Abdominoplasty (Tummy Tuck)

by Dr. Yap Lok Huei

A flat and well-toned abdomen is something many of us strive for through exercise and weight management. Unfortunately, we sometimes cannot achieve our goals with these methods alone.

Thus, some people opt for abdominoplasty, also known as tummy tuck. Abdominoplasty removes excess fat and skin, and in most cases restore weakened or separated muscles, creating an abdominal profile that is smoother and firmer.

Many women opt to undergo abdominoplasty, especially after pregnancy, when the abdominal muscles tend to remain lax, and the skin over the stomach becomes stretched and saggy – to help them get back to their pre-pregnancy figure.

Is It Right For Me?

Abdominoplasty is a highly individualised procedure. Ideally, as with any other plastic surgery procedure, this should be a change that suits you and should not be carried out simply to fulfill someone else's desires or to fit any sort of ideal image.

A good candidate for abdominoplasty procedure is an adult who is not far from his/her ideal weight, with an abdominal area that has not adequately responded to modification by diet and exercise.

Some of the categories of candidates are as follows :

1. After significant weight loss

With significant weight loss, many patients notice that while the fatty tissue is reduced, often the skin has been overstretched and does not contract back to a smaller area well. Thus the skin can become loose and saggy, and may require removal for correction.

2. The ageing process

Similarly, with age, the skin loses some of its natural elasticity and the muscles gradually weaken. The ageing process often has a pronounced impact on the abdominal region, resulting in a flabby, sagging midline. In such cases, a tummy tuck can have a rejuvenating effect on the entire body while making the person look younger, healthier, and more vital.

3. Genetics

Genetics do play a role in the overall shape of one's body. For some, the bothersome fatty tissue thickness that gathers in the abdominal region is resistant to diet and exercise although the person may be active and physically fit. Even someone in his 20s, 30s, or 40s may be genetically predisposed to stubborn abdominal roundness.

What Happens During The Tummy Tuck Procedure?

One or more incisions are made during the procedure. Endoscopic and mini tummy tucks have smaller incisions than other abdominoplasty procedures. Incisions will most likely extend from hip to hip and around the navel. Excess skin will be removed and tightening of the abdominal muscles will be done.

A small amount of liposuction may be performed to remove small pockets of fat. The incisions are closed using surgical stitches and, if necessary, the navel is repositioned.

The number and length of incisions that are made during a tummy tuck surgery will vary, depending upon the type of abdominoplasty that is being performed. There are different kinds of tummy tucks to address different kinds of aesthetic complaints.

The positioning of all incisions is always carefully planned prior to surgery to increase the likelihood that the resulting scars will be easily hidden beneath underwear, bikinis, and other swim wear.

Mini tummy tuck or a partial abdominoplasty - involves only a single, very small incision that is made below the navel.

Circumferential abdominoplasty surgery involves the removal of loose hanging skin from the entire hip area, including the back, and thus requires an incision that extends around the entire waist line.

Traditional tummy tucks involve one incision along the front of the abdomen from hip bone to hip bone.

Tightening of The Muscles

Tightening of the sagging abdominal muscle mass can be performed during abdominoplasty surgery. The skin is separated from the abdominal walls; the abdominal muscles are then pulled closer together and finally stitched into position to give a more toned position. The waistline can be made narrower, with a less protuberant front border of the abdomen.

Skin Removal

As abdominoplasty involves cutting away excess skin around the stomach region, often it is possible to eliminate or improve the appearance of stretch marks depending on the location of the incision. Stretch marks located slightly below the navel are often removed along with the excess skin while the remaining stretch marks often appear less prominent after tummy tuck surgery.

The stretching of the abdominal skin flattens the stretch marks, decreasing the degree to which they indent the skin.

When the abdominoplasty surgery is complete, the skin is sutured together using surgical stitches. The tummy tuck stitches will normally be removed in stages over a period of 2 weeks following surgery, but this is unnecessary if dissolving sutures are used. A surgical drain will also be inserted at the site of incision at the same time that the stitches are put into place.

