One of the goals of tummy tuck surgery, or abdominoplasty, is to deliver smooth skin—i.e., no hanging and redundant skin, bulges from incorrect wound closure or residual fats, or thick scars.
Impressive results from the surgery also preserve the natural valleys and shapes of the abdomen. For instance, the flanks or contours on the sides should appear smooth, and the area between the rib cage and pubis should have no fat rolls or any sign of asymmetry.
Leading Beverly Hills plastic surgeon Dr. Tarick Smaili says smooth results are achieved by removing just the right amount of excess skin. Too little and the hanging appearance will remain, and too much the abdomen will look overly tight and fake.
The amount and location of redundant skin will dictate the tummy tuck scars and their pattern, although Dr. Smaili says the general rule of thumb is to position them beneath the bikini area so they remain discreet.
Most patients are suitable for the standard tummy tuck in which a U-shaped or relatively straighter scar from hip to hip is used, while massive weight loss patients may have to accept a longer scar that reaches their flanks for an additional amount of contouring.
Dr. Smaili says it is crucial to examine the quantity and quality of skin, which will dictate the scar pattern and length. Failure to acknowledge this anatomy—such as using shorter incisions despite the apparent need for a large correction—will lead to skin asymmetries, destruction of the abdominal contour, weird-looking navel and other “stigmata” of surgery, and poor healing.
Aside from the condition of skin, the leading Beverly Hills plastic surgeon highlights the importance of examining the abdominal fat, which may contribute to the appearance of lower pooch, muffin tops, and unsightly rolls. For this reason, he occasionally combines tummy tuck surgery with liposuction.
But if one requires large-volume liposuction, Dr. Smaili suggests staging the procedure to limit the surgical trauma, minimize the risk of complication, and achieve a more predictable result (liposuction first then followed by tummy tuck weeks or months afterward).
Nevertheless, over-correction or aggressive liposuction of the flanks and the quadrants of the abdomen is counterproductive especially if the goal is to achieve smooth results, Dr. Smaili warns.
And lastly, it is important to repair or tighten the muscles (with the use of internal sutures) that have become separated due to massive weight loss or pregnancy, he adds.