TUMMY TUCK (ABDOMINOPLASTY)
A sculpted, flat abdominal region is one of the most coveted physical characteristics, and is responsible for motivating countless individuals to perform seemingly endless numbers of sit-ups and crunches in the hopes of acquiring the ever elusive “six pack” abs. Additionally, many individuals suffer from the frustrating aesthetic problem of abdominal skin laxity (loose, hanging skin), which can be caused by a number of factors, such as: the natural aging process, genetics, childbirth, stress, hormonal imbalances, and significant fluctuations in weight.
Regrettably, fat pockets in the abdominal region can be extremely difficult to eliminate, and abdominal skin laxity cannot be ameliorated through proper diet and exercise alone. Fortunately, abdominoplasty (tummy tuck) surgery provides an effective solution to these problematic aesthetic issues, and can be performed to improve the appearance of a flabby or protruding stomach, and to excise surplus or hanging abdominal skin. During a tummy tuck surgery, excess fat is removed from the lower and middle abdominal region, abdominal musculature is tightened, and surplus skin is excised, resulting in a leaner, smoother abdomen.
Tummy tuck surgery requires a high level of surgical accuracy and proficiency, and should be performed by a board certified plastic surgeon such as Dr. J. Timothy Katzen. Dr. Katzen is a widely respected expert in the field of cosmetic body surgery, and has helped many patients tighten and sculpt their abdomens with tummy tuck procedures at his private practice in Beverly Hills, California. Dr.Katzen specializes in facial rejuvenation and body contouring procedures. Dr.Katzen has a broad scope of knowledge and experience performing tummy tuck surgeries. Tummy tuck surgeries are often performed as a single procedure or in combination with breast or facial procedures.
TUMMY TUCK PROCEDURE AND RECOVERY
Abdominoplasty procedures are generally performed on an outpatient basis, under general anesthesia or intravenous sedation. During the surgery, Dr. Katzen will make a horizontal incision between the navel and the pubic hairline, and will then repair and suture the weakened abdominal muscles. Utilizing the same incision, he will excise any surplus abdominal fat, tissue, and skin, and (if necessary), will make a second incision around the circumference of the navel to reposition the belly button to a more aesthetically appropriate location. Your abdominoplasty results will be visually apparent immediately following your surgery. You will continue to improve over the next few months, as any residual swelling subsides. Patients are advised to abstain from all strenuous physical activity for at least six weeks following tummy tuck surgery. Depending on an individual’s healing capacity, they may need to take off one month for a full, successful recovery.
Dr. Katzen’s practice is built on the foundational principle of surgical customization, meaning that as a patient, you will receive a unique treatment plan, tailored to reflect your specific aesthetic preferences, and designed to bring your surgical goals to fruition. Dr. Katzen and his professional staff have created a warm, welcoming office environment, where you will feel secure and comfortable throughout your abdominoplasty experience.
Dr. Katzen and his professional team understand the importance of well-informed patients, and will take the time to thoroughly explain your abdominoplasty procedural details and options. If you would like additional information about tummy tuck surgery, please contact our office today. We look forward to speaking with you and to scheduling your initial consultation with Dr. Katzen.
TUMMY TUCK FAQ’S
After my tummy tuck, when can I return to work?
Approximately two to three weeks after a tummy tuck, most patients can return to a desk job. About three to four weeks after a tummy tuck, most patients can return to a job that entails a significant amount of lifting or pulling.
After my tummy tuck, can I return to work with my drains in place?
Yes, usually, after a tummy tuck, you can return to work with your drains. For most jobs, you can return to work with your drains. However, if your job entails an environment that could potentially be infectious, it may not be wise to go back to work with your drains. Jobs that may be potentially hazardous include jobs at the hospital, operating room, sanitary cleaning or taking care of animals. In these types of jobs, there could be potential contamination of your drains by others, or your drains could contaminate someone else.
After my tummy tuck, can I fly with drains in place?
Yes, you can fly with your drains in place. The cabin pressure of the airplane will not cause the drains to explode or implode. So there are no issues, I would suggest you tell airport security that you have recently had surgery. You may want to consider bringing a note or letter to the airport from your plastic surgeon stating that you have recently had surgery. While going through the security checkpoint, be sure you do not use safety pins or anything sharp to attach the drains. Metallic objects like safety pins may set off metal detectors and increase security awareness. Also, for your general safety, when you are on the plane, you may want to let the flight attendant know that you recently had surgery.
