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.
Plastic surgeons have developed different types of tummy tuck, aka abdominoplasty, to achieve the best result using the shortest possible incision. The surgery involves a horizontal cut below the navel in order to tighten the weakened abdominal muscles and at the same time remove the excess fat and loose skin.
There are three basic types of tummy tuck, namely the complete abdominoplasty, extended abdominoplasty, and partial abdominoplasty. Meanwhile, it is not uncommon for plastic surgeons to complement the procedure with liposuction to further remove the excess fats.
Remember that the ideal type of tummy tuck primarily depends on the amount of excess skin and fats you have. For instance, partial or mini tummy tuck is ideal if you have less sagging that is mostly on your lower abdomen; however, the same technique would not provide satisfying results if you have a severe case of loose tissue because it has little effect on the upper abdominal area.
Partial tummy tuck has a certain appeal to patients: it uses a very short incision below the navel that heals quickly, allowing the removal of small amount of excess fat and skin from the lower abdomen. At the same time, the technique can also correct the loose abdominal muscles without actually repositioning the navel, which is the case in extended and complete abdominoplasty.
By contrast, complete or full tummy tuck uses a hip-to-hip incision that is positioned close to the pubic region, while another one is put around the navel in order to reposition it to a higher location.
Once the belly button is detached from the surrounding tissue and skin, the surgeon can access the weakened muscles and correct them using tiny sutures before the incisions are sewn together. To protect the surgical site, he will wrap it with a dressing and compression garment.
Meanwhile, the extended tummy tuck uses a longer incision than a complete abdominoplasty, making it more ideal for massive weight loss patients who are left with a severe case of pannus (or hanging tissue and skin). The technique provides additional tightening and contouring, although the tradeoff is the appearance of a longer scar along the sides of the abdomen and upper groin.
As mentioned previously, doctors sometimes complement tummy tuck with liposuction particularly when there is a need to contour the flanks, upper abdomen, back, and thighs. This additional procedure can further smoothen the result, and possibly reduce the amount of postop swelling.
But most of the time doctors will avoid liposuctioning the central abdomen to make sure the area near the horizontal incision maintains a healthy amount of blood supply that could speed up recovery.
As with any body sculpting surgery, tummy tuck or abdominoplasty can only provide predictable cosmetic results if you are near your ideal weight and you are able to maintain it through healthy lifestyle rather than yoyo-dieting and other weight loss programs that are impossible to stick to over the long run.
According to leading plastic surgeon Dr. Tarick Smaili, you must be at least within 25-30 percent of your recommended body weight to be considered a good candidate for any type of body sculpting surgery.
Meanwhile, weight maintenance is more important after surgery because it is the only way to keep the new contour, specifically the narrower waistline and flatter stomach, explains Dr. Smaili.
While it is possible to repeat tummy tuck, the renowned surgeon warns that it could lead to more scarring, additional expenses, and higher risk of skin asymmetry.
Anecdotal reports show that many tummy tuck patients used to be obese or overweight. Since the mid section is the most prone to redundant skin and “fibrous” fat that does not respond to further weight loss, the procedure is considered to be the most important element of total body lift surgery.
In case that you were previously obese, having a stable weight for at least six to eight months is imperative prior to tummy tuck and other forms of body lift. Nevertheless, Dr. Smaili says that sometimes you may have to wait a little longer because it is not uncommon for post-obese patients to be suffering from nutrient deficiencies (e.g., anemia and osteoporosis) because of the sudden change in their diet.
Despite severe deformity caused by massive weight loss, take note that most health insurance issuers do not cover the cost of tummy tuck for post-obese patients because they “categorize” it as a cosmetic plastic surgery.
However, a small study published in the Plastic and Reconstructive Surgery journal last year has suggested that tummy tuck could encourage long-term weight loss by increasing satiety.
The researchers have concluded that removing fat cells from the abdomen could reduce the levels of hormones responsible for triggering a person’s appetite. Nevertheless, they admitted that further studies are still needed to confirm this hypothesis.
