Ruben Abrams MD FACS | Aesthetic | Cosmetic Plastic Surgery | (310) 651-8881

All posts in Tummy Tuck

LIPOSUCTION OR TUMMY TUCK?

LIPOSUCTION OR TUMMY TUCK? image

LIPOSUCTION OR TUMMY TUCK?

At least half of our patients who are clear cut candidates for a tummy tuck come to their first consultation while still under the impression that liposuction is a replacement for tummy tuck.  This is due to the tremendous amount of misinformation that is available online and in the media.  People are convinced through misleading ads that liposuction will eliminate their sagging belly, will remove the excess fat deposits around the belly, will tighten the skin and muscles, and they will be ready to go back to their daily lives in 1-2 days, virtually no down time.

Misinformation about Liposuction

This type of misinformation and misleading advertisement is almost always the work of individuals who do not have any training or background in plastic surgery and have taken a 1-2 week course in liposuction and they think that liposuction is the solution to all problems of the abdomen arising from pregnancy, weight fluctuation, etc.  There is a saying “When all you have is a hammer the whole world looks like a nail”.

HOW BEST TO STAY IN SHAPE AFTER A TUMMY TUCK imageWe have to spend a lot of time with such patients in order to undo all of this misinformation. It is only through appropriate planning and execution of a tummy tuck that the consequences of pregnancy and weight fluctuation such as sagging skin, looseness of the muscles, excess fat accumulation, and possible abdominal herniation can be corrected.  According to the most complete classification of abdominal bulging and redundancy that we have devised, there are eight different types and each has a specific treatment.  Please refer to our web site section on tummy tuck for more information.

When is Liposuction Recommended?

The only abdomen that is suitable for liposuction alone is a type I abdominal bulging, where the problem is limited to localized adiposity (fat accumulation), and there is no skin or muscle looseness. Such a situation usually exists in young girls who have not had any pregnancy.  Other than this the number of candidates for abdominal liposuction alone is extremely limited.

That said, a tummy tuck is almost always combined with liposuction, either at the same time or at two separate sessions.  Studies have shown that in most cases of abdominal bulging and sagging the best result can be obtained when the excess fat is first removed by liposuction and the tummy tuck is carried out 2-3 months later after the liposuction has healed.  If the person is not able to have the two stages, liposuction can be combined with tummy tuck in one session, but the amount of fat that is possible to remove may be somewhat limited due to the risk that this may impose on the blood flow to the abdominal skin.

HOW BEST TO STAY IN SHAPE AFTER A TUMMY TUCK

HOW BEST TO STAY IN SHAPE AFTER A TUMMY TUCK image

HOW BEST TO STAY IN SHAPE AFTER A TUMMY TUCK

Before we discuss this topic a few points need to be clarified:

1. Who is the best candidate for a tummy tuck?

We have discussed this in previous blogs and will discuss it further in the future.  But to summarize, it has to be clearly understood that tummy tuck is not a solution to obesity.  Someone who has an obesity problem must primarily focus on loosing weight.  Of course there are some cases that are borderline and it is at the judgement of the plastic surgeon to decide how much these borderline individuals will benefit from a tummy tuck.  Because at the end of the day it is the patient’s happiness that matters.

2. Does tummy tuck actually result in weight loss?

By the same token, the tissue that is removed during a tummy tuck usually does not have significant weight and therefore does not really affect the weight.  However, again, there are borderline cases where the procedure may result in loosing a few pounds.

3. So how is it that most people lose some weight after a tummy tuck?

This is an excellent question that will be discussed in more detail in future blogs.  But for now lets just say that after a tummy tuck one’s body adjusts to feeling full with smaller portions.  As a result the body goes into a negative balance and some weight is lost. 

NOW HERE IS THE MAIN TOPIC THAT WE WOULD LIKE TO DISCUSS: HOW BEST CAN ONE KEEP THIS WEIGHT OFF AND STAY IN SHAPE AFTER A TUMMY TUCK?

