Tummy Tuck Details Beverly Hills
Different Abdominoplasty Techniques
There are several types of Tummy Tucks, ranging from a minor removal of hanging skin to an extended abdminoplasty where a new umbilicus is made and your entire abdomen is tightened.
Some of the different procedures include:
- The Hybrid Tummy Tuck® : Designed to get rid of this extra bulge by tightening the deep layer through the use of a small incision. According to Dr. Moelleken, he designed the technique to be able to use the existing C-section scar for the incision to prevent plastic surgeons from having to leave their patients with new scar tissue on their abdomen. If a patient does not have an existing C-section scar, Moelleken notes that a small incision is then made near the pubic area.
- Partial Abdominoplasty: If your fat deposits are limited to the area below your navel, you may require a less complex procedure called a partial abdominoplasty or a mini-tummy tuck. This is usually performed on an outpatient basis and the procedure leaves your belly button in its current place, removes the fat below your navel, and tightens your muscles but only from the navel to the pubis.
- Full Tummy Tuck: During a full tummy tuck, Dr. Moelleken will create a new belly button and tighten the muscles from your lower chest area to your pubis. The scar is usually from hip to hip and this procedure is frequently performed with liposuction to obtain the best results.
- Extended Tummy Tuck: An extended tummy tuck is usually performed on obese patients who have a great deal of excess fat and overhanging skin that extends to the back. In order to leave a nice contour, your scar needs to extend beyond your hip area towards your back. Again in this case, Dr. Moelleken will tighten your muscles and create a new belly button.
- Circumferential Tummy Tuck: A circumferential tummy tuck is usually performed on someone who has lost a great deal of weight and fat, usually after gastric bypass surgery. In order to create a nice contour for this procedure, your scar will extend all around your waistline. This allows Dr. Moelleken to lift your outer thigh and buttock creating a better look. Your muscle is tightened and your new belly button is created.
History of Abdominoplasty
One of the most commonly performed aesthetic procedures, abdominoplasty, has changed significantly since its controversial and varied evolution. The first documentation of modern plastic surgery began in the early 1800’s when doctors re-invented techniques first discovered by ancient civilizations that used flaps (pieces of stretched skin) to cover open wounds. With the lack of anesthesia and sterilization, the surgeries were used mainly on critically injured patients instead of for cosmetic surgery. Because of the millions of wounded soldiers treated during World War I, physicians made huge advances in the science and art of surgery. With the new developments in reconstructive surgery, plastic surgery evolved into what we now call cosmetic surgery. The word plastic comes from the Greek word plastikos meaning to mold or shape something.
In 1890, Dr. Demars and Dr. Marx in France performed the first tummy tuck, called a dermolipectomy. In the United States, the history of abdominoplasty dates back to 1899 where a horizontal mid-abdominal incision was conducted at John’s Hopkins in Baltimore, Maryland by a gynecologic surgeon named Dr. Kelly. He called the procedure a transverse abdominal lipectomy, but the transverse nature of the incisions followed by the complete removal of the abdominal pannus (skin flap) caused the patient to lose their belly button. By 1905, doctors in France succeeded in the first abdominal lipectomy that preserved the belly button and in 1909, a doctor in Germany made use of vertical and horizontal flap incisions to completely avoid removal of the belly button during the tummy tuck procedure. With the constant advances to cosmetic surgery technology, patients in the 1970s and 1980s were treated for certain conditions involving massive abdominal pannus resulting from an umbilical hernia, from being overweight, or after experiencing a large pregnancy. The beneficial effects due to the removal of the abdominal pannus to the patient’s appearance caught on quickly. Today, the modern tummy tuck utilizes limited incisions to remove larger C-section scars, tighten your abdominal muscles, remove excess abdominal skin, and place your belly button exactly where it should be.
Anatomy of the Abdomen
The first part of your abdomen’s anatomy is your skin. Since this is the part you see, after being stretched out it can be a depressing feature. The top layer of your skin is called the epidermis. New cells are added at the bottom of your epidermis and slowly pushed to the top where they die and fall off. When you are young, your skin replaces itself every 15-18 days but as you age the process slows considerably. Below your epidermis is the dermis, which contains your oil glands, nerves, capillaries, sweat glands, as well as collagen and elastin. Collagen and elastin give your skin its ability to stretch out and spring back but as we age, we lose that elasticity as well. This is why your skin gets thinner and when stretched out, it cannot bounce back. Loose, excess skin is called redundant skin but not all of the extra skin on your abdomen is redundant. If you have a significant layer of fat on your abdomen, also called adipose tissue, or if the muscles and fascia of your abdomen have loosened, this is not redundant skin.