After my tummy tuck, when can I return exercise?
At about three to four weeks, you should be able to go back to light exercise. Every patient is different and heals at a different rate. About six to eight weeks, most people can do 25% of their routine pre-operative workout. At about eight to ten weeks, most people can do 50% of the usual pre-operative workout. At about ten to twelve weeks, most people can do 75% of the routine pre-operative workout. At about twelve to fourteen weeks, most people can do 100% of the usual pre-operative workout.
After a tummy tuck, when can I fly?
Yes, you can liquid after your tummy tuck. It is recommended that you do not weight for one to two weeks after your tummy tuck. One of the risks of flying is always a blood clot. Even if you don’t have surgery, there is a risk of developing a blood clot during a flight. Your risk of developing a blood clot is increased if you have had a recent surgery. To minimize the chances of a blood clot, I would suggest you use a blood thinner. This blood thinner shot is administered daily. This shot should be given several days before you fly and for several days after you land.
After my tummy tuck, how long do I need to wear the garment?
Swelling is the body’s natural reaction to surgery. Usually, swelling is completely normal. However, swelling does slow healing. Compression garments minimize swelling. As long as there is abdominal swelling, you should wear your compression garment. After a tummy tuck, compression garments are encouraged for at least six to eight weeks. However, if you still have abdominal swelling after eight weeks, I would suggest you continue to wear your compression garment. Compression garments also help to flatten the tummy tuck scars.
After my tummy tuck, when can I shower?
Typically, showering is not allowed while the drains are in place. Once the drains are removed, you are usually allowed to shower. Also, if there are any open wounds or incision, showering may be delayed. Generally, you are allowed to sponge bathe two to three days after the tummy tuck.
Will there be sutures?
Yes, the entirety of the tummy tuck is performed with sutures. Staples should not be used for a tummy tuck as staples leave poor scars.
If there are sutures, how long are the sutures the sutures?
While performing a tummy tuck, three types of sutures are used. There are permanent sutures, which as the name implies, are permanent. These sutures should last you a lifetime. The sutures are used to tighten or plicate the six-pack or rectus abdominis muscles. These permanent sutures lead to a flat belly for years to come.
The rest of the sutures are absorbable. Three sutures are commonly used during a tummy tuck. PDS sutures are often used. PDS sutures usually dissolve at 238 days. Vicryl sutures are also often used. Vicryl sutures dissolve by 70 days. Monocryl sutures are also used. Monocryl sutures dissolve at 119 days.
After my tummy tuck, are there drains?
Yes, drains are used during a tummy tuck. Usually, two drains are placed. The drains are placed to drain fluid from each side of the abdomen. Usually, I place the drains in the pubic or mons region. This location causes the least pain, easiest access, and the best drain site scars. Other plastic surgeons sometimes will bring the drain through the sides of your tummy tuck scar. Drains placed in the tummy tuck incision are less optimal because the drains are on your side and can interfere with the incision healing. Also, if the drain is brought out through your tummy tuck scar, this leads to poor scarring.
After my tummy tuck, how long will the drains be in place?
Everyone heals differently after a tummy tuck. In general, drains can be removed seven to fourteen days after a tummy tuck. However, drains are not removed by the length of time they’ve been in place. Drains are removed by the amount of fluid they are draining. If the drains are not draining much fluid, it is possible that the drains can be removed earlier. However, if the drains are absorbing a lot of liquid, then the drains are left in place. Though rare, some drains need to be left in place more than two weeks.
After my tummy tuck, will the drains hurt when they are removed?
Yes, the drains hurt a little bit when they are removed. When the drains are ready to be removed, I use numbing spray and/or numbing cream to anesthetize the skin. Once the skin is anesthetized, the drain is removed. It stings a little bit during the drain removal, but the pain quickly dissipates. If you anticipate the drains being removed and to minimize your pain, you may consider taking your pain medication an hour before the drain removal.
How are the drains removed?
The suture that holds the drain in place is cut. Then the skin is locally anesthetized with numbing spray and/or numbing cream. The drain is then pulled. A small pad is put on the drain site.
Are the drain sites closed?
No, I do not seal the drain site. The drain site is purposely left open so more fluid can leak out. It is good to have more fluid leak out. The more fluid that leaks out, the faster your healing. However, do not press on your abdomen to express or “milk” more fluid out the drain site hole. Just let your body drain naturally.