Many patients are under the impression that once they have had a tummy tuck, they have regained their desired shape and contour and they have nothing further to worry about.  So once they have fully recovered and have regained their strength, they go back to binges and eating unhealthy foods.  Then they start gaining weight, and because the extra weight usually cannot go into the abdominal area where the fat tissue has been removed, they start gaining in the upper abdomen, flank, thigh, and chest areas, resulting in significant disproportion of their body.  Then they start blaming the operation with sentences such as “What use is there in a tummy tuck?  You lose it in the belly and you regain it in other places”.  Such patients are in denial and do not want to accept their own negligence and lack of sense of responsibility.SAFE EXERCISES AFTER TUMMY TUCK image

What I often tell my patients is that their work does not end with the 2-3 hours that they spend in the operating room.  Rather, this is just the beginning.  We do our job, select the patient, prepare them and perform the surgery, take care of them until full recovery; but from that point on it is the patient who is responsible for maintaining the benefits of the operation.

This responsibility consists of two parts: 1. Healthy eating, 2. Proper exercise

1. Healthy Eating

There are three basic principles that one needs to adhere to if they desire to eat healthy.  A fourth supplementary principle can be added as follows:

   a. Frequent meals: Contrary to what most people think the best way to divide your daily food intake is to split it into 5 meals, rather than the traditional 3 but these meals should consist of small portions, just enough to make you feel full.  This conditions your stomach and your brain “thermostat” to feel full with smaller portions, and not to feel so hungry by your next meal so as to avoid going on a binge.

   b. But these meals should only consist of vegetables, fruits, legumes, beans, nuts, and grilled white meet, chicken, turkey, or fish.  Should you desire to have rice, it should be small portions of brown or black rice only.  Should you desire to have bread, it should only be whole-wheat non-enriched flour, or preferably gluten-free bread.

   c.  Conventionally raised poultry and fish are all injected with different types of hormones to make them grow faster and chubbier, for more profit.  It is no wonder that the population of the U.S. is the “fattest” population in the world.  The types of obesity seen in America are not seen anywhere else in the world, even though the amount of consumed food is almost the same.  So I recommend to my patients to stay with organically grown poultry and fish and to only consume non-GMO fruits and vegetables.

And for the supplemental principle:

   d. The body’s fluid, electrolyte, vitamin, minerals, and trace elements needs to replenished.  There is really no set rule on how much water is ideal for the body, but the best way to determine whether your body is adequately hydrated is to see how many times you have to empty your bladder during the day, how much urine is accumulated each time, and how light or how dark it is.  The optimal urine output under average circumstances is 1 cc per minute, or 60 cc per hour.  This means that your kidneys have to put out around 200 cc in a 3 hour period, approximately 6 fluid ounces. 

As for vitamins and the other substances listed,  we will discuss these and healthy eating in general. along with replenishing the body’s nutritional requirements in more detail in the future.

2. Proper Exercise

Basically, in order to remain in a stable weight and in shape one needs to understand how many calories they burn during the 24 hours without exercise, and place that against their calorie intake.  Of course there are technical ways to determine how much your body burns throughout the day, but as everything else, you are the best judge at that.  Everyone knows their body better than any doctor or any machine.  You also need to understand how many calories your body will burn with each type and cycle of exercise.  For example, one hour of power-walk on a flat surface in the average individual amounts to burning approximately 300 calories.  But this could vary from one individual to another. 

For further information on this topic please refer to our recent blog on safe exercises after tummy tuck. Also be on the lookout for further detailed discussion on this topic in the near future.

SAFE EXERCISES AFTER TUMMY TUCK

SAFE EXERCISES AFTER TUMMY TUCK image

SAFE EXERCISES AFTER TUMMY TUCK

As can be seen from our page on abdominoplasty (tummy tuck), there are many different types of this operation.  But in almost all of these much excessive tissue is removed and as a result the suture lines are closed under some tension.  As a result advancing to your pre-operative exercise routine needs to be done cautiously and under guidance by your surgeon or other professional familiar with the operation.  You have to remember that maintaining optimal results of your surgery is in your hands and the more you keep in shape the longer lasting the results of your tummy tuck will be. 

Brisk Walking

In our practice we usually start the patients on brisk walking as soon as they can tolerate it, in most cases around one week after surgery.  During the first week after surgery we encourage patients to walk as much as they can tolerate and this is crucial because many studies that go back 30-40 years have shown clearly that the sooner patients are encouraged to ambulate after surgery the more rapid their recovery and the less the likelihood of complications such as deep vein thrombosis and pulmonary embolus.  Walking that can be considered a work-out routine is known as “power walk” and it means the popular 13-minute mile, i.e. each mile in 13 minutes.  A 3 mile power walk on a flat surface would take 39 minutes and in most Weight Loss by Tummy Tuck Imagecases results in burning around 300-400 calories.  This has been shown to be the most effective and practical cardio exercise.

