Now the function of the abdominoplasty is really to make the abdomen flat. There are two things you do when you do an abdominolplasty: You tighten the muscles on the abdominal wall, this is the thing that makes the abdomen flat; and the second thing is you remove the skin.
Pretty much you remove the skin from the belly button to the pelvis. What you end up doing is taking off the bottom half of the skin then stretch in the top half to cover the entire abdomen.
When you stretch the top half of the abdominal pannus it will get thinner. If you think of it, if you stretch something to twice the length, it’ll go to half the thickness. That’s how you’re really thinning the upper half of the abdomen.
Now the person who has to have an abdominoplasty is a person who has a distended, round abdomen because the muscles and the fascia on the abdominal wall are weak. This usually happens after pregnancy but can happen after weight loss.
But generally, if the person’s stomach is round because of fat and skin and if the muscles are strong, then liposuction becomes an option to make the stomach flat.
If the stomach is round not because of the excess fat, but because the muscles are weak, then that’s the person who has to have an abdominalplasty. Because in order to make the stomach flat, you have to tighten the muscles. That’s generally the idea of who needs a tummy tuck.
When we look at this photograph, this is a thin person who needs a tummy tuck because the stomach is round because the muscles are weak. There’s not a lot of fat, this not a heavy person the stomach is not round because of the fat, it’s round because the muscles are weak.
Tightening the muscles is required to make the abdomen flat. That’s the thing that determines who needs a tummy tuck.
Liposuction is responsible for making the waist narrow and making the curves. We did liposuction here on the waist and that’s what makes the curves and makes a narrow waist. The tummy tuck does not really do a lot to bring in the waist and make curves. The tummy tuck’s function is to make the abdomen flat and that’s exactly what it does.
What we physically are doing when we do a tummy tuck is we’re making an incision from hipbone to hipbone. You’re raising a flap from the pelvis all the way up to the ribs, then you tighten the muscles. You tighten the muscles by imbricating the muscles and sewing them together. This is the main thing that makes the stomach flat.
You’re imbricating the muscles you leave the bottom half of the belly button in place. And then you will removing the skin from the belly button down and stretch the skin on the top half of the abdomen to cover the whole abdomen, making new top half of the belly button and then sewing to the old bottom half of the belly button then closing the wound below.
You can see the goal is to get the wound low enough so it can be covered by the underwear or a bikini.
The three things that make a good tummy tuck. These are the things that I think make a good tummy tuck:
One – the scar is exactly where you want it low, hidden by the bikini. Two – the scar around the belly button is hidden inside of the navel, not outside where you see a scar. The last thing is, that the top of the abdomen is as flat as a bottom, maybe even a little tighter.
A lot of problems that people have with abdominalplasty is that the top is looser and the bottom is tighter. That’s because when you do the tummy tuck, it is physically harder to tighten the top half above the belly button, and very easy to tighten the bottom half.
A lot of times, the problem is that the top of the abdomen is not flat and pokes out. And that looks abnormal. We can have the top and bottom the same, or the top a little bit tighter than the bottom. TZhis looks normal.
Every supermodel is like this, the top of the abdomen’s flat and is a little pooch of the bottom. I think these are the three things that are important to do to get a good result from the tummy tuck. That’s kind of an overview of what we’re trying to do with the tummy tuck. Also we told you about physically what we’re doing and how mechanically we’re doing it.
Now the recovery, recovery from a tummy tuck hurts. The first two days are hurt a lot. It’s like C-section type of pain,a sharp pain. You’re tight, you’re bent over. You don’t want to move, you don’t want to walk, you don’t want to shake.
The important that you move, moving prevents problems and open up the lungs. In the beginning which is hard for the patients.
The second day people feel better and they’re moving a little bit more, they’re getting up. They’re walking but they’re walking slow, they’re bent over, they don’t want to shake.
You need at least two-weeks off after the tummy tuck and probably three weeks would be better. Very few people are ready to go back at activity at a week. Most people at a week are still bent over and walking very slow.
By two weeks most people get a normal gait and are feeling better. But three weeks off is actually even better than two weeks. That’s kind of what to expect in that recovery.
It’s a little bit rough the first 48 hours, then eases up then you’re walking slow. You’re guarded for the next two weeks. Two weeks – you start to loosen up, get a normal gait, moving a little bit more normally. Two to three weeks off of work.
It takes three months, maybe even four months to get 90% of the swelling to resolve. You will still be swollen at three weeks after the surgery.
AT three months 90% of the swelling is gone. The scars will improve for up too a year. The scar will get flatter, better and smoother. Now that is kind of the idea of the recovery.
So far as activity, you cannot do any lifting, pulling or exercise for four to six weeks after the surgery. You’re waiting for strength for the plications, the muscles to get strong. If you do too much too early, they will rip. The wound can separate, the plications on your abdominal muscles could rip.
You cannot do any exercise for four to six weeks. Afterwards the four to six weeks, you can start doing some exercise. Again three months for all the swelling to go away. That is the idea of the recovery.
The complications. The complication you have to worry about. One is the wound separating.
Hematoma, that’s a bleeding under the skin flap. You’ll see one area bulging. Small hematoma, you just let it heal by itself. For large hematoma, you have to go back to surgery and drain it.
Infection. Mild infection you will treat it with antibiotics. Severe infection or an abscess you have to go back to surgery and drain it.
Necrosis of the flap, this happens in smokers and sometimes in heavier people. The blood supply is very low to this portion of the flap after you raise up that skin paddle. Because when you raise a skin paddle, you destroy some of the blood vessels so the skin could die right here especially in smokers.
Smoking and tummy tuck is very dangerous and you have to really stop smoking. Be committed to stop smoking before a tummy tuck if you don’t want to have any problems.
The other things can be related to anesthesia. Allergy to anesthesia, atelectasis which is a lung collapse with the anesthesia, pneumonia, throat spasm are all possible complications that could happen anytime you have a general anesthesia.
The other thing you have to worry about is blood clot. Whenever you have general anesthesia your muscles are paralyzed, your blood vessels dilate, blood can sit still in your leg and clot.
If it clots in your leg, it’s called the Deep Vein Thrombosis. That would be one leg swollen and painful, the other one normal.
If the clot breaks from the leg and goes to lung and it’s called the Pulmonary Embolism. That will cause shortness of breath to chest pain. These are the complications you have to think about with the tummy tuck.
In closing, the tummy tuck is needed for one or two reasons: either the muscles are very weak or the skin is very redundant. That’s what the tummy tuck does. It takes away extra skin and it also tightens the muscles.
These are the people that have to have a tummy tuck who cannot have liposuction. If the muscles are weak, you have no choice but a tummy tuck.
The other thing we always think about is pregnancy. You should really try to do your tummy tuck after you’ve completed your pregnancies because you can have problems with pregnancy due to the muscle tightening.
With muscle tightening, you can get a tear or develop a hernia. You could have problems with the pregnancy, with a stomach expanding and baby going down to pelvis. You don’t want to do a tummy tuck before pregnancies if you can help it.
The length of the scar needs to be the area you’re dealing with. Example in this patient, the skin and the muscles are weak in this area so we need a scar at that length.
If you had problems with skin all the way around the body, then you could have to carry the scar all the way around the body. Pretty much however long the scar is, that’s the area you can work on.
If you need to just work on the front, a scar from hipbone to hipbone is needed. if you need to work on the whole body you will need a scar all the way around body. That’s the idea about the length of the scar.
This is a general idea of the tummy tuck and what it can and cannot do. I appreciate you watching the video and we’ll try to make more videos and continue with the video education. Take care. This is the end of the video.