I appreciate your spending time to view my series
on cosmetic surgery. This time the subject is tummy
tuck or abdominoplasty. The operation is characterized
by removing skin, and usually removing fat, to reshape
the abdomen. I have developed an operation that is somewhat
unique, or at least I thought it was unique until I
found in the surgical literature another surgeon proposing
a technique that is similar to the one I use. But the
essence of the method is that fat is removed by liposuction
and the extra skin is removed without undermining the
skin over the underlying muscles of the abdomen~ Details,
without being gruesome, will follow.
First, who is a candidate for a tummy tuck? Of course
the patient must have a desire for reshaping the abdomen.
There must be extra skin which results in sagging with
unwanted folds in the lower abdomen and frequently skin
folds above the navel. And there may be muscle laxity
which can cause protrusion of the tummy. And almost
always there is too much fat under the skin.
The surgery may be very simple, as in removing a small
amount of skin and fat, or it may be a more complex
operation. The complex surgery can involve, in addition
to removal of fat and skin, sewing the muscles together
to tighten the tummy and possibly repositioning the
belly button. Obviously the more work that has to be
done will increase the time in surgery.
Most plastic surgeons make a long incision above the
pubic hair from side to side, and then elevate the skin
and fat from the underlying muscles. In most instances
the belly button is separated from the skin and is left
attached to the abdominal wall. The fat is then removed
from the undersurface of the skin and, the muscles are
tightened if necessary, and the extra skin is removed.
The skin and the remaining fat are repositioned on the
abdominal wall and the wound is closed in layers with
drains exiting from each side. A small circle of skin
is removed and the navel is brought to the surface and
sewn to the abdominal skin. The problems with this type
of operation relate to the disturbed blood supply to
the abdominal skin. In addition, the skin and fat take
a long time to stick to the underlying muscles because
of motion. This results in a long healing time and potential
for loss of skin just above the pubic hair. In addition
there is frequently no shaping to the waist, and the
scars around the navel can easily be seen.
My operation has almost no undermining; indeed none
at all if there is no muscle separation or need to repositioned
the belly button. This leaves all of the large perforating
blood vessels from the underlying abdominal muscles
to nourish the skin. The skin and fat are never separated
from the underlying muscles. Thus the skin heels faster.
Drains are used to prevent fluid pooling and the drains
are removed in two to three days. And very important,
the propeller shaped skin removal allows excellent shaping
of the abdomen with tightening the waist, an accomplishment
not easily done with the standard tummy tuck.
Of course there are some circumstances where there
is so much skin in the upper abdomen, which overhanging
the belly button that the umbilicus must be moved toward
the pubis to tighten the skin. This is fortunately uncommon;
usually the belly button is not repositioned and when
it is necessary to move it there are no skin scars associated
because the skin around the navel is not incised as
the surgery is performed deep to the skin.
One fact is paramount--all tummy tucks require skin
removal. The scars can be quite long, depending upon
the amount of skin to be removed.
The surgery is performed on an outpatient basis under
general anesthesia. My outpatient surgical center is
licensed and supervised by both state and federal government
agencies. Our anesthesiologists are physicians who specialize
in anesthesia. They are board certified and have extensive
experience.
|
