FAQ’s – Abdominoplasty without drains!
What is an abdominoplasty? (Tummy Tuck)
Abdominoplasty, often referred to as a “tummy tuck,” is a popular procedure used to flatten and shape the abdomen. During this procedure, the abdomen is recontoured by the excision of skin and fat. This is in contradistinction to liposuction, which is removal of fat alone without the removal of skin. Dr. Epstein has been performing abdominoplasties with excellent cosmetic results for many years. His patients love the way their new contours look after this surgery.
Who is a good candidate for abdominoplasty?
The ideal candidate for an abdominoplasty is in good physical health. They have excess, loose abdominal skin, or at the very least, laxity of the abdominal wall that hasn’t improved following diet and exercise. It is best that they are not obese (body mass index – BMI – <30). Most candidates for this procedure are women who have finished bearing children, although occasionally men are candidates for this procedure. Other indications for this procedure include significant weight loss with resultant excess skin remaining. The very best candidate is someone who has excess skin with little, if any, excess subcutaneous fat, although most patients who undergo abdominoplasty have a combination of excess skin and subcutaneous fat. Subcutaneous fat is the layer of fat that lies between the skin above and the muscles below. Individuals who have good quality skin without excess and whose only problem is excess subcutaneous fat would most likely better be served undergoing liposuction.
Women with stretched skin and muscles from pregnancy often benefit from a tummy tuck. As pregnancy will stretch abdominal skin, Dr. Epstein advises patients who plan to become pregnant to consider postponing this procedure until they are done having children. Dr. Epstein also recommends that the patient be at their ideal weight prior to surgery, so as to achieve the very best contouring result. Patients who intend to lose weight should do so before undergoing the procedure. If you lose weight after the procedure, there may be additional laxity of the skin. Dr. Epstein requires that the patient not be a smoker, as nicotine interferes with the circulation of blood in the tissues after surgery and can increase the risk of complications substantially.
What are the different types of abdominoplasty?
There are several different variations of the abdominoplasty procedure. Most abdominoplasties include the following components: an incision in the crease of the waist, elevation of skin and subcutaneous fat off the abdominal wall, tightening of the abdominal wall, removal of the excess skin and fat, and lastly, wound closure. Body contouring after massive weight loss is more involved and often takes longer than a mini or standard abdominoplasty. Surgery is performed under general anesthesia. There are several variations on this theme.
In this procedure, an incision is made from hip to hip, or not quite as long. The skin is elevated off the abdominal wall to approximately the level of the umbilicus. The umbilicus is left undisturbed. The abdominal wall muscles are tightened as necessary. This flattens the tummy and narrows the waist. The excess skin and subcutaneous fat is removed, the lower abdominal skin flap is thinned and the wound closed. Approximate surgical time is one to one and a half hours.
Standard or full abdominoplasty:
An incision is made from hip to hip The skin is elevated off the abdominal wall to the lower margin of the rib cage. The umbilicus is left attached to the abdominal wall. The abdominal wall is tightened as necessary to flatter the abdomen and accentuate the curvature of the waist. The excess skin is removed. As the abdominal skin is brought downward, the umbilicus is then brought through a small new opening in the abdominal wall skin. The lower abdominal skin flap is thinned and the wound closed. Approximate surgical time is two to three hours.
This procedure includes the standard abdominoplasty as described above with the addition of excisions of excess skin and subcutaneous fat in the flanks. Patients who are candidates for this procedure usually have a significant amount of excess skin, usually 3″-4″ minimum on each flank along with sagging of the outside of the thigh and the outer buttock. Patients who on initial examination are noted to have a prominent flank roll (spare tire) in addition to the excess skin in the front of the abdomen may also be a candidate for this procedure. In this procedure, the standard abdominoplasty is performed and then the patient is placed on each side and the flank excisions are performed. Approximate surgical time is four to five hours.
Circumferential or Belt Lipectomy (360 degree body lift):
This procedure includes the standard abdominoplasty as described above with the addition of an excision of skin and subcutaneous fat completely around the entire circumference of the lower torso. It provides not only lateral recontouring of the flanks and elevation of the lateral thigh and lateral buttock as in the extended abdominoplasty, but also the middle and medial portion of the buttocks are elevated and recontoured as well. Sometimes the excess skin can actually be used to augment a flattened buttock (gluteal auto-augmentation). This is usually performed on massive weight loss patients who have undergone bariatric surgery to lose weight. Approximate surgical time is five to six hours.
Where are these surgeries performed?
These procedures may be performed on an outpatient or inpatient basis depending on your anatomy, the complexity of your surgery, your personal preferences and your overall medical health. It is generally recommended that a circumferential/belt lipectomy be performed with a one or even two-night stay, however the other procedures are often easily performed as an outpatient.