How do the drain sites heal?
After the drain is pulled, there is a soft tissue tunnel that has been created by the drain. The body secretes fluid to seal the drain tunnel. Usually, the drain site and tunnel seals itself within three to four days after the drain has been pulled.
What happens to the fluid after the drains are pulled?
If the drains are removed at the appropriate time, there is only minimal fluid being produced. Since the fluid is minimal, your body naturally absorbs this liquid. However, if the fluid is too much, the fluid can collect. This fluid collection can turn into a seroma.
What is a seroma? Why does a seroma occur? What does a seroma feel and look like? How is this seroma treated?
A seroma is a collection of serous fluid. Serous fluid is a liquid that your body makes to heal and stick to edges together. During a tummy tuck, there are large tissue surfaces that are exposed and then sandwiched together. These tissue layers secrete serous fluid. Because the body produces too much serous fluid, drains are placed. Most of the serous fluid is absorbed in the drains. A seroma occurs when there is a localized collection of this serous fluid. Usually, after a tummy tuck, seromas do not develop. However, seromas can form when the drains are removed too early. Very rarely, seromas can form even when the drains are in place. A seroma feels like a small water balloon. Sometimes seromas can be small like a marble or large like a cantaloupe. Sometimes when you press on one area of a seroma, you will see a fluid wave pulse from one end of the seroma to the other end of the seroma. If you do have a seroma, you need to see your plastic surgeon routinely. Seromas may require drainage with a needle several times a week. Alternatively, if your seroma does not drain with repeated needle aspirations, you may need surgical drainage. During this in-office procedure, a small incision is placed in the seroma and a drain is left in place. While the drain is in place, the seroma will leak serous fluid. After some time, the seroma seals itself.
What is a hematoma? Why does a hematoma occur? How is the hematoma treated?
A hematoma is a collection of blood. Hematomas can occur during the tummy tuck surgery or even several days after the tummy tuck surgery. Usually, the drain absorbs most of the blood and minimizes the risk of a hematoma. However, even if the drains are in place, hematomas can still develop. Initially, hematomas are treated with pressure. Pressure stops the bleeding and minimizes the creation of a larger hematoma. Most hematomas can be treated with needle aspiration. If needling does not drain the hematoma, you may need surgical drainage. Surgical drainage of a seroma is often an in-office procedure. Usually, after hematoma drainage, a drain is left in place for several days.
After my tummy tuck, when can I have sex?
I would suggest you wait two weeks after your tummy tuck or at least, till the drains have been removed. In the beginning, I would advise you and your partner take it easy. I would not suggest any “rough play.” Usually, in general, four to six weeks after your tummy tuck, you can return to your previous sexual activities.
After my tummy tuck, how long will I have pain?
Everyone’s pain is different after a tummy tuck. Everyone heals differently, and everyone has different tolerances to pain. Most patients will have pain after a tummy tuck. However, narcotics will be prescribed to control the pain. Almost all patient’s pain is controlled with oral medications. Most patients have some pain for five to seven days. After about one week, the pain becomes less intense and less frequent Usually by the second or third week, most of the pain is gone, and you will only rarely need to take pain medication.
After my tummy tuck, how long will I be swollen?
Every patient heals differently and at a different rate. In general, at four weeks 80% of the abdominal swelling is gone. Approximately eight weeks after your tummy tuck, almost all the abdominal swelling should be gone. You will notice increased swelling of the abdomen during exercise this is because blood rushes into the abdominal area and leaks fluid into the capillaries. This fluid that is the abdominal flap tissue sometimes has a hard time returning to your circulation. I would suggest you continue wearing your compression garment for six to eight weeks after your tummy tuck. If you are swollen even after eight weeks, I advise you to continue your compression.
After my tummy tuck, when will I see my final results?
After a tummy tuck, everyone heals at a different rate. The timing to see your “final results” after a tummy tuck ultimately depends on what your definition “final results” is. Most of the abdominal swelling is gone approximately eoght weeks. The abdominal scar then takes about two years to mature. Therefore if your question regarding “final results” has to do with the complete maturation of the abdominal scar, then it will take two years. However, most patients very content with their tummy tuck results at approximately to six months
After my tummy tuck, when can I exercise?
