St. Louis Tummy Tuck Specialist
Bodyaesthetic Plastic Surgery & Skincare Center has been located in St. Louis, Missouri for almost 15 years and helps tummy tuck patients with addressing the excess skin of their abdomen along with toning and tightening their abdomen. The following paragraphs will help you to learn more about an abdominoplasty (tummy tuck) Procedure.
Everyone wants to have a flat, toned abdomen. As a person ages, there are multiple factors that can cause you to lose that flat abdomen. Sometimes diet and exercise are all that a patient needs to redevelop the flat contour of the abdomen. However, there are some changes that are not fixable with just diet and exercise. Genetics (that spare tire that mom or dad has), pregnancy, major weight changes (up and down), previous abdominal surgery, and back issues that affect posture are some of the reasons that patients lose their flat abdomen and develop the “tummy pooch.” Separation of the abdominal muscles (rectus or “six-pack” muscles) can also worsen the abdominal bulge and this is frequently seen following pregnancies and those patients that lose a large amount of weight. It is common to have patients with normal body weight and still have an abdomen that protrudes or has sagging skin and fat.
For those patients that would like to have a flatter abdomen with a more toned appearance, a “tummy tuck” (abdominoplasty) may be the correct answer. An abdominoplasty typically removes the skin and fat of the lower abdomen. This allows us to visualize if there is any separation of rectus abdominus muscles (“six-pack”) muscles and then this can be corrected at the same time. Typically, the skin and fat from the about the level of the belly button down to the level of the pubic bone is removed during a tummy tuck. This also includes the stretch marks of the lower abdomen. Then the muscles are brought back closer to the midline from the breastbone to the belly button and then from the belly button to the pubic bone (think of wearing a corset inside your skin). Since the skin and fat of the upper abdomen are then pulled down to cover defect created by removing the lower abdominal skin, the entire abdomen becomes flatter, smoother, and tighter.
There are several different types of tummy tucks and which one that a patient chooses depends on their anatomy, the amount of skin excess that is present, and the patient’s tolerance for an incision. A good way to estimate the length of the incision is that for every centimeter of skin that you can pinch in the vertical direction from you belly button to pubic bone will result in a transverse incision that is three times as long. This means that if you can pinch 12 centimeters, the incision will be 36 centimeters. A “mini-abdominoplasty” or “mini-tummy tuck” means that incision is shorter and that it is typically kept between the hip bones. This does limit the amount of skin that can be removed and is for patients that have a minimal skin excess. It also limits the amount plicating or tightening of the muscles that the surgeon can perform during the surgery. For a “full abdominoplasty” or “tummy tuck,” the incision extends just beyond the hip bones and allows more skin to be removed and the muscles to be tightened from the breast bone to the pubic bone. Most patients that are interested in addressing their abdomen achieve their maximal benefit from a full abdominoplasty. Patients that have lost a significant amount of weight (greater than 70 pounds), may find that incision needs to be extended all the way around their abdomen to address the loose skin of the flanks and back in addition to the abdomen. This is called a circumferential body lift or lower body lift. During your consultation, Dr. Boswell will discuss the different tummy tuck options and see which one is best for you based on your anatomy and your goals with this surgery.
Since an abdominoplasty is an elective procedure, it should be performed on adults that are in good physical health and are close to their ideal body weight. It’s best if patients are within about 20 pounds of their desired weight when having a tummy tuck. If a patient is significantly larger and then loses the excess weight after surgery, then the patient can develop additional loose skin that may require more surgery. Also, the extra fat limits the amount of skin that can be removed at the initial surgery. This incision will produce a permanent scar. Just because it is plastic surgery, does not mean that it is scar-less surgery. The scar is positioned just above the pubic bone and is located low on the abdomen to try and hide the scar under a patient’s underwear or swim suit. The incision usually extends from hip bone to hip bone and the length is determined by how much tissue is removed.
A tummy tuck is most effective in addressing the issues that are below the navel because the skin and fat below the navel is directly removed. Patients will see some benefit to the middle and upper abdomen when that tissue is pulled down to cover the newly created defect. Liposuction can be carefully performed in some areas at the same time as an abdominoplasty (the flanks, love handles, back, thighs, and knees are common areas). However, liposuction of the upper abdomen performed at the same time as an abdominoplasty can significantly increase a patient’s chance for wound healing problems along the incision and these procedures should be performed at two separate procedures
The results of a tummy tuck are considered permanent and most patients will only have one tummy tuck during the course of their life. However, all patients will notice some changes after surgery. Almost everyone redevelops a little bit laxity to the abdomen. This is usually fairly minor, but significant weight fluctuations can stretch the skin out again. Patients that still need to lose more than 20 pounds to achieve their desired weight should postpone their surgery until they reach their weight goals. Becoming pregnant after an abdominoplasty can stretch the muscles and skin causing the belly to protrude and undo the results of the abdominoplasty. Most scars that are located below the belly button, such as C-section scars or hysterectomy scars will be removed during an abdominoplasty. If there is tethering of the skin over a C-section scar, this will usually be removed during the abdominoplasty improving the appearance of the abdomen.
Tummy Tuck (Abdominoplasty): The Surgery
A full abdominoplasty is a 2-3 hour procedure that is performed in the hospital under a general anesthesia (you are asleep). You will spend one night in the hospital and then go home the next day. There will be two drains coming out near your pubic bone (mons region) and these drains are usually in place for about 7-10 days. The incision is placed low on the abdomen extends just beyond the hip bones, although the length of the incision is determined by the amount of skin that needs to be removed. The fat and skin below the belly button is removed down to the level of the rectus muscles. The fat and skin above the belly button is then lifted off the muscles up to the breast bone in the midline and to the ribs out laterally. This allows the rectus muscles to be sutured back together which flattens the abdomen and narrows the waistline. The separation between the muscles is called “diastasis recti” and this suturing of the muscles together corrects the separation. The skin flap is then pulled downward and the incision is closed. A new opening in the skin flap is made to expose the belly button and then all incisions are closed with absorbable sutures (they don’t need to be removed). The incisions are closed in three layers, so it is very unlikely that the incision would open up again. The incisions are then sealed with Dermabond Prineo (essentially medical grade superglue), which allows patients to shower the next day, improves the scar quality, and reduces the risk of infection.