A Unique Approach to Achieve the Very Best Cosmetic Results
Dr. Epstein believes that it is very important to listen to the patient during every pre-operative consultation to learn what that patient wants to achieve from a tummy tuck. Only through thorough understanding of the patient’s concerns and a detailed physical examination can Dr. Epstein design a surgical procedure to meet all of the patient’s goals. He does not believe in a “cookie-cutter” or “one size fits all” approach.
Recovery After Abdominoplasty
Dr. Epstein previously used a pain pump, a small grenade-shaped device that is filled with local anesthetic (numbing medicine) to bathe the inside wound continually for four days. This dramatically reduced your level of postoperative discomfort and reduce the need for narcotic pain pills. However, recent developments have now permitted us to eliminate the pain pump! Our patients now have significantly less discomfort immediately after surgery than when we used the pain pump. And this level of comfort persists for several days after surgery. The end result will be a much quicker and easier recovery with less discomfort, especially in the first few days, when patients tend to be the most uncomfortable. So, after surgery, you will have no drains, no pain pump, no binders, and no gauze bandage dressings…just a thin mesh tape over your incision with Dermabond!
You should limit strenuous activities for at least six weeks to allow the muscles that were tightened to heal, and may need to take off from work for one to three weeks in most cases. Dr. Epstein will give you specific instructions for your individual recovery. Following these instructions is very important and can help speed up your recovery and reduce the risk of any post-surgical complications.
How much pain is there after abdominoplasty?
When performed by traditional methods, abdominoplasties are associated with a moderate level of discomfort. However, Dr. Epstein now utilizes a very new technique which has resulted in dramatic reductions in the amount of postoperative discomfort, with most patients ambulating easily the same day as surgery. This results in a quicker recovery and less need for postoperative pain medicine.
Are drains used?
Previously, drains usually two drains were used to evacuate bloody fluid from underneath your abdominal skin. Using a new technique, Dr. Epstein has been able to eliminate the need for such drains, along with the need to regularly empty the fluid. This will result in quicker healing between your abdominal skin and the underlying muscle, thus shortening your recovery. For most patients, having the drains and the subsequent care was the most unpleasant part of the entire healing process. Now with the need for drains eliminated, recovery is hastened and the entire experience is more enjoyable!
What sort of bandages, garments or binders are needed after surgery?
Although Dr. Epstein previously used abdominal binders to compress the abdomen and help secure bulky gauze dressings, he has discontinued the use of both. The incision line is dressed with Prineo – a type of thin mesh tape impregnated with Dermabond. This is a skin adhesive and wound sealant. It is made specifically for sealing wounds and does a great job of sealing and protecting the wound while eliminating the need for a bulky and uncomfortable dressing after surgery. As a sealant, the wound is better protected against infection than if conventional bandages are used. This helps promote early ambulation and a quicker recovery as well as much greater patient comfort and acceptance.
Is there swelling after surgery?
Most surgical procedures involve a certain amount of swelling. With abdominal recontouring procedures, there is typically a moderate amount of swelling in the lower portion of the abdominal skin flap near the incision. This does gradually diminish over several weeks to a few months, yielding a very nicely recontoured abdominal wall.
Will I lose feeling in the abdominal skin?
It is not uncommon to lose feeling in the lower abdominal skin after surgery, similar to the feeling one may have in the area of a horizontal c-section scar. Sensation may or may not return. If it does not, there will be no functional loss or problem because of this.
What is the quality of the scar?
The quality of the scar depends on several factors. Dr. Epstein will attempt to close the wound with the most exacting precision and attention to cosmetic detail as possible, however, your own biologic potential for wound healing will influence the final quality of the scar greatly. Neither Dr. Epstein nor the patient has control over this. An excisional body contouring procedure (such as abdominoplasty), trades scar for improved contour. Dr. Epstein is very careful to make the incision low enough for the scar to be concealed by most articles of clothing. Sometimes, depending on your particular anatomy, even a bikini will conceal the scar.
A tummy tuck leaves patients with a flatter, more toned abdominal area that fits the natural contours of your body. It can improve a patient’s appearance both in and out of clothing and bolster self-confidence by helping them look and feel younger and slimmer. Although there is swelling of the lower portion of the abdomen right after the procedure, the results are visible right away and will continue to improve over the next few months. Incorporating a balanced diet and regular exercise will help to retain those results for many years to come. Scars fade with time, leaving your stomach sleeker and more defined than ever before.
Risks of Abdominoplasty
Though rare, post-operative complications from any surgical procedure are possible. They may include infection, bleeding, blood clots, and poor healing, which may require further surgery. Sometimes, a minor scar revision, which is usually performed in the office under local anesthesia, can help “tweak” a scar to make it look a little better. In most cases, this is not necessary.