In general, if everything is healing well, four weeks after a tummy tuck, I allow my patients to return to “light” exercise. “Light” exercise includes walking around your neighborhood and moderate treadmill. Six weeks after your tummy tuck, you can do more vigorous physical exercise including lifting upper body weights and going on the elliptical. If there are no contraindications, eight to ten weeks after your tummy tuck, you should be able to return to all your workouts. The only exception is I do not want you to do sit-ups for six months after your tummy tuck. The reason I don’t want you doing sit-ups after your tummy tuck is that the rectus abdominis muscles have been tightened with permanent sutures. Doing sit-ups on the repaired anterior abdominal wall puts undue strain on the repair. Sit-ups can tear the rectus abdominis repair. Tearing the rectus abdominis repair may defeat one of the primary reasons for having a tummy tuck. There is no point in doing sit-ups in an attempt to strengthen your core or flatten your abdomen when you may ruin your tummy talk results.
After my tummy tuck, what exercises am I allowed to do?
For the first two weeks after your tummy tuck, you should rest. You should only do activities of daily living. These activities include going from your bed to your bathroom, kitchen, sitting room, etc. I would not do anything else. I would not do laundry for any house cleaning. I would not suggest you do any vacuuming.
Four weeks after your tummy tuck you are allowed to do light exercises, including walking and going on the elliptical. Six weeks after your tummy tuck, you are allowed to do more vigorous activities. The only exercises you should not do, are exercises that involve your rectus abdominis muscles. You are free to do almost all other exercises. If you are involved in contact sports (like kickboxing), I would suggest you wait until you are six months after your tummy tuck.
After my tummy tuck, what exercises do I need to avoid?
I would suggest you avoid doing core exercises, especially sit-ups for six months after your tummy tuck. During your tummy tuck, the rectus abdominis muscles are tightened. Muscle tightening is one of the foundations of the tummy tuck. Tightening the rectus muscles establishes the anterior abdominal wall and makes the abdominal wall flat from the sternum to the pubic region. The skin and fat are then draped on top of this. If the rectus muscles are not repaired, no matter how tightly the abdominal skin is pulled and tightened, you will not get a flat abdomen. This is why the rectus abdominis muscle repair is so critical to the tummy tuck. For six months after a tummy tuck, I would suggest you avoid doing sit-ups. Sit-ups will put undue stress on the rectus repair muscles; instead, I would focus your efforts and concentrate on other body parts
After my tummy tuck, when can I start doing sit-ups?
I would suggest you wait six months after your tummy tuck before you start doing sit-ups or core exercises. During the tummy tuck, the six -pack muscles are sutured and tightened. Six months should be enough time for the rectus abdominis muscles to heal.
After my tummy tuck, what can I take for the bruising?
If you have a history of excessive bruising, I would suggest you take a product called Arnica. The full name is Arnica Montana. Arnica comes in a pill form and ointment form.
Arnica has been medically proven to decrease the amount of bruising. Also, arnica reduces the amount of time it takes to heal from bruising. For a tummy tuck, taking Arnica is by no means mandatory. If however, you are inclined to take Arnica, please notify your plastic surgeon. It is vital for your plastic surgeon all the medications you’re taking during your recovery.
After my tummy tuck, what can I take for the swelling?
Bromelain may help with the swelling after a tummy tuck. Bromelain is a pineapple extract made from the bromeliad plant. Bromelain has been medically shown to decrease swelling and inflammation. If you have a long history of swelling, Bromelain may help. Taking bromelain is not mandatory during an abdominoplasty. If however, you feel inclined to take Bromelain, please notify your plastic surgeon. It is crucial that your plastic surgeon knows the complete picture, especially if you are taking other medications.
If the swelling is excessive, you must notify your plastic surgeon. There may be other stronger medication that may be better and more effective.
How long does the tummy tuck procedure take?
Every patient is uniquely different in every plastic surgeon has a different technique and surgical team. However, on average, the tummy tuck should take between three to five hours to complete. If there is excessive abdominal scar tissue, abdominal wall hernias, or if other procedures are being performed at the same time like liposuction or breast procedures, the tummy tuck will take longer to complete.
Are the tummy tuck sutures absorbable?
