Karin Germe

Abdominal Aesthetics

Abdominoplasty is the operation consisting of the removal of excess skin and abdominal fat and the correction of muscle flaccidity. This situation of excess skin and relaxation of the abdominal wall usually occurs in patients who have had weight gain and subsequent loss or in women who have had several pregnancies. The tummy tuck achieves a flatter, firmer abdomen and a narrower waist.

The intervention is performed under general anesthesia, an incision being made above the pubic hair that extends towards the hips. The skin of the abdomen is released and, if necessary, the abdominal muscles are reinforced with sutures. The excess skin is pulled down and removed.

After the operation the patient will wear a special girdle, reinforced with a bandage, according to each individual case. The scars around the navel and in the lower abdomen will improve over time. However, in some cases it is necessary to perform a scar revision with local anesthesia. More than in any other intervention of Cosmetic Surgery the phrase is valid: “the surgeon makes the suture and the patient the scar”.

As possible, although rare complications, it is worth mentioning the loss of vitality (necrosis) of the skin located above the pubis that may require a longer postoperative treatment. Senescence and / or bruising that require evacuation may also occur.

What is a tummy tuck?

Abdominoplasty is a major surgical procedure whose purpose is to remove excess skin and fat from the middle and lower abdomen and strengthen the abdominal wall musculature. This procedure can drastically reduce the bulging aspect of the abdomen (colloquially known as “gut”). In return, it leaves a permanent scar that, depending on the extent of the original problem and the surgery required to correct it, can be more or less long.

If you are considering the possibility of undergoing a tummy tuck, you will obtain basic information about the surgery, when it is indicated, how it is performed and what results can be expected. However, it is impossible for all of your questions to be answered, since they largely depend on personal factors and the preferences of the plastic surgeon.

Who is the ideal candidate to undergo a tummy tuck?

The ideal candidates to undergo a tummy tuck are those women or men who have a relatively good silhouette but who are concerned about the accumulation of fat or excess skin in the abdomen and that does not improve despite diet or physical exercise . This surgery is especially useful in women who have had several pregnancies, after which the skin and abdominal muscles have relaxed and have not recovered their initial tone. The loss of skin elasticity in elderly people may also be better, a situation frequently associated with moderate obesity.

Those patients who must lose a lot of weight should postpone surgery, as well as patients who intend to have future pregnancies, since during the surgery the vertical muscles of the abdomen are tensed and can relax again during the course of the surgery. If there are previous scars on the abdomen, this surgery may be contraindicated or the scars may change position. In other cases, this surgery manages to eliminate them.

Planning surgery

In the initial consultation, the plastic surgeon will evaluate your state of health, determine the extent of the accumulation of fat in the region of the abdomen and the tone of the skin. Do not forget to mention if you are a smoker, you are taking some medication or vitamins. You must express your expectations in a sincere and frank manner, so that the plastic surgeon is also frank and shows you the available alternatives for your problem, with the risks and limitations of each of them.

If, for example, you only have fat accumulation in the area below the navel, it may be enough to perform a less complex procedure called mini-abdominoplasty, which requires a shorter stay in the clinic and is done in less time. In other cases, whether you are going to perform a full tummy tuck or a mini-tummy tuck, a liposuction of the hips can be associated to improve the body shape in a more harmonious way.

Some cases, even, can be solved only by performing liposuction of the abdomen. In any case, the plastic surgeon next to you will determine which is the optimal procedure that will provide you with a more suitable body shape. During the consultation, the plastic surgeon will also explain what type of anesthesia you will use, the need or not to enter the clinic where the surgery is performed and the costs of the surgery. Abdominoplasty, except in invalidating cases, is not included in Social Security benefits.

Where is the surgery performed?

The tummy tuck and mini-tummy tuck is always done in the operating room, inside a clinic or hospital. These are procedures that should not be consulted. Liposuction should also be performed in the operating room, under strict conditions of asepsis.

What type of anesthesia is used?

