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When it comes to a tummy tuck, I frequently explain to patients that the procedure is not a single surgical step, but rather a series of elements that can be combined to create customized results.
Whereas liposuction focuses solely on removing unwanted fat cells from the body—such as those that create a noticeable bulge at the belly—a tummy tuck is intended to create sleeker contours by addressing any number of conditions that keep the abdomen from looking toned.
Of course, stubborn pockets of fat are an obvious culprit when it comes to a larger waistline. While liposuction is frequently performed as a standalone procedure, it can also be used as part of a tummy tuck to help flatten the area. For this element, just about everything is handled as it would be for a solo lipo procedure: Fat is loosened and suctioned out via a cannula. The difference is that while liposuction requires small incisions that are later sutured closed, the incision made for a tummy tuck allows the surgeon access.
While extra fat causes bulges, extra skin creates a sagging pouch that can hide even well-defined abdominal muscles that sit beneath. The amount of excess tissue can range from a little to a lot (sometimes referred to as an "apron"). For a tummy tuck, the surgeon essentially re-drapes the abdominal skin so that it sits flat and tight, then trims away the excess. The incision and subsequent sutures for this element are typically hidden lower on the torso, where they can be covered by a swimsuit bottom or underwear.
Over time, belly muscles and their covering fascia can become loose. Whereas firm fascia holds everything in place—something like interlaced fingers keeping a water balloon from bulging outward—lax fascia allow the contents behind to bulge outward. Abdominal muscles can separate, giving the entire midsection a flabby look. During a tummy tuck, a surgeon can, if necessary, stitch these muscles and fascia back together to make everything tight and toned. In some cases, as with a mini-tummy tuck, this may be the primary element of the procedure. It is often chosen by moms who have a small bulge that sits below the belly button.
Depending on the tummy tuck details, the surgeon may need to "relocate" the belly button, which involves creating a hole in the newly taut abdominal skin so the navel appears where it should to remain proportional with the rest of the body. This is called "umbilical translocation."
While these factors are the standard parts of a tummy tuck, I also incorporate other elements to create what I have dubbed the NaturaTuck™. A chief component of this is using what are known as progressive tension sutures to secure the underlying muscle to the abdominal wall. This essentially compartmentalizes the area so that there isn't a single, open space where fluid can build up and cause swelling or necessitate drainage. By employing this technique, as well as using a surgical glue, I have found that most patients do not require drains to be installed post-surgery.
Following this, the body can be further contoured to encourage an hourglass shape by creating an "internal corset." I have performed measurements that show narrowing of the waist and improvement of the waistline due to work at this stage.
When all of the steps are completed, the incision will be closed with either a special glue or absorbable sutures, such that the patient can take a shower the next day and there is no need to remove the sutures. Lasers can be used post-operatively to hasten the healing of scars. Also, use of Exparel injections numb the abdomen for three days, which can minimize pain for patients.
Since every patient has a unique body shape and size, as well as personal goals for an ultimate look, each tummy tuck is its own procedure. While there are commonalities between all such surgeries, no two will be exactly alike.
The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.