A mini-abdominoplasty is approximately an hour procedure in which a medium sized ellipse of skin is removed in the lower abdomen. The ellipse is approximately 4x12 centimeters, although the dimensions can change depending on the amount of skin excess. The muscles usually are not sutured back together in a mini abdominoplasty and no incision is placed around the belly button. Like the traditional abdominoplasty, the incision is closed in 3 layers and then covered with Dermabond Prineo. Most of the time drains are not necessary for the mini-tummy tuck.
What to Expect After a Tummy Tuck
Following the abdominoplasty you will have some bruising and swelling of the abdomen. The bruising has usually resolved within 7-10 days. The swelling will increase each day for the first 4-5 days, and then it will gradually improve. Approximately 80-85% of the swelling resolve in the first month after surgery and it will take 6-8 months for the rest of the swelling to resolve. In terms of post-operative pain, most patients rate their pain in 6-8 of 10 range and they find that oral pain medicine controls their pain well. Patients tend to use the narcotic pain medication for less than one week. Of those women who have had both a C-section and an abdominoplasty, most patients feel that the C-section is more painful.
After an abdominoplasty, most patients spend one night in the hospital and then go home the next day. You will have an abdominal binder on for the 2-4 weeks to help with reducing the swelling. There are two drains the come out about 7-10 days after surgery and wearing the binder helps them to come out sooner. To reduce the risk of blood clots, patients should be up and moving as soon as possible. We will have patients walking on the day of surgery. Some patients feel like they are unable to stand up straight following an abdominoplasty because of the pulling sensation on the incision. It is fine to standing up straight and this will not cause the incision to separate.
Following surgery, you will have a 10 pound limit on things that you lift for the first two weeks and then you will have a 20 pound limit for the following two weeks. There are no restrictions on the amount of walking that you can perform immediately after surgery. We have had patients that were back to walking five miles per day within the first week after surgery. You will be able to add the elliptical machine and biking back to your regimen at four weeks after surgery. At six weeks after surgery you will not have any restrictions or limitations on physical exercise. Most people feel comfortable going back to work 1-2 weeks after the abdominoplasty.
Some of the more common risks associated with an abdominoplasty include swelling, bleeding, infection, seroma formation (fluid collections), and unfavorable scarring. Unwanted loss of skin and blood clots in the legs (deep venous thrombosis or DVT’s) than can travel to the lungs (pulmonary embolus or PE’s) are rare complications, but if they occur are very significant. To help lower your risk of blood clots you will have “squeezy boots” on your leg, get out of bed early and often, and will be on a blood thinning medication.
Smoking and all nicotine containing products, including gum, patches, vapes, and dip can increase the risks of blood clots and death of the skin flaps. All patients should discontinue nicotine products at least one month prior to your tummy tuck and remain off the nicotine products for at least a month after surgery to lower the risks of blood clots and delayed healing of the skin flaps. Delayed healing can result in conspicuous scars that require additional surgery.
We will always make every effort to minimize the scars as much as possible. However, any time a surgeon makes an incision, it will make a scar. It takes about 18 months for scars to fully mature and fade. Scars tend to be red and raised for about 6 months, scars then lose the redness and fade between 6 and 12 months, and then scars flatten out between 12 and 18 months. The scars are located on the lower part of the abdomen and are typically not visible when wearing a swim suit or shorts.
The results from an abdominoplasty are immediate, although there will be changes to the skin and contour that will continue for at least the first six months after surgery. The results of a tummy tuck are nor permanent in that effects of gravity, aging, weight changes, and future pregnancies can cause the skin to stretch out again. Most patients do not need to have a second abdominoplasty even if they become pregnant after their abdominoplasty.
Length of Surgery
An abdominoplasty usually takes 2-3 hours, depending on the amount of skin excess that a patient has.
An abdominoplasty is performed with general anesthesia (you are asleep).
Patients usually spend one night in the hospital
Tummy Tuck: Side Effects
Following an abdominoplasty, patients will have temporary pain, swelling, and bruising. All patients will have some numbness of the abdomen this will improve with time. The area of skin between the belly button and the incision usually remains permanently numb. The scars are permanent although they do fade with time. Most patients will feel tired for several weeks after surgery.
Tummy Tuck: The Risks
The risks after an abdominoplasty include bleeding (hematoma), infection risk is (1-2%), unfavorable scarring, loss of the skin flaps or belly button, need for revision, recurrent laxity, blood clots (DVT’s or deep venous thrombosis) with risk of the blood clots traveling to the lungs.
Tummy Tuck: The Recovery
Most patients will return to work within 1-2 weeks.
Activity: Patients may walk as much as they want immediately after surgery. They can start using the elliptical machine and exercise bike 4 weeks after surgery and return to unrestricted exercise at 6 weeks after surgery.
Maximal scar improvement usually takes about 18 months. Scars tend to be red and raised for about 6 months, they lose the redness over the next 6 months, and flatten out between 12 and 18 months.
Duration of Results
Usually the results are long lasting to permanent and most patients will only have one abdominoplasty during the course of their life. Extreme weight fluctuations and pregnancy after the surgery will cause the skin to stretch, but typically not enough to consider repeating the surgery. Patients will develop some recurrent laxity of the skin and stretching of the muscles with time.