Working out the “Abs”, Sit-Ups

A major part of the tummy tuck operation is tightening the abdominal muscles after they have lost their tone due to lack of exercise and pregnancy.  This muscle tone needs to be maintained otherwise it can be lost again.  This is done through different types of abdominal muscle exercises and different modifications of sit-ups.  In most cases we start patients on this group of exercises around 6 weeks after surgery.  Each patient is advised to start with a few partial sit-ups and gradually increase the number and intensity. It needs to be mentioned that power walking also plays a role in maintaining abdominal muscle tone. If you put your hand on your belly while power walking you will feel the muscles tightening with every step you take.

Further Work Out, Weights, etc.

Most people are ready to go to more intense and higher impact work out at around 2-3 months.  At this time you can start muscle toning exercises and weights as your body allows.  But remember that every advance you want to take should be approved by your surgeon or other professional familiar with the operation.

Once again I will repeat what I said at the beginning: You have to remember that maintaining optimal results of your surgery is in your hands and the more you keep in shape the longer lasting the results of your tummy tuck will be.

All About Bariatric Surgery

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ALL ABOUT BARIATRIC SURGERY

Bariatric surgery is a general term used to categorize all surgical procedures that are performed for the purpose of weight management in overweight individuals.

 

Why did this type of surgery come about?

Obesity & Tummy Tucks

We all know that obesity is unhealthy and jeopardizes the body in many ways.  Unfortunately with people relying more and more on unhealthy and processed foods, and with corporations deliberately keeping the public in the dark in terms of healthy eating habits, obesity has become more and more of a serious problem.  The types of obesity that we have been witnessing over the past half century literally did not exist before.  A detailed discussion of the reasons for this will be left for a later blog, but suffice it here to say that in many instances the obesity is beyond what can be controlled by the individual through the usual modalities of healthy eating and exercise.  This is why surgical weight management came into being, eventually became a subspecialty of general surgery, and came to be known as “BARIATRIC SURGERY”.

bariatric surgery History

 Historically bariatric surgery has gone through many stages of development.

ileo-ileal bypass:

The earliest forms of bariatric surgery consisted of surgically connecting the beginning of the small intestine to the end, the so-called “ileo-ileal bypass” and the “ileo-jejunal bypass”.  This resulted in a major portion of the small intestine which is responsible for digesting and absorbing the food to be “bypassed”.  These procedures were effective, but they resulted in major metabolic imbalances which had to be corrected by supplemental medications, vitamins, etc.

gastro-intestinal bypass:

The next phase in the development of bariatric surgery was the coming of the so-called “gastro-intestinal bypass“, a procedure where the end part of the small intestine was connected to the outflow of the stomach, again bypassing a major portion of the small intestine.  This procedure also resulted in major metabolic imbalances.

 

gastric stapling:

Next surgeons thought the best solution would be to eliminate a portion of the stomach so the individual would feel full quickly, the so-called “gastric stapling” procedure.  This procedure was not as effective because individuals compensated by continuous and frequent eating.  However, it did not have the metabolic ill-effects of the other procedures.

 

gastric balloon:

At some point in the development of surgical weight-management a balloon was developed which was placed in the stomach endoscopically and inflated.  The idea was that this balloon would take up a major portion of the space in the stomach and the individual would feel full all the time.  After being put to the test it was noted that individuals would compensate by continuously eating small portions of fattening items.

 

inter-maxillary fixation:

Some authorities even suggested placing individuals in IMF (intermaxillary fixation), which in simple terms is referred to as “wiring the mouth shut”.  Even with this modality people were caught sipping high calorie milk shakes all the time.

So, as can be seen many modalities have evolved in the quest for a practical solution to excessive obesity.

 

Lap Band and Gastric Sleeve

Obesity and Tummy Tuck ImageAs it stands today, the most effective procedures for surgical weight management are the “Lap Band” and t he “Gastric Sleeve”.  The Lap Band is a tourniquet-like device that is placed around the stomach endoscopically, basically dividing the stomach into to chambers, thus causing the person to feel full quickly.

In the Gastric Sleeve procedure, a major portion of the stomach is removed endoscopically, leaving basically not more than 25% of the stomach in between the esophagus and the small intestine.  Obviously a person would feel full and not have much of an appetite with a very small portion.