Another separate study has suggested that massive weight loss patients were more likely to keep a healthy weight after tummy tuck compared to those who did not undergo the procedure. The researchers have concluded that their new contour could have motivated them to keep a stable weight.
Tummy tuck surgery or abdominoplasty requires a relatively long recovery because it involves removing the excess skin and fat and reshaping the abdominal muscle. In fact, the general rule of thumb is to take things slow for at least three weeks to avoid bleeding and healing problems.
In the first three days of recovery, post-op symptom such as pain and swelling is at its highest peak. To help you cope with the discomfort, your doctor will recommend pain catheter and medications.
It is important to note that while pain meds will not completely eliminate all the post-op discomfort, you still have to move around (i.e., short walks several times a day, although you must slightly stoop to prevent tension on the incision site) to avoid blood clots especially in the legs and increased swelling, which could lead to longer recovery.
In case that you are not still ready to take short, gentle walks, at least try to alternate your resting positions to improve blood flow and avoid muscle stiffness.
While pain medications can minimize discomfort, the tradeoff is that you are at risk of constipation. You can avoid this by taking laxatives, eating foods rich in fiber, and drinking plenty of water especially during the first week of your recovery.
Five to seven days after tummy tuck, most of the pain is gone or at least tolerable. This will allow you become more mobile. Nevertheless, a slightly stooped posture at the hip level while walking or standing is still recommended to reduce the tension on the wound.
While it all depends on your level of comfort, take note that a week after tummy tuck most patients no longer need pain catheter and surgical drains, so during this period expect that you can resume most of your light activities. However, you still have to avoid rigorous exercises and heavy lifting, which could affect your healing.
Within a week or so, your posture will be more upright, although it is not uncommon to experience some slight discomfort because of the “tightness.” During this period, you should also increase the duration of your walks, but not to the point that you feel exhausted.
If your job is not physically demanding, you could return to work within two weeks. Just make sure that you avoid heavy lifting and prolonged standing (more than two to three hours).
A month after tummy tuck, you will start to feel normal again. Nevertheless, you should still avoid rigorous exercises and activities for at least another two weeks, or depending on your surgeon’s instructions.
Tummy tuck or abdominoplasty creates a narrower waistline and preserves the natural curves of the abdominal area by reshaping the skin and deeper muscle, explains leading plastic surgeon Dr. Tarick Smaili.
To further achieve a smoother profile, it is not uncommon to use liposuction to remove the excess fat especially in the flanks and upper abdomen at the time of surgery.
But aside from contouring the soft tissue in the abdomen, the renowned surgeon says that the appearance of navel after tummy tuck can also make or break the result.
The majority of patients require the use of a full tummy tuck wherein a horizontal hipbone-to-hipbone incision is placed as close possible to the pubic region to hide the scars. In this procedure, a new navel is created through a rather complex technique to achieve natural-looking results.
But what really constitutes a natural-looking navel?
Dr. Smaili says that a navel that is perfectly round looks operated and unnatural, so any skilled plastic surgeon will simulate the appearance of “hooding” from 11 o’clock to 2 o’clock.
A natural-looking belly button also appears more oval in shape and is “sufficiently sunken,” the surgeon explains. This appearance is achieved by suturing the top of the navel to the skin flap and deeper muscle fascia.
Aside from the navel’s appearance, Dr. Smaili also highlights the importance of making its size not too small or too large, and positioning it in a way that it looks “balanced” relative to the waist and hips.
Because the new navel may shrink as the skin redrapes to the new contour, some plastic surgeons recommend putting a small retrievable marble a couple of hours every day on the belly button. It is important to keep the area dry and clean to prevent wound infection.
However, Dr. Smaili warns that not every tummy tuck surgeon recommends the practice, adding that it should be only done by patients who are specifically instructed to do so.
In case the patient is not happy with the appearance of her navel, Dr. Smaili recommends waiting at least eight to 12 months before getting a revision surgery to give the skin enough time to shrink and redrape to the new contour.
A revision surgery involving the navel is often considered as a minor procedure performed in a doctor’s office and under local anesthesia.
It is important to note that the tummy tuck results can last a lifetime as long as the patient is able to maintain a healthy weight throughout her life.