after two years.
Tummy tuck recovery with Exparel injection has completely revolutionized postop pain management.
Dr. Tarick Smiley, one of the most prominent Beverly Hills plastic surgeons, uses Exparel in most of his tummy tucks. This drug is injected directly into the abdominal muscle right after surgery while the patient is still on the operating table.
Exparel is a type of local anesthetic (bupivacaine) that is slowly released into the surrounding tissue; its effects can last up to four days. According to studies, patients who had this medication took less pain relievers and were less likely to use narcotics than non-Exparel patients; they also recovered quicker because they breathe better, experienced less stress, and moved more freely.
(Note: Some patients require additional [oral] painkillers, while others may avoid them altogether; it really depends on their pain threshold.)
In addition, Exparel is a non-opioid medication and thus it is not addictive. According to recent studies, patients who use opioid/narcotics for more than three days postop face an increased risk of addiction.
This injectable drug lasts 3-4 days, which is the worst period of the post-surgical discomfort. Afterwards, patients might take non-narcotic pain relief for a few more days until they are able to tolerate the [slight] discomfort.
In the past, narcotic medications were the only option to minimize discomfort following tummy tuck or other surgeries. Aside from risk of addiction, they also have unfavorable side effects that include drowsiness, constipation, abdominal cramps, nausea, and vomiting.
Then came pain pump, which is a small balloon-like device attached with a tube to slowly deliver numbing medications into the surgical site for three days. While it manages the pain quite well, due to its tubes and straps (worn by the patient that goes around the neck) it can restrict one’s movement.
To avoid any cumbersome device, Dr. Smiley now recommends Exparel injection to his patients.
Facial proportions refer to the relationship in size and placement between features, while symmetry pertains to how similar the left and right side of the face appear, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Just like artists who need to an in-depth knowledge of facial proportions to create their masterpiece, facial plastic surgeons must also possess such critical but nonetheless hard-to-grasp concept of beauty and balance.
But what constitute a face that is deemed attractive? And what are the features that distinguish it from plain and not-so-pleasant ones? Or does the axiom “beauty is in the eye of the beholder” have merit despite claims made by scientists and researchers suggesting that there are indeed mathematical ratios that can quantify objectively the level of attractiveness or lack thereof?
On top of these conundrums surrounding physical attractiveness, some research studies have pointed out that the perception of beauty is affected by variables that include culture, media, and socio-economic background.
Nonetheless, Dr. Smiley believes that beauty does possess certain hallmarks that transcend culture and milieu; these hallmarks, he suggests, can help plastic surgeons deliver natural and pleasant results from rhinoplasty (nose reshaping), facial implants, fat injection, chin reduction, etc.
Chin and Jawline
When the face is divided into three horizontal segments—from the forehead hairline to the outside corner of the eyes, from the eyes to the base of the nose, and from the base of the nose to the chin margin—and their distances are all equal, the face is considered more attractive.
The aforementioned ratio can help guide surgeons during chin reduction/augmentation and jawline enhancement.
Rhinoplasty, aka nose job
A nose deemed attractive has a breadth that is similar to the distance between the eyes; however, it does not strictly apply to ethnic noses, which can even tolerate a slight nostril flare that may even contribute to facial attractiveness.
Furthermore, the length of the nose is ideally equal to the chin’s vertical height in order to increase the attractiveness of the face. It should be noted that the chin and the nose play a critical role in facial proportion and harmony and thus it is not uncommon to combine rhinoplasty and chin augmentation.
Typically, the length of attractive faces is roughly one-and-a-half times longer than their width. This hallmark of beauty and youth may guide plastic surgeons during cheek augmentation (via implants or fat injection) and buccal fat reduction.
Furthermore, the lower two-thirds of a youthful face has an inverted triangle shape thanks to fullness of the upper cheek (or prominent cheekbone), which gently tapers toward the lower cheek and jaw.
Forehead and hairline
The ancient Greeks believed that the Golden Ratio, now more commonly referred as the Divine Proportion or phi (1.618), was the key to beauty and was seen in nature. When applied to facial proportions plastic surgery, it states that the ideal distance between the forehead hairline and the upper eyelid is 1.6 times the distance between the top of the upper eyebrow and the lower lid.
Hence, the concept of phi might be applied during brow and forehead lift surgeries.
You might be surprised to hear that the benefits of tummy tuck surgery transcend cosmetic improvements. For instance, several studies have found that it can reduce appetite-inducing hormones, which could help patients sustain their weight loss.
Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained some surprising health benefits of the surgery.
After massive weight loss, patients are generally left with apron-like skin and fat hanging from their abdomen. Hence, tummy tuck typically involves a hip-to-hip incision to remove this excess soft tissue.
According to a 2013 study, tummy tuck could help sustain weight loss because it removes copious amounts of fat cells from the abdomen. Researchers have concluded that these cells affect appetite and thus after surgery patients might improve their satiety.
