After childbirth or weight loss, the abdominal area often has loose or sagging skin, and may also include stretching of the abdominal wall muscles or fascia (the tough gristle-like layers that surround the abdominal wall muscles and give it strength). There may also be hernias (bulges of intraabdominal contents—intestines and fat) through tears or openings in the abdominal wall. These can be tiny asymptomatic bulges such as in the umbilicus, or can be large enough to cause strangulation of small bowel which protrudes and becomes caught in the hernia. The latter is rare and dangerous, the former, common and unsightly. Generalized weakness and protrusion of the abdomen with loose overlying skin that often has visible stretch marks are the hallmarks of patients who need abdominoplasty, or “tummy tuck.” This operation removes loose skin, tightens the abdominal wall muscles, and repairs any hernias found.
Some patients may have a tight abdominal wall (some men and those women that have not had children) but still have localized fatty tissue outside the abdomen; these patients may be a candidate for suction-assisted lipoplasty (liposuction). Other patients, including some men with round or protruding abdominal areas and little fat outside the abdominal wall, are not a candidate for abdominoplasty or liposuction, since their weight is carried inside the abdomen, and will respond only to diet and exercise.
But if you have loose, wrinkled, or sagging abdominal skin, no amount of exercise will restore the lost elasticity and collagen content in that stretched skin. Abdominoplasty is the only answer for this concern. The good news is that other areas of localized fatty tissue, such as the hips, lateral thighs (“saddlebag” area), or other areas, can be treated with liposuction at the same time as abdominoplasty. If the loose skin continues to the hips, thighs, and buttocks, extended abdominoplasty, or even complete circumferential beltlift, can be performed. In addition to excess skin removal and tightening, abdominoplasty and abdominal contouring include tightening of the abdominal wall muscles with several layers of suture—restoring the abdominal fascia and contour to its pre-pregnancy or pre-stretched state. This usually results in flattening of the abdomen and a loss of one or more belt or dress sizes!
Both Dr. Gervais and Dr. Tholen perform abdominoplasty, abdominoplasty plus liposuction (abdominal contouring), and other forms of body contouring such as circumferential beltlift, thighlift, breast lifts, and arm lifts (brachioplasty), often in combination with selective liposuction (body contouring), all in our office surgical facility as an outpatient procedure.
Our skilled anesthesia providers (CRNAs that provide one-on-one care, full monitoring, and years of experience with our plastic surgical patients) utilize the most effective (not the least expensive) anesthetic medicines for your surgery, as well as complete continuous monitoring of blood pressure, EKG, pulse, temperature, oxygen in your bloodstream, exhaled CO 2 , and fluids during surgery and your recovery. Since we utilize intravenous anesthetic medications rather than inhalation anesthetics (gas and nitrous oxide) for virtually all cases, our post-operative nausea and vomiting (PONV) rate is significantly lower than the hospital and/or surgicenter rate of 7-28%. We have tracked our own patients after surgery for the past decade, and our present PONV rate is between 1.5 and 2% (for all our surgeries, including complex and longer operations). Our team of CRNAs is the best of the best, and use state-of-the-art techniques to help you feel better, do better, bruise less, have fewer bleeding concerns, and have a much more comfortable experience.
Most patients undergoing abdominoplasty or abdominal contouring will require one or two small surgical drainage tubes beneath the skin to evacuate fluid or blood that may collect after this surgery. To minimize drainage as well as bleeding, it is essential that every patient avoid aspirin, ibuprofen, Aleve™, vitamin E (the amount in a daily multivitamin is OK), or herbal preparations a minimum of two week prior to surgery. The drain(s) remain in place until drainage is reduced to less than an ounce of fluid per drain per day. Drain removal is simple, and is done at a routine recheck visit without anesthesia. While drains are in place, and for at least two to three weeks after surgery, an abdominal binder or compression garment will need to be worn to assist the tissues in healing to their new tightened placement. The umbilicus (belly button) remains in exactly in the same place it was when you were born—just with a new opening for it in the tightened skin that has been brought down around it. Except for the drain stitch and a few tiny sutures around the belly button, all sutures are below the skin surface, leaving no cross-hatch or suture marks, and yielding the best scar possible when fully healed.
There will be numbness in the lower abdominal skin after surgery; most, but not all, sensation returns as the sensory nerves regrow in the months after surgery. Strenuous activities should be limited after this kind of surgery for at least two weeks, and no sit-ups or abdominal crunches should be performed for at least six weeks. Most other activities are resumed quickly, and most patients return to social activity and work after 1-2 weeks, or after drain removal.
Because abdominoplasty, abdominal contouring, and more extensive operations such as extended abdominoplasty or beltlift all lift, remove, and tighten skin, adequate circulation to the skin flaps is necessary for proper healing and minimal scars. In non-smokers, circulation problems that can impair healing and increase scarring occur in less than 1-2% of patients. Smoking even one cigarette, using nicotine gum or patches, or even exposure to second-hand smoke can raise the risk of dead skin or belly button to as much as 15-20%. For this reason, all tobacco and nicotine products must be stopped completely at least two weeks before surgery, and continued after surgery until all things are healed. Failure to comply with this requirement will result in the cancellation of your surgery; concealing your own failure to follow this requirement may result in prolonged dressing changes, skin grafts, or additional surgery to deal with scarring.
Fortunately, abdominoplasty and abdominal contouring are among the most common plastic surgical procedures we perform; Dr. Tholen and Dr. Gervais perform well over 100 of these operations per year. Most patients are thrilled with their results. Complimentary consultation can help you determine what procedure or procedures are best suited for your own concerns.
For more information or to arrange a complimentary consultation with one of our plastic surgeons, please call 763-545-0443.