The surgical drain helps quicken the healing process and often makes healing less painful because it drains fluids that build up up beneath the skin as the body works to repair the damage to the surrounding cells. The surgical drain is usually removed before the stitches, about a week after surgery.

Healing Process

Several factors determine the speed of a patient's abdominoplasty recovery, including the patient's overall state of health and physical fitness at the time of surgery, which type of abdominoplasty surgery was performed, and the patient's cooperation with the surgeon's post-operative guidelines.

Some patients will require up to 4 weeks of tummy tuck recovery time. Although it takes most patients several weeks or more to feel completely 'back to normal' and to see their final tummy tuck benefits, patients who were in good physical condition at the time of the surgery will have a shorter tummy tuck recovery time.

Tummy Tuck Scars

Post-surgical tummy tuck scars are unavoidable. The larger the amount of skin you would like to have removed during the tummy tuck procedure, the longer the scar will be.

Most qualified cosmetic surgeons will take great care to try to achieve good scars for their patients. Be conscientious about following post-surgical care instructions, as they are designed for your benefit. Patients who smoke have a higher risk of almost all of the complications of abdominoplasty surgery, including wound breakdown, fat necrosis and unsatisfactory scarring.

Amongst other things, cigarette smoke causes the blood vessels in the skin to constrict, decreasing the amount of oxygen being delivered to the skin cells. This will slow healing and make the wounds more vulnerable to breakdown and infection.

The general rule regarding tummy tuck scars is that the longer and more difficult the tummy tuck recovery process, the more noticeable the tummy tuck scars will be. Most tummy tuck scars become lighter and flatter with time, but they may appear to grow more noticeable before they begin to fade. Tummy tuck scars never completely disappear. In the latter stages of the healing process, a topical application on your scar may be helpful.

Topical Aid

Effective healing of a scar is the primary concern following surgery. Scar healing is a complex process and supporting the natural regeneration process of skin cells is important to minimise or eliminate scarring and to help heal and repair damage. Topical support for wound healing is one way to ensure an effective healing process and minimise the risk of scarring.

A user friendly topical application would be an oil-based product that spreads and is absorbed easily into the skin. Preparations containing purcellin oil in combination with vitamins A & E, and calendula have been known to help improve the appearance of scars.

This should be used in conjunction with guidance from your surgeon – do make sure that the wounds are fully healed before commencing topical treatments. Anecdotal reports suggest that moisturizing preparations which are oil-based, used in conjunction with gentle local massage, can reduce irritation and tightness of the wound scars.

Male vs Female Tummy Tuck

Abdominoplasty is a form of body contouring. A male tummy tuck differs from a female tummy tuck in that the surgeon is trying to achieve a very different body aesthetic. However, the underlying surgical principles and the way the results are achieved are very similar.

There are men who are concerned about having 'love handles', a 'pot belly', or a 'spare tyre'. Such concerns are not unfounded; right or wrong, our society places a high value on looking fit and young, for men as well as women.

Male abdominoplasty is a common procedure that can reduce the size of a protruding belly by removing excess skin and tightening the muscles in the midsection. Tummy tuck surgery for men can deliver a flatter, tighter, more aesthetically appealing abdominal contour.

Maintaining My Figure

Exercising routinely is essential and following a balanced diet would certainly help maintain the improved body figure post abdominoplasty surgery for many years. For some patients, occasional 'touch-ups' with limited liposuction may be necessary to help achieve their final contours.

Exercise after abdominoplasty is crucial for the maintenance of your new figure. Other benefits of exercising post abdominoplasty is that it will significantly aid in recovery, help reduce swelling, tones muscles, and reduces the chances of blood clots. However, this should be commenced only after your surgeon has given you the all clear, since exercising too early may increase the risk of disrupting your tummy tuck procedure.

It should be noted that abdominoplasty is not a weight-loss procedure! Thus, it is possible to gain weight after a tummy tuck, and if you do put on weight, it may reduce the impact of the contouring achieved after a tummy tuck. So do continue on your healthy new regime, monitoring what you eat in order to stay and live healthy!

More info on ABDOMINOPLASTY here.

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