98% of the sutures used during a tummy tuck are absorbable. Absorbable sutures are used to re-approximate the skin layers. Permanent sutures are used to re-approximate two different fascial layers. Fascia is a layer of tough connective tissue that often separates anatomic structures and surrounds muscles. Permanent sutures are often used to re-approximate Scarpa’s fascia. Also, permanent sutures are used to flatten the abdominal wall muscles by tightening the rectus abdominis muscles. This row of rectus abdominis sutures corrects for rectus muscle laxity and rectus diastasis (gapping in the rectus muscle). Rectus muscle laxity and rectus diastasis often occur with pregnancy and/or weight gain and subsequent weight loss. I place two or more layers of these permanent sutures on the rectus abdominis muscle. These permanent sutures are placed from the xiphoid (bottom of the sternum) to the top of the pubic region. These rectus muscle sutures are permanent and do not need to be removed.
After a tummy tuck, do any sutures need to be removed?
Sometimes areas of skin discrepancy need one or two sutures. One or two weeks after the tummy tuck, these sutures are removed. The removal of these tiny sutures is usually painless. Sutures also need to be withdrawn from the drain site. Usually, there are one or two sutures that are used to anchor the drain to the skin. When the drains are removed, the drain sutures are also removed.
After a tummy tuck, when can I tan?
I never suggest tanning or tanning bed. Whether it’s natural or synthetic sun, these cause radiation damage and increase your risk of skin cancer. However, if you must have that golden tan, I would suggest a spray on tan that can usually be applied four weeks after a tummy tuck. If you absolutely must have a natural suntan or even worse, from a UV bed, you should be able to tan six weeks after your tummy tuck. If you do decide to go in the sun or a tanning booth, I would strongly suggest wearing something that covers your tummy tuck scar. If you cannot do this, I would recommend an SPF 50 or higher. All scars are very sensitive to sunlight; your tummy tuck scar is no exception. Excessive sun and UV radiation will turn fresh tummy tuck scars to a bright pink. It may take several weeks for the pink scars to fade.
In conclusion and in general, I would avoid tanning. If you must have that golden tan, I would consider a spray tan.
After my tummy tuck, what can I put on the scars?
After a tummy tuck, the best thing is to apply silicone. There are two things that I suggest to optimize the tummy tuck scar and are the best ways to deliver silicone. One is silicone ointment and the other is silicone tape. Once everything has completely healed, approximately six to eight weeks after the tummy tuck, I would suggest using a silicone-based cream to the tummy tuck scar. Personally, I recommend a product called Biocorneum. In my experience, this is the best product on the market. If your scar cream does not contain silicone, it is not worth using. I would suggest you apply Biocorneum two to three times a day. One drop the size of a pea should cover approximately four inches of the scar.
The other product I suggest is a silicone-based tape. Tape can be placed on top of the Biocorneum. I would recommend a roll of silicone tape so you can have one piece and custom cut it to your individual scar. Mepitac makes the silicone tape I like best. Usually, one piece of silicone tape can last several weeks. I would suggest you use the silicone cream and tape for six months.
After my tummy tuck, when can I put the scar cream on?
If everything is healing well and all the incisions are closed, you can start applying your silicone scar cream. Typically, I wait for six weeks after a tummy tuck before applying scar cream. There is no rush to start using silicone scar cream. It takes a scar up to two years to fully mature. After about two years, scar cream and tape will probably have no effect.
After my tummy tuck, what can do about the scars besides cream?
If you are still dissatisfied with the tummy tuck scar after applying silicone and tape, there are other ways to improve the final tummy tuck scar. There are a wide variety of lasers that can be tailored to your individual tummy tuck scar. One excellent laser for the tummy tuck scar is the Fraxel laser. The Fraxel laser helps to break-up and flatten scar. Please discuss with your plastic surgeon when to start tummy tuck scar therapy with the Fraxel laser. It may take several Fraxel laser treatments to get the tummy tuck scar optimized.
Can the procedure be done under IV, Local or general anesthesia?
Tummy tucks can be performed under IV sedation or local anesthesia, but tummy tucks should be performed under general anesthesia. One of the foundations of the tummy tuck is sewing the muscle together or rectus abdominis plication. To perform rectus plication, the rectus muscle needs to be paralyzed. The only way to paralyze the muscle to achieve plication is to undergo general anesthesia.
What are the different types of tummy tucks?