Fat cells can expand enormously, getting larger as your body stores more fat in them. Many of us hate body fat, especially around our stomach, but without a fat layer our body would not function properly. We would freeze to death, we would have to eat constantly without a place to store energy, and every time we exerted more energy than we took in from food, we would burn valuable muscle. This rationale does not help however when we have more fat than we need.
There are three layers of abdominal fat:
- The superficial layer of fatty tissue just under the skin is denser and tightly packed with nerves, and blood vessels.
- The extra-abdominal fat layer is below the skin but not within the abdominal cavity, also known as the peritoneal cavity. Extra-abdominal fat is the fat between your muscle and your skin. It is the fat that you pinch when you grab your stomach and the most commonly removed fat in a tummy tuck.
- The intra-abdominal fat layer, which is within your abdominal cavity and the deepest area of fat, is also called the visceral layer. The intra-abdominal fat layer is composed of two types. The first type is the fat surrounding your internal organs. The second is the Omentum layer, which is like a large fat blanket that is found in your abdomen. It covers all of your organs and its function is to protect your internal organs from infections. That is why it is called the protector of the abdomen. The combination of these two internal fat structures in excess can increase the intra-abdominal pressure stretching your abdominal muscles.
Fascia is a thin membrane that covers almost all of your muscles and many organs. Fascia protects what it is covering and the important fascia membranes in your abdomen are the superficial fascia and the deep fascia. When the superficial fascia becomes stretched out, it can give your abdomen a distended look even if your muscles are toned. The deep fascia, which lines the inside wall of your abdominal muscles and separates them from your abdominal organs, can also become stretched out. In an abdominoplasty, the surgery tightens your muscles, superficial fascia, and skin only–not the deep fascia. In an abdominoplasty, the most important part of the fascia of the abdomen is the linea alba, which is Latin for “white line,” since it is a band of fascia that looks like a vertical white line. This is the centerline of your abdomen that runs vertically between your rectus abdominus muscles and when it is not stretched or widened, it is a narrow partition between the two muscles.
There are more muscles in your torso than just the external obliques, the internal obliques, and the rectus abdominus muscles but for a tummy tuck, they are the ones that matter most. These three sets of muscles are responsible for the shape of your abdomen and are the chief muscles that become stretched with age and pregnancy. The external oblique muscles, sometimes called by their Latin name, the obliquus externis, run on each side diagonally down and in from the lower eight ribs at your sides to the linea alba and the part of your pubic bone called the pubic crest. The internal oblique muscles, sometimes called the obliquus internis, run on each side diagonally down and out from your lower three or four ribs to the iliac crest at the side of your pubic bone. The external and internal obliques run at an angle to each other.
Through the years, our bodies change. Pregnancy, eating habits, physiologic changes, and activity levels take their toll on your shape and form. The most common cause of abdominal deformity is pregnancy, most often multiple pregnancies. When women have children, the lining of their abdominal muscles, or the fascia, can rip and the abdomen can develop a bulge or type of hernia. Pregnancy stretches your skin beyond its biomechanical capability to spring back because it stretches the musculoaponeurotic structures of your abdominal wall. The stretching and thinning of these structures and the diastasis of your rectus muscle is usually the result and that is why you can often feel a layer of fat on your lower abdomen. Although liposuction removes excess fat, only an abdominoplasty can tighten the fascia and remove hanging skin. Massive weight loss, whether from dieting or after a gastric bypass surgery, also plays a role in excess skin and laxity of the abdominal wall. When your skin is badly stretched and abdominal muscles separate at your midline, plastic surgery will help you accomplish what you cannot accomplish on your own.
Safety is our primary concern; therefore, you must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your primary physician and if you do not have one, we will refer you to a local doctor in your area, as we do not provide these services. All pre-op paperwork is required to be in our office at least two weeks prior to your surgery. During your initial consultation, it is very important that you make us aware of any medical conditions you have and all medications you are currently taking.
Other Pre-Operative instructions you should follow include:
- Do Not Smoke: Smoking causes spasms of your blood vessels and also creates poor oxygenation to your tissues. This increases the chances of complications; especially skin necrosis, so it is imperative that you do not smoke two weeks prior or two weeks after your surgery as this greatly impedes your healing. If this is a problem, you can discuss options with Dr. Moelleken.
- Avoid Certain Medications: Prior to your surgery, there are certain medicines you should avoid including Vitamin E, aspirin, or aspirin products. These may increase the chances of bleeding during your surgery. After your consultation with Dr. Moelleken, you will receive an extensive list of medications to avoid.
- Exercise: Starting a mild exercise program before the surgery may be helpful especially if you are overweight. This does not have to be complicated as walking around the block several times a day will help.
- Plan Meals in Advance: If you plan on preparing your own meals at home after surgery, have easy meals on hand or already prepared frozen meals.
