Tummy tuck surgery, or abdominoplasty, not just involves skin removal to create a flatter, more toned abdomen. For many patients, they will also require muscle tightening to achieve a smoother contour, as suggested by leading LA plastic surgeon Dr. Tarick Smaili.
Massive weight loss patients and mothers who have developed splayed muscle due to previous pregnancies often need muscle tightening or repair. While this additional procedure contributes to most of the pain and discomfort, and possibly longer recovery, most patients consider its benefits worth it.
To tighten the splayed muscles, doctors either use permanent internal stitches or slow-dissolving absorbable sutures.
Nowadays, absorbable sutures are becoming popular because they are believed to cause less problems compared to permanent nylon stiches that tend to create small tears in the muscle over time.
Dissolvable sutures work by holding the muscles in place until scar tissue forms or the healing process permanently “secures” them. For most patients it takes about six weeks for the muscles to heal together.
While permanent sutures can still provide good results in the hands of skilled surgeons—since their knots are tight and strong and are relatively easy to handle—they might cause problems such as chronic irritation and infections.
The aforementioned complications rarely occur in absorbable sutures because there is no foreign material that stays longer after the surgery. Nevertheless, using them requires great care to prevent knots breaking or becoming loose.
Some surgeons only choose one type of sutures, while others “vary” their choice depending on the underlying anatomies and the patient’s cosmetic goals and expectations.
Other plastic surgeons also use mesh in addition to one or two layers of sutures to further create a stronger support. According to previous studies, the additional “scaffolding” is suitable for massive weight loss patients.
The use of several layers of closure is important to remove or at least minimize the tension on the skin, thus promoting “good” scarring—i.e., thin, flat, and faded scars.
By removing most of the tension on the skin, the wound can heal more efficiently and the scars are less likely to spread, become uneven, or migrate higher (thus becoming more visible), explains Dr. Smaili.
Aside from avoiding external sutures when doing the surgery, many surgeons these days are also using steri-strips and/or silicone tapes. The idea is to further eliminate tension on the skin to promote favorable tummy tuck scars.