There are five different types of tummy tucks. There is a low horizontal tummy tuck, high lateral tension tummy tuck, vertical tummy tuck, inverted T tummy tuck, and reverse tummy tuck. If you have excess skin and fat in the lower abdomen between the on the belly button and above the pubic region, you may be best served with a horizontal tummy tuck. If you want to create more of an hourglass figure and do not mind more visible scars, you may be a good candidate for a high lateral of tension tummy tuck. If you have excess skin and fat from the sternum to the belly button, you may do best with a vertical tummy tuck. If you have excess skin and fat from sternum to the belly button and from the pubic region to the belly button, you may be best served with an inverted T tummy tuck. If you do not want any scars on your abdomen and only have a minimal amount of excess skin and fat of your upper abdomen, you may be a candidate for a reverse tummy tuck.
If I gain weight, will my tummy come back?
If you are planning to gain weight, do not have a tummy tuck. With that being said, if you continue to eat right and exercise, you should be able to maintain your tummy tuck results. Even if you do gain some weight, it will be difficult to regain all the weight lost with a tummy tuck
Can I get pregnant after a tummy tuck?
Yes, you can get pregnant after a tummy tuck. I have many patients have uncomplicated, full-term deliveries with completely healthy children. If however, you are planning to get pregnant in the next year, I would suggest delaying your tummy tuck. If you are not planning to get pregnant in the next year and you are medically healthy, you can undergo a tummy tuck.
Where is the tummy tuck scar?
There are several different types of tummy tucks, and therefore, there are several various types of resulting scars. Every patient is different. However, most tummy tucks are done with a horizontal incision. During a horizontal tummy tuck, an incision usually goes from hip to hip and across the top of the pubic region. If you have a C-section scar, the C-section scar is usually removed during a horizontal tummy tuck. Sometimes the tummy tuck scar is placed low and under hip hugger jeans. Sometimes the tummy tuck scar is placed high to result in a high lateral tension tummy tuck. This hi lateral tension tummy tuck helps to accentuate an hourglass figure. This type of scar is usually not hidden under hip hugger jeans. However, clothing hides the high lateral tension tummy tuck scar if the clothing is brought high over the hips.
Another type of tummy tuck is the vertical tummy tuck. During a vertical tummy tuck, an incision is made from the sternum to the pubic region. This type of tummy tuck is for patients with excess skin and fat from the sternum to the belly button. Other patients require a combination of the vertical and horizontal tummy tuck. The result of this type of tummy tuck is a scar that looks like an upside-down letter ‘T”. This is called an inverted T abdominoplasty. Another type of tummy tuck is a reverse tummy tuck. During the reverse tummy tuck, instead of the tummy being pulled down like a horizontal tummy tuck, the tummy is pulled up. The incision is placed underneath the breast.
After my tummy tuck, when will I be able to walk?
The day after your tummy tuck you should be able to walk. You may not be able to walk a significant distance, but you should be able to walk about five or ten feet. As your tummy tuck healing progresses, you will be able to walk more. About two weeks after your tummy tuck, you should regain a lot of your energy. Four weeks after your tummy tuck, you should be able to walk almost as much as you want.
Before a tummy tuck, do I need to shave my pubic region?
No. I do not want you to shave your pubic area before your tummy tuck. The reason I don’t want you shaving your pubic region before your tummy tuck is that I need to see your pubic hair pattern for the tummy tuck incision planning. I like to place the tummy tuck incision low in the pubic region. This low tummy tuck incision pattern raises and flattens the pubic region without raising the pubic hairline.
If the pubic hair is pulled up during a tummy tuck, will I have pubic hair around my bellybutton?
No. Your pubic region and pubic hair are not pulled up. Rather, during a tummy tuck, the tummy is pulled down to meet the pubic region. Also, during a tummy tuck, the pubic region is reduced and flattened. Your pubic hair does not wind up next to your belly button. Your pubic hairline should be at the same level or lower after your tummy tuck.
After my tummy tuck, when will I be able to stand up straight?
For the first seven to ten days after a tummy tuck, you should be bent at the waist. You should bend approximate 45°. Bending 45° at the waist protects the abdominal incision and allows healing. Standing straight is not advised. Standing straight puts too much tension on the abdominal incision. Too much tension on the abdominal incision can cause the abdominal incision to split and open.
After a tummy tuck, how should I sleep?
I would suggest you sleep in a recliner. A recliner will keep you inclined at 45 to 90°. The more your abdomen is bent, the better the incision is protected. You can rent recliners from local vendors. Recliners chairs can be delivered to your home. Some medical insurance plans even cover the rental of recliners.
