Cosmetic surgery of the abdomen is a very common request. Many women and men are dissatisfied by the appearance of their abdomen. Once stretched by pregnancy or weight gain, the abdomen often does not return to its original state even with the most rigorous diet and exercise. People who just don't have the time or inclination to do rigorous diet and exercise can also be greatly helped by plastic surgery. Aging too is a factor with tissues sagging as the years pass.
Improvement of the abdomen requires a complex decision process. The patient and plastic surgeon must weigh the benefits, scars, recovery and tightening aspects of various procedures. Dr Koenig is very experienced in all options available and once the patient's goals are understood, will recommend the appropriate procedure.
The simplest plastic surgery procedure and often the best may be liposuction. In the patient whose muscle tone is excellent and who is not bothered by redundant skin, liposuction of the abdomen can have impressive results with a rapid return to normal activity. Patients who have some muscle laxity, but no skin laxity, can benefit from endoscopic tightening of the abdominal fascia and liposuction.
The next step in complexity is mini-abdominoplasty which keeps the incision short (just above the pubic hair area) and then tightens the muscle layer as well as the skin layer below the belly button.
The next step is a mini-abdominoplasty with umbilical float - this is similar to a mini but can have some tightening effect above the belly button. Next on the list is a full abdominoplasty. Here the incision lies in the bikini line but goes from hip to hip. The belly button is left in place and the abdominal wall is stretched downward with the excess being cut off. There is also an incision around the belly button. This tightens the entire anterior abdomen.
If laxity of skin extends more laterally, an extended abdominoplasty may be necessary. Often in patients with a great deal of weight loss, this can be quite helpful in tightening the flanks which full abdominoplasty does not do.
Finally the most extensive procedure is belt lift. This is usually performed on patients who have had massive weight loss often through gastric bypass surgery. The patients benefit not only from a tightening of the abdomen but also a tightening of the lateral thighs and a lift of the buttock.
Liposuction of the hips is a common adjunct to abdominoplasty and helps many patients with the final shaping.
THE OPERATION- TUMMY TUCK
Tummy tuck surgery is usually performed under general anesthesia, but liposuction and mini abdominoplasty can be done with local anesthesia and sedation. In patients with a full abdominoplasty (tummy tuck) and lesser procedures, the patient is able to go home the same day. A tummy tuck procedure takes about 2 hours. More extensive procedures require more time and recovery. An extended abdominoplasty requires an overnight stay and a belt lift may require 2 days in the hospital. The pain level after tummy tuck surgery is significant and pain medications are required. A garment is put on in the operating room and the patient must keep it on for the first 3 weeks after tummy tuck surgery. A drain is placed in most patients and removed in one week after your tummy tuck.
RECOVERY- TUMMY TUCK SURGERY
A full abdominoplasty (tummy tuck) usually has significant pain for the first 2-3 days and is sore for the first week. Often the patient cannot stand up straight for the first week after tummy tuck surgery. After 2 weeks most patients can return to driving and normal household activity; after 3 weeks most people return to work. Walking is encouraged on day one of the tummy tuck surgery and it is important not to become too sedentary. Restrictions on lifting and sit ups are in place for 6 weeks. After 6 weeks, full wound strength is present and there are no limitations. Mini tummy tuck has an accelerated recovery by comparison and extended abdominoplasty takes a bit longer.
COMPLICATIONS- TUMMY TUCK SURGERY
Abdominoplasty (tummy tuck) is major surgery and complications are possible. Bleeding and infection can occur. The most common complication for tummy tuck surgery is a collection of fluid under the skin which is drained in the office. More rare complications can occur with the most feared problem being a blood clot in the leg. Blood clots in the leg can be serious and even life threatening if the clot moves into the lungs. This is a rare problem and measures are taken to minimize the chance of this happening. Nevertheless patients must understand that it is a possibility. Smoking increases the chance of all complications and Dr. Koenig does not perform abdominoplasty on active smokers. If the patient is a smoker, they must quit one month before tummy tuck surgery and cannot resume smoking for one month after surgery.
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