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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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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Revision of Abdominal Liposuction Deformity with Abdominoplasty and Fat Grafting

It is not uncmmon for patients to have undergone liposuction in the past and who now present with a deformity. This can be caused from the patient having had liposuction performed too agressively in one region or area of the body, or the patient my have had significant flucutations in weight following liposcution.

The patient in the above photograph had aggressive liposuction of the abdomen in the past which caused a rippling deformity of the abdomen. There was also significant relative protrusion of the umbilicus relative to the srurrounding fat. This rippling deformity can be very distressing to patients when they want to wear summer clothes. The deformity was corrected with a modified abdomioplasty, plication of the rectus, shortening of the umbical stalk and fat grafting to the remaining areas that were deficient in fat contour.

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Abdominoplasty & Abdominal Muscle Plication

Abdominoplasty procedures are common operations. Plication of the abdominal muscles is important to improve the contour of the abdomen and restore the abdominal domain to its original dimensions. The psychological impact of this physical change can be quite powerful. Frequently the patient returns to exercise with greater energy and zeal, the diet improves significantly, and often reminders of past eating behaviors are placed in the "rear view mirror". It is not uncommon for the patient to develop extremely healthy habits and continue to have significant improvement in health and well being.

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Abdominoplasty: Mommy Makeover

Often after many pregnancies athletic women return to the gym and spend many hours trying to improve their abdominal contour. Despite numerous hours of Pilates, Yoga, or weight-training these women have a difficult time restoring their abdominal contour. In addition, while spending many hours in the gym burning calories, a significant amount of volume can be lost from the breast tissue.

It is very common for women to undergo an abdominoplasty to restore their abdominal contour as well as a concomitant breast augmentation to restore their breast volume. After these procedures, patients feel comfortable with the manner in which they fill out clothing. Typically, patients are allowed to return to unrestricted exercise within four weeks following their operation.

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Revision Abdominoplasty Surgery

Revision abdominoplasty is becoming a very popular part of my practice. There are many women who had abdominoplasty procedures several years ago an who did not have muscle tightening of their lower and upper abdomen to improve body contour. In addition they may have gained additional weight.

I have found it very helpful in these patients, when their skin laxity allows, to perform a second abdominoplasty. It is important in these patients to perform significant muscle plication above the umbilicus or "belly button" as well as below.

I also find it helpful in these patients to re-locate the umbilicus or "belly button" on the most concave portion of the abdomen to give the best abdominal contour.

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Abdominoplasty

Abdominoplasty procedures are a very common operation. Patients who typically get the best results following an abdominoplasty operation, are those patients who attempt to maximize their diet and exercise prior to their procedure. I encourage patients to do both cardiovascular as well as weight training exercise.

When patients add weight training to their exercise regimen, weight loss occurs more rapidly. This is sometimes counterintuitive to patients. Weight training or resistance exercise allows patients to increase their muscle mass. When one increases their muscle mass, the body's basal metabolic rate increases. An increase in the body's basal metabolic rate means that one's body burns more calories during their regular daily activities.

Often after a tummy tuck operation, patients continue to loose weight because they are more motivated to go to the gym, feel more comfortable in exercise clothing, and often the muscle placation from the tummy tuck causes patients to feel full after eating. It is important that patients continue to consume a diet rich in protein following aesthetic surgical procedures.

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Abdominoplasty & Liposuction

The type of "body habitus" or body shape the patient presents with allows different techniques of abdominoplasties to be performed. For example if there is very little loosening of the muscles of the abdominal wall, then there is little muscle tightening to be done.

However, if there is a larger than normal deposits of fat in the anterior abdominal wall, then these patients are candidates for liposuction in combination with their tummy tuck. In these cases, if liposuction is performed, than a majority of the blood supply to the abdominal wall skin and fat remains intact. There is little subcutaneous undermining. Because there is no muscle tightening, then the recovery process tends to be very quick. Patients are required to wear an abdominal binder for 4 weeks post-operatively.

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Tummy Tuck. Improving Abdominal Contour. Removing Scars

Many women present to our office with prior appendectomy or cesarian section scars that they wish to have removed. Often these scars can be excised and removed at the same time as an abdominoplasty or "tummy tuck" operation. Typically in an abdominoplasty or "tummy tuck" operation the skin from the lower abdomen is removed from just above the pubic hair line to above the umbilicus or "belly button". These scars are then removed and the abdomen is contoured.

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Abdominoplasty. Body Contouring Principles

Abdominoplasty is the medical term for a "tummy tuck". Frequently women come to our office as they find it nearly impossible to restore the contour to their abdomen that they once had despite strict diet and exercise.After the delivery of several children, the rectus abdominus muscles and fascia of the abdominal wall become lax. When this occurs, despite women performing numerous hours of sit-ups in the gym, the abdominal contour can not be restored because the rectus muscles are no longer in correct alignment.

An abdominoplasty of varying degrees can be performed depending upon the amount of fat that needs to be removed, the amount of skin that needs to be removed, or the amount of muscle or fascia tightening that needs to be performed. One of the most effective techniques performed during the abdominoplasty is repair of the rectus diastasis or separation of the rectus abdominus muscles. This procedure effectively reduces their abdominal domain and tightens the abdomen.Traditionally, women are encouraged to maximize their weight loss through cardiovascular and weight training exercise prior to surgery.

Post-operatively patients stay over one night in an aftercare facility. The medication and exercise regimens that I use post-operatively are described below.

Medications:

1. Emend 40 mg by mouth mourning of surgery to prevent nausea.

2. Toradol 20 mg by mouth x 1, then 10 mg by mouth four times per day x 3 days.3.

Percocet 5/325 by mouth every 4-6 hours as needed for pain.4.

Keflex 500 mg by mouth four times per day. (Antibiotic)

Post-Operative Exercise Regimen:

1. First week post-operatively. Walking only.

2. Second week post-operatively. Walking only.

3. Third week post-operatively. Stationary Exercise Bicycle.

4. Fourth week post-operatively. Stationary Exercise Bicycle.

5. Fifth week post-operatively. Upper Body Exercises.

6. Six week post-operatively. Lower Body Exercises. (No Squats)

7. After six weeks patients have unrestricted return to exercise.