Common ancillary tummy tuck techniques such as liposuction, umbilicoplasty, and muscle repair aim to create a smoother, more natural result, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Tummy tuck primarily aims to remove the apron-like skin that forms after massive weight loss and pregnancy. But for most patients this alone is not enough to provide natural-looking and balanced results.
Dr. Smiley almost always incorporates muscle repair when doing his tummy tuck. This rather critical step is believed to counteract the effects of inadvertent pregnancy and mild to moderate weight gain, in addition to the impressive contouring effects it provides.
During muscle repair, the loose or splayed abdominal muscle that starts below the breastbone and extends down into the pubic region is tightened with internal suture. But instead of the usual “one long running stich” technique, the celebrity plastic surgeon prefers using individual permanent sutures, which are believed to provide a stronger support.
To further achieve a smoother result, tummy tuck techniques may also involve liposuction in which small round incisions are created to remove excess fats via cannula, a flexible hollowed tube attached to a vacuum pump.
Tummy tuck in itself can remove the excess fat in the lower abdomen. However, it cannot eliminate the fat rolls along the flanks and upper abdomens, thus some patients require a simultaneous liposuction for smoother results.
Some patients can also benefit from liposuction of their mons pubis to reduce its fullness and ultimately create a smooth transition between the lower abdomen and the pubic region.
To prevent healing problems due to compromised blood supply, simultaneous liposuction is only ideal when treating areas far away from the hip-to-hip tummy tuck incision and the fat volume is rather small.
But when large volume liposuction is warranted, or the liposuction sites are quite near the tummy tuck incision, it is best to have liposuction at a later date.
Umbilicoplasty, or more commonly referred to as belly button surgery, is another common ancillary procedure of tummy tuck. The goal is to create a new navel that will not distract from the flatter, smoother abdomen.
The “ideal” navel appearance should have its shape vertically oriented with some small hooding on its side, rather than looking like a perfect circle. Furthermore, it should lie at the same level as the uppermost portion of the pelvis in order to appear natural.
Buttock augmentation with implants and fat graft offers unique benefits, particularly to naturally thin patients in which a fat transfer-alone approach cannot deliver the desired results.
While buttock augmentation via fat transfer can mostly deliver good results, the results will largely depend on the donor sites or liposuction sites. For this reason, patients with low body fat percentage (e.g., body-builders and naturally thin people) can benefit more with buttock augmentation with implants and fat graft.
With this combo procedure, most of the augmentation will come from the implants, while the fat grafts will serve just as additional soft tissue coverage to minimize rippling, palpability, and other surgical stigmata. Simply put, the results will appear more natural, smoother, and softer.
Aside from hiding the “signs” of butt implants, simultaneous fat graft can also help reshape the waistline, leading to a more hourglass figure, according to the California Surgical Institute website.
It is important to note that fat graft typically uses the lower back, hip-flank region, and frontal abdomen as the donor or liposuction sites. As a result, the projection and contour of the buttocks are further emphasized.
Furthermore, an implant-alone approach cannot improve the hips. Hence, about one-third of the transferred fat is ideally used in the area to deliver a more feminine figure. The remaining amount is then used to improve the projection of the actual buttocks.
However, most surgeons feel that buttock augmentation with implants and fat graft should not be performed at the same time due to the issue of low survival rate. It is important to note that the transferred fats must form new blood supply for them to persist long term.
If the implants are placed at the same time, the amount of blood flow is greatly diminished and the additional “pressure” can lead to low survival rate of fat grafts.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that with proper handling of fat grafts, about 70 percent of them are expected to last a lifetime. Hence, blood supply ingrowth is a critical issue in buttock augmentation with fat transfer.
Some doctors prefer doing fat graft surgery first to give their patients enough time to decide if buttock implants are warranted, while others do this in reverse.
There are several factors influencing male breast reduction surgery cost; these include the surgical maneuvers (excision-based techniques, liposuction, or both), clinic location, surgeon’s fee, among others.
Sometimes, insurance coverage for male breast reduction is possible provided that the abnormal enlargement of the breasts, a condition referred to as gynecomastia, poses serious health problems. A good example is a tumor developing alongside with the tissue.
Another situation that makes insurance coverage possible is that gynecomastia comes with extreme pain and discomfort.
Meanwhile, health insurance issuers rarely recognize psychological and emotional benefits as valid reasons for coverage. Simply put, the patient must provide sufficient evidence that his condition poses a serious medical condition.
Because most patients seeking for male breast reduction do not qualify for insurance coverage, they must be in good financial position prior to the operation. The consensus is to have available funds at least twice the actual cost of the surgery as a way to prepare for “unexpected” events like a longer than usual recovery and the need for some type of revision.
In Beverly Hills plastic surgery, the average male breast reduction surgery cost involving excision-based techniques (i.e., removing the excess glandular tissue and possibly some skin and fat) is between $5,000 and $7,000.
For liposuction-alone surgery, which is only reserved for patients with a condition called fake or pseudo gynecomastia, the average cost is between $3,000 and $5,000.
But sometimes, the excess fat extends far into the armpit area, which of course also requires this treatment to achieve smooth results, thus increasing the cost.