The type of anesthesia most used to perform a tummy tuck is general anesthesia, during which you will be asleep until the end of surgery. In some cases, especially in mini-abdominoplasty and abdominal liposuction you can use local anesthesia plus sedation, so that during surgery you will be awake but relaxed, and the region of the abdomen is insensitive to pain (sometimes you may feel some annoyance).

What does the surgery consist of?

A full tummy tuck usually lasts between 2 and 4 hours, depending on the amount of correction needed. A mini-tummy tuck usually lasts between 1 and 2 hours. The tummy tuck is performed through a long incision from one hip to the other, just above the pubic bone. A second incision is made around the navel, to be able to separate it from the surrounding tissues.

In the mini-abdominoplasty a much smaller incision is used, also above the pubis, not being necessary the incision around the navel, which in some cases can be lowered by stretching the skin.

Next, the skin of the abdominal wall is separated upwards until reaching the ribs, exposing the abdominal muscles. These muscles are tensed and joined in the midline, thus providing a firm abdominal wall and a narrower waist. The separated skin is stretched in the direction of the pubis and the excess skin removed; The navel is placed in its new position.

Finally the sutures are made and a bandage and a temporary drainage tube are placed to eliminate the excess of fluids that may accumulate in the intervened area. In the mini-abdominoplasty, the skin separates only between the incision and the navel, the excess skin is removed and the sutures are made.

After surgery (post-operative)

During the first days the abdomen is usually somewhat inflamed and some discomfort or pain can be noticed that is controlled with medication. Depending on the extent of the surgery, you can go home after a few hours or stay 2 or 3 days in the clinic. Your plastic surgeon will instruct you to shower and change your bandages.

Although at the beginning you should not stretch at all, you should start walking as soon as possible. External skin points will be removed between 5 and 7 days; the internal points, whose ends come out at the ends of the incision, in 2 or 3 weeks. The bandage will be replaced by an abdominal band.

The return to normality

It can take from a few weeks to a few months to return to feel like before. If your physical condition prior to surgery is good, including strong abdominal muscles, recovery after tummy tuck will be faster. Some people return to work in about 2 weeks, while others require 3 or 4 weeks of rest and recovery. The physical exercise helps to recover before.

Even people who do not practice sports before surgery should perform an exercise program to reduce inflammation, decrease the possibility of venous thrombus formation and tone muscles. However, strong exercises should be avoided until one feels comfortable.

The scars can appear to get worse during the first 3 to 6 months while they are in the healing period; this is normal. You have to wait between 9 months and 1 year for the scar to flatten and clear up. Although the scars will never disappear, they will not be visible, even when wearing a bikini or swimsuit.

Are there risks? Are there guarantees?

Every year hundreds of tummy tucks are performed successfully. When it is performed by a qualified plastic surgeon the results are usually very good. However, whenever surgery is performed there are risks, as well as complications related to this particular procedure. Complications after surgery, such as infection or venous thrombi, can occur, but they are rare.

The infection is resolved with antibiotics and drainage, but it will prolong the stay in the clinic. Venous thrombi are prevented by moving the legs and rising as soon as surgery allows. Poor scarring can produce a scar of poor quality that, at times, will require a second surgery. Smokers should stop smoking a few weeks before surgery and should be advised that tobacco increases the possibility of complications and delays healing.

You can reduce the risk of complications arising by carefully following the instructions given by your plastic surgeon before and after surgery, especially those that refer to when to resume physical activity.

Surgery of abdominal scars

Occasionally, there are unattractive scars in the abdominal region, almost always due to previous surgical interventions on the abdominal cavity. Although there are no means to make a scar disappear completely, if its appearance can be improved by a new intervention in which the scar is removed and sutured in optimal conditions.

These interventions are almost always done under local anesthesia with or without sedation; they do not usually require hospital admission. The duration of the procedure is usually 1 hour. The recovery is fast.

The results

Abdominoplasty, either complete or mini-tummy tuck, provides excellent results in patients whose abdominal muscles are weakened and have excess skin and fat. In most cases the results are definitive, as long as it is accompanied by a balanced diet and periodic exercise. If you are realistic in your expectations and are able to tolerate the presence of a definitive, albeit concealed, abdominal scar, and a long recovery period, a tummy tuck may be right for you.

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