These two modalities have been found to be most effective in surgical weight management.  Both are endoscopic outpatient procedures, meaning that they are done with minimal incisions through which endoscopic equipment and scopes are inserted, and the patient is discharged home after adequate recovery from anesthesia.  They both take around one hour to perform and patients are able to return to their work and day-to-day activities within 1-2 days.

The Ideal BMI for Abdominoplasty | Tummy Tuck

IDEAL BMI Image

The Ideal BMI for Abdominoplasty

In previous blogs we discussed what BMI means, how it is calculated, and what are the risks of having surgery, especially abdominoplasty (tummy tuck) with high BMI.  Let us now see what is the ideal BMI for obtaining the most satisfactory result with abdominoplasty.

 

Obesity Types and Variations

Obesity & Tummy Tucks

Obesity manifests itself in many different ways, depending on one’s gender and genetics.  For example men generally gain weight within the abdomen, around the gastrointestinal tract.  This is called visceral adiposity.  It is for this exact reason that men usually are not suitable candidates for abdominoplasty because when their abdomen increases in size, the increase is within the abdominal cavity, like a pregnant woman.  Most people have heard the term “beer belly”.  It is this type of intra-abdominal obesity that the term refers to.  Women, on the other hand, accumulate fat in the subcutaneous plane (under the skin) in different parts of the body, most prominent in the abdominal area.  Some women are “top heavy”, meaning that their obesity is concentrated in the torso area (chest, abdomen), and some are bottom heavy, meaning that their obesity is concentrated in the extremities (thighs, hips).

 

Ideal BMI for the Most Satisfactory Result with Abdominoplasty

High BMI ImageMany studies and statistical analyses have been carried out trying to correlate abdominoplasty outcome with BMI.  Most of these studies have come to conclude that the ideal BMI for a satisfactory result is in the 25-27 range.

Of course, if a person with a lower BMI is a suitable candidate for abdominoplasty they will have a satisfactory result.  But as we go up the scale, higher BMI’s usually do not result in the same degree of satisfaction and contentment.  Now, of course, there are individuals with BMI as high as 32-33, in whom a significant amount of the obesity is related to a hanging abdominal panniculus.  In these individuals also an abdominoplasty results in a satisfactory outcome and contentment from the result of the surgery.

abdominoplasty-photos-9-1During the past month we have performed abdominoplasties in 3 women with BMI as high as 33, in whom a major portion of the obesity was related to a heavy hanging panniculus.  The removed panniculus in these individuals weighed an average of eight lbs.  It is noteworthy that in a 160 lb individual this 8 lbs is 5% of their weight.

However, ideally one should try to bring the BMI down to the 25-27 which is the ideal BMI range if necessary before an abdominoplasty, for the optimum result.

High BMI and Tummy Tuck Risks

High BMI Image

High BMI and Tummy Tuck Risks

Is my BMI too high for Tummy Tuck surgery? We have discussed previously what BMI (Body Mass Index) means and how it is calculated.  Lets see now what the significance of this index is in a tummy tuckAbdominoplasty has become one of the most common plastic surgery procedures carried out in the united states and around the world.  Especially since the popularization of bariatric surgery and its subsequent post-massive-weight-loss redundancy, mainly in the torso area, the need for standard abdominoplasty and its several variations which have come into existence to deal with the many different situations at hand has increased significantly.

 

The Risks of Abdominoplasty Surgery

Tummy Tuck Risks Image

Even though abdominoplasty is a very safe operation its overall risk of complications is higher than other plastic surgery procedures.  The combined number of complications in plastic surgery procedures that has been reported is around 1.5%, while in abdominoplasty the overall risk of complications is 4%.  We will discuss these complications in future blogs, but for now lets see if a high BMI adds to the risk of complications in abdominoplasty.

 

High BMI and Tummy Tuck

What is the Body Mass IndexImageThere are many studies in the plastic surgery literature correlating high BMI with surgical complications and the general consensus is that a BMI of greater than 30 does increase the risk of complications such as deep vein thrombosis.  In abdominoplasty specifically this increased risk is important to bare in mind because as mentioned abdominoplasty carries a higher risk of complications as compared to other plastic surgery procedures.  However, the problem is that in most situations it is actually people with high BMI that require an abdominoplasty.

In our practice we encourage individuals with BMI of higher than 30 who request an abdominoplasty to follow our weight loss instructions for a period of 3-6 months, until their condition has been optimized as best as possible for the surgery.  When patients realize that it is for their own good and it will not only improve the outcome of their surgery but it is also safer for them they usually do not have problems following our recommendations.