What are the indications for a tummy tuck?
If you have excess skin and fat of your abdomen, you may be a candidate for a tummy tuck. If you were dissatisfied with the appearance of your abdomen, you might be a candidate for a tummy tuck. Most patients have had several children and/or lost weight. Most patients seeking a tummy tuck have dieted and exercised, but they just cannot get that flat abdomen they desire. Both men and women undergo tummy tucks to improve their appearance and achieve a flat afternoon.
How do I know if I need abdominal liposuction or tummy tuck?
In general, if you have localized fat you may only need liposuction. If you have excess tummy skin, you would probably be best served with a tummy tuck. Liposuction does not remove excess tummy skin; liposuction only removes fat and depends on your skin’s ability to recoil and contract. If the skin does not contract after liposuction, you may be left with ripples or wrinkles. Most patients can have a tummy tuck. The main question should be, “do you think I can get by just with abdominal liposuction?” The answer depends on many variables. It depends on which liposuction machine is used, the aggressiveness of your plastic surgeon, the amount of fat removed, your skin contractility, and your generalized healing, to name just a few. If you have undergone a significant weight loss of hundred pounds or more, you would probably be best served with a tummy tuck.
What happens to my C-section scar?
Most C-section scars are placed horizontally. I usually place my tummy tuck incision below the C-section scar. Therefore, after a tummy tuck, the C-section scar is completely removed. Some C-section scars are placed vertically. If this is the case, the vertically oriented C-section scar is also removed.
Do I get a “new” belly button?
Yes and no. When I perform a tummy tuck, I keep the original belly button. An incision is made around the rim of your belly button, and the belly button is pushed inside. The abdominal flap is lifted and pulled down. A new incision is made on the abdominal flap for the new belly button position. In the end, the base of your belly button is the same, but all the skin around the belly button is moved. Typically, on females, I change the sad face bellybuttons to more aesthetically pleasing, vertical bellybuttons. On males, I change the sad face bellybuttons to more aesthetically pleasing, round bellybuttons.
Can other procedures be performed at the same time as the tummy tuck?
Yes. If you are healthy, other procedures can be conducted at the same time as your tummy tuck. Please discuss these options with your plastic surgeon. Often, I perform breast surgery and/or liposuction at the same time as a tummy tuck. Sometimes, I will perform an arm lift or leg lift at the same time as a tummy tuck.
I feel lumps under my scar. What are these? When will they go away? How do I get rid of them?
Lumps under your tummy tuck scar are not uncommon. These lumps are scar tissue. The scar tissue can either be due to primary scar, or scars around existing or dissolving sutures. I call these “scar balls.” These “scar balls” or internal scars may take six to eight months to dissolve. Usually, these “scar balls” or internal scars disappear on their own. If these “scar balls” are concerning to you, I would suggest deep tissue massage. For deep tissue massage, I would recommend using a golf ball or a vibration device to break up the scar tissue. If the scar tissue persists for more than eight months after your tummy tuck, you may need an internal scar revision. Internal scar revision is often performed with a small liposuction cannula or through direct scar excision.
After the sutures dissolve, what happens?
Sutures are placed to allow the tissues to be reapproximated. Once your tissues are reapproximated, your body makes scar tissue. Scar tissue keeps the structures together. For approximately two years, the body breaks down scar, rebuilds scar and makes the wound stronger. At the same time, the sutures are slowly dissolving. Eventually, all the absorbable sutures have dissolved, and the structures are held together by your scar tissue.
During a tummy tuck, why are drains necessary?
During a tummy tuck, the abdominal skin and fat are separated from the underlying fascia and rectus abdominis muscles. The abdominal flap extends from the pubic region to the rib cage. This flap creates a significantly large surface area. In an attempt to glue the edges together like a sandwich, the body creates serous fluid. One of the problems is that the body makes too much fluid. Just like super glue, whenever there is too much fluid, the edges float away from each other and cannot stick together. The drains minimize the amount of fluid that collects under the abdominal flap. Abdominal drains allow the flap to stick together. Also, the drains absorb any residual blood. Too much blood can also separate the abdominal layers and decrease healing time.
Are both drains removed at the same time? Can one drain be left in place?