Other studies, meanwhile, have pointed out that sustained weight loss is more likely caused by “tangible” cosmetic improvements that may encourage people to keep a healthy weight.
- Relief from skin-related problems
Sagging skin can trap perspiration, which can lead to non-healing rash and tissue breakdown. In fact, it is not uncommon in MWL patients to use powder, cornstarch, and fabric to minimize the risk of rashes and yeast infections in their skin folds.
The trapped perspiration and moisture not only lead to skin irritations, but also to poor hygiene and foul odor.
- Increased physical activities
Some MWL patients have large redundant skin hanging from their abdomen that weighs as much as 40 lbs. Others even have difficulty moving around due to skin lesions and pain.
Removing the large redundant skin can help improve mobility, which of course is the key to sustained weight loss and physical fitness.
The large apron-like skin and fat may upset a person’s center of gravity, leading to postural problem. Hence, some tummy tuck patients who were previously obese have reported improved posture after surgery.
Tummy tuck also tightens the weak muscle with the use of internal sutures. Consequently, some patients have reported improved posture (and possibly relief from lower back pain) since the stronger abdominal muscle provides better support to the spine.
Although chin reduction surgery is done in several ways, the goal remains the same: to improve facial proportions and physical attractiveness, which scientists and artists believe can be quantified by mathematical ratios.
Renowned Inland Empire plastic surgeon Dr. Tarick Smiley says the chin, along with the nasal tip and forehead, plays a critical role in facial profile and harmony.
Chin plays a critical role in facial profile and harmony. (Photo credit: Ambro at FreeDigitalPhotos.net)
To determine if the chin is too long for the face, the latter is divided into three horizontal segments—from the hairline to the middle of the eyes, from the middle of the eyes to the base of the nose, and from the base of the nose to the chin. Ideally the distance should be [approximately] equal to each other.
Oftentimes, chin reduction is done by shifting the chin backwards and shaving the bone margins. This is either accomplished through incisions made inside the mouth or behind the chin.
It should be noted that shaving the chin would not just change its vertical height and profile, but also its inherent shape.
Contrary to popular belief, markedly prominent chins are not just a simple bone “problem.” Oftentimes, abnormal projection and height also stems from too much skin and muscle, which if not properly addressed could result in sagging and other surgical stigmata.
Occasionally, chin reduction also involves cleft removal and symmetry improvement.
Unlike its antithesis chin augmentation (which can be done via implant or fillers), reduction surgery involves a more invasive approach and thus it leads to longer downtime. In fact, “social” recovery can take up to six weeks due to the amount of swelling and bruising.
It should be noted that while most patients are back on their feet 10-14 days postop, strenuous activities and heavy lifting should be avoided for 4-6 weeks to prevent healing problems.
Also, patients are generally asked to stick to soft food or liquid diet in the first few days postop to minimize movement of the jaw and chin, which in turn can promote healing.
Fat grafting, also called fat injection and fat transfer, involves removing fat tissue from other parts of the body, which is immediately processed into liquid to be injected into the soft tissue that requires additional volume. In facial rejuvenation surgery, this has completely revolutionized how surgeons eliminate or reduce signs of aging.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos to demonstrate liquid facelift via fat grafting performed on a female patient.
Dr. Smiley uses liquid facelift to conceal the patient’s pre jowl sulcus.
“Liquid facelift is a non medical term used to describe fillers or volumizers that are used to correct the appearance of gaunt cheeks, poor transition between the lower lid and cheek, and other signs of soft tissue atrophy or shrinkage,” says Dr. Smiley.
The female patient shown in the Snapchat videos had sought liquid facelift via fat grafting to correct three specific problems: prominent lines below her eyelids, flat mid cheek, and pre jowl sulcus.
Pre jowl sulcus is different from “true” jowl, which is the appearance of slack flesh along the jaw.
Pre jowl sulcus is a subtle bulge on both side of the chin that is a precursor to a full-blown jowl. Instead of standard facelift, this early sign of aging can be concealed by liquid facelift, which can be in the form of fat grafting or traditional fillers such as Radiesse and Juvederm.
Some doctors call liquid facelift via fat grafting as a minimal downtime procedure because patients are back on their feet immediately afterwards; however, the social downtime is almost comparable to facelift surgery—i.e., the swelling and bruising will take about 1-2 weeks to subside.
Bruising particularly affects the tear trough in which the skin is the thinnest. But by the third week, most patients are happy with the results although that they would lose a bit of volume (as the swelling further subsides) over the next 3-6 months.
For most patients, the final results of their surgery become apparent after six months.
Aside from volume improvement, Dr. Smiley says fat grafting also provides some lifting effect although not as substantial as the standard facelift surgery in which long incisions are made behind the hairline and within the ear’s curvature.
Also, patients who receive fat grafting can expect some improvements in the texture and appearance of their skin as fats contain copious amounts of stem cells, says the celebrity plastic surgeon.