High BMI Image

 

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What is the Body Mass Index? How is BMI Calculated?

What is the Body Mass IndexImage

What is the Body Mass Index? How is BMI calculated?

We have all been hearing about BMI which stands for body mass index and almost everyone knows that it is used to determine whether certain individuals are suitable candidates for certain surgical procedures(e.g. Tummy Tuck). But most people do not know what it exactly means and how it is calculated.  We will try to shed some light on these questions in this brief discussion.

History of Body Mass Index

Weight Loss by Tummy Tuck ImageLets look at a brief history. Before the development of modern technology, cars, comfortable homes with TV’s, and all the stationary means of entertainment that occupy modern life, people were much more active physically and obesity was rarely an issue. With the coming of all of these “gifts” of the twentieth century a new problem arrived at the doorsteps of physicians: OBESITY. It did not take long for doctors to realize that obesity carried with it increased risks of certain problems such as CAHD (coronary artery heart disease), CVA (cerebrovascular accidents), etc. So with this knowledge came the need for ways to assess the degree of obesity.

Assessment of Obesity

Body-ProceduresAssessment  of obesity has gone through different stages in its evolution. It used to be that doctors and insurance companies had charts that placed height against weight and based on these two figures they would determine the degree of obesity. Of course the chart would be different for men and women. Based on these charts doctors would decide whether an individual was obese, and if so what percent of excess weight did the individual have. For example if according to the chart a man was 5’5″ and 180 lbs and his ideal weight according to the chart was 155 lbs, he was 25 lbs overweight, or approximately 18% overweight.

Two terms developed in the course of this knowledge:

MORBID OBESITY, a person who was 50% overweight, and

MORIBUND OBESITY, a person who was 100% overweight.

Now, in the early 19th century scientists had come up with the BMI formula, but it had been forgotten until it was re-discovered by Ancel Keys in the early 1970’s and was popularized after an article he wrote about obesity and its detrimental health effects. Since then there have been many scientific and statistical studies correlating BMI with all sorts of risks such as heart disease, high blood pressure, cerebrovascular disease, surgical risks, etc.

Calculation of BMI

We will talk about the role of BMI as a risk factor in different types of plastic surgery procedures in future blogs. But for now, lets see how this index is calculated. There are basically two formulas that can be used for this purpose, one being based on the metric system and the other based on the inch and pound system:

BMI = MASS (kg) / (HEIGHT (m))2

BMI = MASS (lbs) / (HEIGHT (inches))2 x 703

What does this mean. Lets look at an example.  A certain individual weighs 160 lbs and is 5’7″. First lets convert the 5’7″ into inches, that would be 67″. Now lets take 160 and divide it by 67 to the power of 2, i.e. 160 / 4489 = 0.03564268. Now lets multiply this number by 703, so:

0.03564268 x 703 = 25.  So this individual has a BMI of 25, which is the ideal BMI and we will talk about this further in future blogs.

 

References:
1. Keys, Ancel (1980). Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Harvard University Press.

2. Keys, Ancel (1936). “The Physiology of Life at High Altitudes”. The Scientific Monthly 43 (4): 289–312.

Is Mommy Makeover for Me? Signs of Aging: Body

mommy makeover image

Signs of Aging: Body

IS MOMMY MAKEOVER FOR ME?

In our practice Mommy Makeover has become the most common type of surgery carried out.  The patients that refer for this purpose are from all walks of life.  Some in their late twenties, some in their late sixties.  Some with BMI of 25 and some with BMI as high as 35 and more.  BMI (Body Mass Index) is the number we use to determine how close to or how far from their ideal weight individuals are.  We will discuss this in a later blog.  For now lets talk about Mommy Makeover.

 

Effects of Pregnancy and Nursing on Moms’ Bodies

Prevent Saggy Breast ImageWhy do we call it Mommy Makeover anyway?  As most people know the effects of pregnancy on the body are extremely variable in different individuals.  Basically, there are three areas that undergo change with pregnancy and childbirth.  The abdomen looses its tone resulting in stretching of the muscles, sagging of the skin, and stretch marks.  The breasts become floppy and sag.  Occasionally breasts remain excessively large after nursing.  Finally, many women’s bodies are not able to completely eliminate the pockets of adiposity (fat tissue) that accumulate in the torso and hips.