Typically, both abdominal drains are removed at the same time after a tummy tuck. Usually, the amount of fluid draining from each drain is somewhat equal. However, sometimes one drain drains more fluid than the other. In this case, one drain can be removed, and the other drain is left in place. When this is the case, the remaining drain may increase in output since it is the only drain left. Usually, this increased output in the remaining drain is normal.
What is the pain pump? What does the pain pump do? What does the pain pump drip in? Do I need to do anything? Is the pain pump mandatory? When is the pain pump removed?
A pain pump is a mechanical device that slowly drips in medication to minimize pain. Usually, the drug that drips in is an anesthetic, like lidocaine. This anesthetic helps to numb the abdominal wall. Most pain pumps are automatic, and you do not need to push any buttons or release any valves. The pain pump is not mandatory, but most patients have significant pain relief with the pain pump in place. The pain pump typically lasts three to five days. Usually, the pain pump is removed at your first office visit.
I want my tummy tuck drains out now. What happens if the tummy tuck drains are pulled too early?
During a tummy tuck, drains are placed to remove blood and serous fluid. If the drains are removed too early, you may develop a collection of blood (hematoma) or serous fluid (seroma). If the fluid collection becomes large, you may require needle aspiration. Needle aspirations to remove the excess accumulation of serous fluid or blood are done in the office. These needle aspirations may need to be done every two to three days depending on the amount of liquid. If the fluid collections do not resolve, you may need an office procedure to drain the fluid. During this procedure, another drain may need to be reinserted. In summary, it is best to be patient and to leave the drains in place to absorb all the fluid.
I have numbness below my belly button and above my tummy tuck scar. Will this numbness ever go away?
No. There will always be a small area of numbness on your anterior abdominal wall. This area is usually above the pubic region and below the belly button. Sometimes, the area can be as big as your hand with fingers included. Sometimes, the area of numbness can be as small as a quarter. Nonetheless, there will always be an area of numbness on the anterior abdominal wall after a tummy tuck.
I have a hernia. Can my plastic surgeon fix my hernia at the same time as my tummy tuck?
Yes and no. If your plastic surgeon is comfortable with fixing your hernia, you can have your hernia repaired at the same time as your tummy tuck. If your plastic surgeon is uncomfortable with fixing your hernia, I would suggest he/she consult with a general surgeon. Ideally, the general surgeon can repair your hernia during the tummy tuck. If not, first, I would suggest a general surgeon fixture hernia. Several months later you can undergo your tummy tuck. This option is not optimal because it would involve two surgeries and two healing phases.
I have mesh from a pervious hernia repair. Can I still have a tummy tuck?
Yes. It is critical that your plastic surgeon knows of any previous surgeries. This is especially important if you have undergone a previous hernia repair. Often, during a tummy tuck, ventral or incisional hernias need to be revised or repaired. In addition, your plastic surgeon will have to be notified if mesh was used to correct your previous hernia. This would be important for them to know before the surgery. This may impact whether or not the rectus abdominis muscles are to be tightened.
I have stretch marks. Are all my stretch marks removed after a tummy tuck?
During a tummy tuck, excess abdominal skin and fat are removed from the pubic region to the belly button. If you have stretch marks from under the belly button to the pubic region, then the stretch marks in this area will be removed. If you have stretch marks above the belly button, these stretch mark cannot be removed during a horizontal tummy tuck. Instead, these stretch marks above your belly button are pulled down towards the pubic region.
I had my gallbladder removed. There is a large scar on the right side under the rib cage. Can I still have a tummy tuck?
Yes. The surgery you had is called an “open cholecystectomy”. With the invention of laparoscopic surgery, most gallbladder surgery with the laparoscope. This is significantly improved technique, offer to time, recovery, hospital stay, return to work, pain, and has minimal scarring. The laparoscopic cholecystectomy is by far a better procedure than open cholecystectomy. However, sometimes a patient needs to undergo an open cholecystectomy this may be due to a variety of reasons. One of the problems with the open cholecystectomy is that the incision cuts off blood supply. This restriction in blood supply was thought to cause problems with healing after a tummy tuck. Multiple studies have shown that it is safe to perform a tummy tuck even with an open cholecystectomy scar. When I evaluate patients for a tummy tuck who already have an open cystectomy scar, I tried to design a tummy tuck scar in such a way that the open cholecystectomy scar is completely removed. I doing this, the issues of healing due to blood supply are usually significantly diminished.