Managing Supra-Umbilical Scars in Abdominoplasty

It is typically said that supra-umbilical scars or "scars above the belly-button" can impair healing in abdominoplasty incisions. I have found that often this problem can be circumvented by excising the abdominal scar completely. Often the midline scar can be revised and/or excised and closed, which is a technique often used in body contouring to remove excess skin from the trunk in the vertical direction in addition to the horizontal direction.

It is common after abdominoplasty for patient to experience "early satiety" after meals as there is less abdominal domain. Typically, patients get full during their meals much more quickly. Because of this, patients tend to lose a significant amount of weight post-operatively following their meals. I encourage patients to consume at least 1.5 grams of protein per kilogram of body weight following surgery.

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Abdominoplasty & Mastopexy Augmentation

Mastopexy augmentation and abdominoplasty when performed in combination can be quite a powerful combination to overall total body aesthetics.

During mastopexy augmentation or simultaneous breast lift and breast augmentation, a breast implant is placed as in a standard augmentation and at the same time, the nipple areola complex is elevated to a much higher position on the chest. When this is performed alone, the result can restore a youthful appearance to the breast.

When an abdominoplasty, or tummy tuck, is performed at the same time, the contour of the abdomen can be significantly improved which even further improves the aesthetic proportion of the breast.

Many patients are very happy with this combined procedure. We see many patients around the holiday season who wish to undergo simultaneous mastopexy/augmentation and abdominoplasty as the holiday season offers an opportunity to rest and recover in Newport Beach, California.

Mini-Tummy Tuck and Liposuction

It is quite common for women to present in our office who have lower abdominal laxity as well as localized deposits of fat around the abdomen. Often these women do not wish to undergo a full abdominoplasty and would rather keep their scars to a minimum.

Often patients may have a prior cesarean section scar that can be used to gain access to the lower abdominal muscles that need to be tightened. Often these scars can be revised at the same time that the lower abdominal muscles are tightened.

Liposuction can commonly be performed at the same time that the lower abdominal muscles are tightened to remove fat from the upper abdomen, the flanks, the lower back, and bra fat.

The photograph above demonstrates before and after photographs of a patient after “mini-tummy tuck” and liposuction of the abdomen, flanks, lower back, and bra fat.

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Abdominoplasty Surgery. Body Recontouring

Abdominoplasty surgery is one of the more common procedures performed for body contouring. Typically, the scar is marked in a pre-existing crease along the abdomen. During the surgery the skin is raised off of the anterior abdominal wall and the muscle and fascia beneath the skin is recontoured. Often during this time, any hernias around the umbilicus or hernias from prior C-section scars can be repaired and then the fascia of the abdomen tightened on top of the hernia repair. Then the skin is re-draped over the new abdominal contour and any excess skin is removed.

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Muscle Plication and Hernia Repair

It is quite common to see patients in our office who present with a chief complaint of either and umbilical hernia, and incisional hernia from a prior c-section, as well as myofascial weakness. Typically these patients which to undergo repair of their hernia and also have their myofascial weakness repaired at the same time. Quite commonly many women have weakness of their abomdinal wall from prior childbirth. At the time of hernia repair we can also reconstruct the muscles of the abdominal wall to improve the appearance and contour of the abdomen.

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Abdominoplasty to Remove Unwanted Stretch Marks

It is common for many women to present in our office wishing to remove the extra tissue from their lower abdomen as well as unwanted stretch marks. During an abdominoplasty procedure, the tissue from the lower abdomen is removed typically from a point 6 cm above the vulvar commissure to a level above the umbilicus or "belly button. This skin excision almost invariably removes the unwanted stretch marks from the lower abdomen.
During the abdominoplasty the rectus diastasis is plicated to bring the rectus muscles back to their core position. Patients typically notice a continued loss in weight as the capacity of their stomach for food is greatly reduced. It is important to keep protein intake high in the post-operative period.

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Abdominoplasty. Restoring Core Musculature and Posture.

It is common for us to hear in consultation that despite doing hours of crunches and sit-ups in the gym, many women post-pregnancy cannot restore their abdominal contour.

Abdominoplasty involves plication of the rectus abdominis muscles. When the rectus muscles are plicated in the midline the core abdominal muscles such as the rectus abdominis, the external obliques, internal obliques, and transverse abdominis muscles are restored to the midline. It is quite common for patients to observe an improvement in their posture post-operatively.

The before and after photograph above demonstrates improvement not only in the abdominal wall contour, but also in the position of the lower back.

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