In our practice we have seen many different versions and degrees of these changes.  We have seen women who after three pregnancies have a belly that looks like a teenager’s, and we have seen those who after only one pregnancy have a hanging apron that covers their mons pubis.  We have also seen women who after nursing have lost all of their breast volume and are left with two empty sacs, and we have seen those who went from a C cup to DD while nursing and never went back, except now the breasts are sagging.  Same goes for pockets of adiposity which vary significantly in different individuals after pregnancy.

 

How can Mommy Makeover Surgeries Help?

mommy-make-over-23-5So, Mommy Makeover means a complete correction of all the changes that have resulted in the body from pregnancy.  There is some degree of ethnic variation in terms of what women require after pregnancy.  In our practice the most common combination of Mommy Makeover consists of Breast Reduction and Tummy Tuck, with or without liposuction as necessary.  The second most common combination is Tummy Tuck and Breast Augmentation.

Fortunately, with the availability of modern outpatient surgery centers and advanced anesthesia techniques, these combinations can be carried out safely during one operation, but patients are required to spend the night at an aftercare facility.

 

Is Mommy Makeover for Me?

mommy-make-over-17-1Finally, to answer the question that we set out to answer: Is mommy makeover for me? For starters, you have to be certain that you are not planning any further pregnancies.  Because it does not make sense to undergo so much surgery, sometimes difficult recovery, fairly high expenses, and then ruin the results with another pregnancy.  Next, you need to have lost as much of the post-pregnancy weight that you were able to and maintain the lowest weight for as long as the surgeon feels appropriate.  Finally, you need to commit yourself to a healthy lifestyle change, healthy eating habits, and regular exercise.  Our happiest patients have been those who have judiciously followed these recommendations before and after mommy makeover surgery.

Post Tummy Tuck Lifestyle Changes and Care

tummy tuck image

Post Tummy Tuck Lifestyle Changes and Care

HOW CAN ONE MAINTAIN THE BENEFITS OF A TUMMY TUCK OR ABDOMINOPLASTY IN THE BEST MANNER?

Post tummy tuck lifestyle changes are as important as the surgery itself. Abdominoplasty (tummy tuck), is an extensive operation.  As has been explained on our site, there are different types of abdominoplasty, and the operation can be anywhere from one and a half hours to 4 hours, depending on the problem at hand.  But this time that the patient spends under anesthesia and surgery is not where the patient’s responsibility ends.  It is only the beginning.  The patient who agrees to undergo such an extensive operation has to accept the responsibility of maintaining a healthy life style in order to maintain the benefits of a tummy tuck as best as possible.

 

Post Tummy Tuck Lifestyle

Tummy Tuck Surgery Preparation ImageOkay, so what are these responsibilities? What is an ideal post tummy tuck lifestyle?  As mentioned in previous blogs(Tummy tuck surgery preparation), before surgery a patient’s condition has to be optimized.  If there is an obesity issue it has to be taken care of by proper weight reduction regimens and exercise as best as possible.  If there are healthy issues such as high blood pressure or diabetes, they have to be brought under control.  But the most important thing in order to maintain the benefits of an abdominoplasty is to maintain healthy eating habits after surgery and a regular exercise routine.  In addition, smoking after a tummy tuck is an absolute no no.  We will discuss the ill effects of smoking on plastic surgery at a later date.

 

Tummy Tuck Success and Lifestyle

Weight Loss by Tummy Tuck ImageOver the past 30 years that we have been providing these services to patients, our happiest abdominoplasty patients have been those who have followed these instructions and recommendations for post tummy tuck lifestyle and care.  Meaning, most importantly, bringing their weight to as close to ideal as possible prior to surgery, and maintaining it with healthy eating and adequate exercise after surgery.  On the other hand, the worst thing a patient can do after an abdominoplasty is to think to themselves that since they have undergone the surgery they don’t have to worry anymore and they can eat whatever they want.  Such patients will sometimes return after a few years with disproportionate obesity, meaning fat accumulation in areas other than the abdomen, requesting secondary correction.  And it is these patients that people see and think to themselves negatively about the tummy tuck operation, not realizing that such unfavorable results are due to the patients’ lack of responsibility and it is unfair to blame the surgery.

 

Tummy Tuck Recovery: How to deal with Scars, Pain, and Swelling

Tummy Tuck Recovery Image

Abdominoplasty or Tummy Tuck Recovery

How to deal with scars, pain, and swelling after tummy tuck?