- Purchase Special Garments: We recommend that prior to your surgery, you purchase two pair of the Higher Power with Tummy Control 032 Spanx garments. You will need to wear the garment 24 hours a day for five days after the removal of your drains as it helps reduce swelling. This can vary depending on what Dr. Moelleken recommends after your surgery.
- Sleep in a Recliner: After your surgery, we recommend you sleep in a recliner chair. This is because your stomach muscles will be tightened so sleeping at a 45-degree angle may alleviate some of your discomfort. If you do not have access to a recliner, you can place several pillows under your head and some under your knees to keep them flexed at 45 degrees.
- Arrange For Someone to Drive You Home: Whether your surgery is done as an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery. You should also arrange for transportation to and from our office for your post-operative appointments until Dr. Moelleken authorizes you to drive again.
The Surgical Procedure
Abdominoplasty surgery is performed under a “light” general anesthetic, which will cause you to sleep. This method provides excellent operating conditions while affording maximal comfort and safety for you. A Board Certified Anesthesiologist (M.D.), who monitors you throughout your operation, will administer the anesthetic. Prior to surgery, your anesthesiologist will provide additional information and answer any questions you may have. An I.V. is routinely placed in your hand or arm prior to surgery for fluid maintenance. A urinary catheter may be inserted at the time of surgery and this is removed after surgery. A complete abdominoplasty takes approximately two to three hours, depending on the extent of work required. A partial abdominoplasty can take one to two hours.
There are usually two incisions associated with this type of surgery. Your abdominal skin is lifted in order to reveal the underlying fascia and abdominal muscle. In elevating your skin, the umbilicus has to be preserved and this is accomplished by making a second incision around your belly button so that it can be freed from the surrounding tissues. Once your skin is elevated, the abdominal muscle is tightened from the xyphoid (solar plexus) to the pubis. Suturing the muscle close together tightens your inner girdle and narrows your waistline. Stretch marks, where possible, will be removed along with your excess skin however; stretch marks on the remaining abdominal skin cannot be removed. The skin flap is then stretched down and the extra skin and fat is removed. The skin flap is now ready to be closed but prior to closing, a small incision is made in the skin flap and your umbilicus is brought out through your abdominal skin and repositioned. Drains may be placed in order to collect the fluid that forms inside your body after your tummy tuck and if used, they will be removed approximately seven days after your surgery. The skin flap is then closed, completing your abdominoplasty. Liposuction can be combined at the same time as your abdominoplasty but this will depend on Dr. Moelleken’s recommendation. With a partial abdominoplasty, the incision is much shorter and the navel may or may not be moved. Your skin is separated only between the incision line and your navel and this skin flap is stretched down, the excess is removed, and the flap stitched back into place. The length of the incision will depend on your particular skin and muscle anatomy.
The Recovery Period
Abdominoplasty is now frequently performed on an outpatient basis, which is a big change from the traditional inpatient hospitalization for up to 2 days. A recent report highlights and supports the safety and effectiveness of abdominoplasty performed on an outpatient basis and the extent of your surgery will determine your release time. In terms of discomfort, the first three days are the hardest but can be easily controlled with medications and ice packs. You will immediately notice a great change in your shape but you will not be able to show off your new body with tight clothes since you will be required to wear your Spandex garments. It will take one month before your clothes start to fit properly and approximately two months before you have to change your wardrobe. Because your stomach muscle has been tightened, you will notice a difference in your breathing and this will require you to make a conscious effort to concentrate on deep breathing techniques until you are comfortable. Returning to work will depend on how well you recuperate; the majority of patients are back between 10-14 days. Some patients heal incredible well however and have returned after only one week. When you first return to work or your normal activities, you will tire easily and it will take at least a full month before you are back to your old self.
All surgery carries risks and some of these include:
- Infection: Although it is common to develop some localized area of redness from your sutures, it is rare to develop an infection. If an infection does occur, it is easily treated with antibiotics.
- Scaring: This is perhaps the most common problem because as with most scars, they will fade but never completely disappear. They will not show under most clothing however, even under a bathing suit, and it is up to your own healing process how your scar heals. Some things we offer to speed the healing process include silicone patches, external pressure with silicone or tape, vitamin E, scar guard, and steroid injections.
- Sensation Changes: It is normal to have sensation changes after your surgery but this will return to normal except in very rare cases.
- Coughing: Coughing is a normal response after any surgery and it will help tremendously if you place a pillow against your stomach when you cough in order to help with the discomfort.
- Posture: At first you may not be able to walk straight but you should focus on improving your posture and make an effort to straighten out. The quicker you can do this, the faster you will recuperate.
Some additional and rare complications include, necrosis of the skin, lower abdominal bulging, bleeding, and tissue damage. Possible complications will be discussed during your consultation and if you have any additional complications or concerns, feel free to contact us immediately.