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.
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.
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 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.
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.
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 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 previous 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.
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.
If the pubic hair is pulled up during a tummy tuck, will I have pubic hair around my belly button?
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.
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.
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.