Many people are afraid to undergo an abdominoplasty (tummy tuck), thinking that they would not be able to deal with the pain.  Such individuals are worried that they will take a long time to recover and this will jeopardize their job or business.  Or, they are just worried that the pain will be too much for them to handle and they will suffer until the pain subsides.  For these reasons, most patients refer for a tummy tuck with the notion of a very strong pain after surgery in the back of their minds and after having heard the explanations regarding the way the surgery is done, usually the first thing they ask is how painful the surgery is.

 

Pain During Tummy Tuck Recovery

Lets begin by saying that individuals’ reactions to pain and their pain threshold are quite variable and are different from one individual to another.  For example, we have seen patients who four days after a tummy tuck were up and about, driving to places and returning to work.  On the other hand, we have seen patients who decided to take off time from work for 6 weeks.  Second fact is that people, especially women, like to talk about their experiences to friends, and if they are of the type who has low pain threshold, they are bound to exaggerate their experience to their friends in a very negative manner, such that these friends are turned away from considering a tummy tuck, as much as they may need it.  Some women have undergone a C-section and have referred for a tummy tuck.  This group comprises roughly 50% of tummy tuck requests in our practice.  For these individuals there is a basis for comparison and based on what previous patients have experienced it is safe to say that the pain of a tummy tuck is much less than that of a C-section.

 

Different Types of Tummy Tuck and Recovery Time

Weight Loss by Tummy Tuck ImageNext issue to consider is the type of tummy tuck.  As has been described in our section on tummy tuck, there are several different forms of this operation, depending on the problem at hand.  Under identical circumstances a mini tummy tuck is the least painful, and the combined fleur-de-lis / circumferential body lift is the most painful.  Again, there are exceptions to this rule.  There are individuals who may experience more pain with a mini tummy tuck than some other individuals who undergo a circumferential body lift.

 

How to Reduce the Pain During Tummy Tuck Recovery Period

So, what can be done to reduce the pain?  First of all, we infiltrate the muscle fascia and skin edges with long-lasting local anesthetic, the effect of which usually lasts for up to 12 hours after surgery.  This has helped to lower the need for oral pain medication.  Secondly, there are strong oral pain medications on the market which are remarkably effective in controlling the pain after a tummy tuck.  These are basically either codeine derivatives (e.g. hydrocodone) or morphine derivatives (e.g. dilaudid).  Thirdly, there is also a “pain-pump” that is available, if the patient desires.  This is a device that continuously injects local anesthetic into the space that is created between the abdominal muscle layer and the skin / fat complex with a tummy tuck.

 

How to Deal with Scars After Abdominoplasty

tummy tuck recoveryAs for scars, most people who need a tummy tuck and undergo this operation are not concerned about scars, because first of all the scars are hidden within the bikini line, and secondly, most individuals would rather have a visible scar than the hanging, bulging, and unaesthetic abdomen.  What I usually tell my patients is that if you are concerned about the scar, this operation is not for you.  Because no one can predict how an individual will heal and whether they will have invisible scars, or very visible and significant scars.  However, there are certain things that can be done to help with improved scarring.  One thing that has become almost the standard of care over the past few years is the application of a special type of tape (Hypafix tape) to provide additional support to the suture line.  Experience, at least in our practice, has shown that the use of this tape has truly made a difference in how our scars heal and we see much better scars since we started using this product.

 

Swellings After Tummy Tuck Surgery

Finally, swelling is a result of any type of surgery dealing with soft tissues, which is what plastic surgery is all about.  So whenever any type of surgery is carried out, tummy tuck, breast reduction, etc., tissues are expected to have some swelling, the majority of which will subside within six weeks and the remainder will subside over the ensuing few months.  Individual experience has shown that by the use of pineapple juice, papaya juice, and Arnica, it is possible to keep the swelling to a minimum and help with its subsidence.  These products have to be started the day before surgery and continued for 1-2 weeks.

 

Feel Free to Contact Dr. Abrams For More Information

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References:
1. Efficacy of a Local Anesthetic Pain Pump in AbdominoplastyBray, David A. Jr; Nguyen, John; Craig, Jason; More

Plastic & Reconstructive Surgery. 119(3):1054-1059, March 2007.

2. Painless Abdominoplasty: The Efficacy of Combined Intercostal and Pararectus Blocks in Reducing Post-Operative Pain and Recovery TimeFeng, Lu-Jean

Plastic & Reconstructive Surgery. 126():125-126, October 2010.