Pseudo gynecomastia means the underlying problem is the excess fat. However, the vast majority of male breast enlargements are caused by too much tissue, which is typically removed by creating a U-shaped incision precisely at the lower border of the areola.
While it may be tempting to choose a surgeon offering the lowest price, it is important to note that using this as a benchmark could preclude one from selecting a qualified doctor.
Qualified doctors, i.e., board-certified plastic surgeons who perform the surgery on a regular basis, will not lower the price too drastically because of the cost involving accredited surgical facility and anesthesiologist (and other licensed professionals and staff).
A surgery that is priced way too low can be interpreted as a sign of desperation, i.e., to compensate for the surgeon’s lack of training and experience and attract “less” prudent patients. Also, this could be a sign that a doctor has compromised patient safety, such as performing the surgery at a non-accredited facility.
Tummy tuck swelling comes in various degrees depending on whether the patient has received simultaneous liposuction and muscle repair. Nevertheless, most people can expect noticeable improvement in their abdominal area after 2-3 months when most of the inflammation has subsided.
Tummy tuck swelling is primarily due to the interruption of blood vessels and lymphatic channels that occurs at the time of surgery.
More and prolonged swelling is expected when muscle repair is performed, which has become an integral part of tummy tuck as it “holds” the new contour and minimizes to some extent the impact of unintended pregnancy and weight gain, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
In addition to the actual swelling in the soft tissue, the postop swelling is also caused by fluid accumulation between the abdominal wall and the skin. For this reason, some surgeons recommend lymphatic drainage massage, which involves gentle pressure techniques to eliminate the waste fluids (seroma and hematoma) from the affected area.
Some doctors allow their patients to start their lymphatic drainage massage one week postop, while others feel that waiting at least 2-3 weeks is more ideal.
Furthermore, the use of medical-grade compression garments is believed to control tummy tuck swelling. Some proponents even suggest wearing them round the clock for the first two weeks postop.
The goal of compression garments is to prevent seromas or fluid accumulations and ultimately encourage the skin to heal smoothly and evenly.
As previously stated, most of the swelling will resolve after 2-3 weeks. But if it remains persistent beyond this period, it might be caused by the unintended separation of the sutures that hold the abdominal muscle in place. To prevent this complication that warrants a revision surgery, Dr. Smiley says he prefers making “individual stitches,” as opposed to “one long running suturing” technique, when performing muscle repair.
With the use of individual permanent stitches, the risk of muscle separation is almost eliminated, explains the celebrity plastic surgeon.
Another possible cause of persistent tummy tuck swelling is the presence of fat, which can be diagnosed on physical examination. Again, this can be avoided with proper surgical execution and possibly the use of simultaneous liposuction, says Dr. Smiley.
Most Brazilian butt lift risks can be eliminated with proper patient selection. The idea is to achieve one’s optimal health and rule out serious medical condition prior to surgery.
Sound judgment on the surgeon’s part also plays a critical role in patient safety. The consensus is to avoid unrelated or multiple surgeries, particularly if they require more than six hours under general anesthesia, as suggested by plastic surgeons at California Surgical Institute.
In essence, the Brazilian butt lift is reversed liposuction as it collects the excess fats (usually in the tummy, flanks, and bra rolls) from the donor sites, which are later processed and re-injected into the patient’s backside.
Dr. Tarick Smiley, a celebrity Los Angeles plastic surgeon, has explained the most common Brazilian butt lift risks and the corresponding ways to avoid them or at least minimize their incidence.
The truth is, the biggest risks for this procedure are related to cosmetics—e.g., asymmetry, low survival rate of grafts, and poor shape. However, choosing a board-certified plastic surgeon who performs the surgery on a regular basis (ideally over a hundred procedures per year) generally has a good eye for detail.
Aside from the surgeon’s skills and experience, the cosmetic results will also depend on the patient’s “active participation.” For instance, she should avoid prolonged sitting for 3-4 weeks after surgery to prevent inadvertent shifting of fat grafts and low survival rate.
Over-liposuction must be avoided at all cost due to skin irregularities and other surgical stigmata that could be hard to correct later on. For this reason good surgeons will always assess skin elasticity and can easily predict how much “shrinkage” will occur once a certain amount of fat has been removed.
- Fluid shifts and increased surgical trauma
These are often caused by large volume liposuction or performing simultaneous surgeries at the same time as Brazilian butt lift. By simply avoiding them one can minimize such risk.
- Anesthesia-related complications
All surgeries come with such risk, although there is a perceived lower risk if a board-certified anesthesiologist will be the one who will administer general anesthesia; hence, reputable plastic surgeons often work with them.
Certain drugs and even smoking are known to interfere with anesthesia, thus any prudent patient should notify her doctor about her medication use, including vitamins and supplements.
This is another risk associated with any type of surgery. This happens when blood clots form usually in the legs that may travel to the lungs and cause more serious complications. Obesity, multiple surgeries, and certain medical conditions are closely tied to this problem.
To minimize risk of deep vein thrombosis after surgery, Dr. Smiley advises most of his patients to take short walks throughout the day as soon as they are able to do so. The goal is to improve circulation, which can also promote healing and reduce lethargy and even postop constipation.