Cosmetic abdominoplasty or tummy tuck techniques are yielding better results and lower complications than ever before due to a technical revolution which started in Brazil less than 10 years ago. The new tummy tuck has several names: lipoabdominoplasty, abdominolipoplasty, the Avelar abdominoplasty, minimally-invasive abdominoplasty and mini-abdominoplasty are some of the more common terms.The new method of abdominoplasty represents the first safe and effective fusion of cosmetic abdominoplasty and abdominal liposuction
Unlike traditional abdominoplasty, lipoabdominoplasty does not require the separation (undermining) and elevation of the entire abdominal wall skin, fat layers and blood vessels from the abdominal muscles in order to tighten loose skin and to tighten loose muscles. Avoiding this process eliminates much of the discomfort and significantly reduces the frequency of complications associated with traditional abdominoplasties. Instead, lipoabdominoplasty relies on the ingenious use of tumescent liposuction under local anesthesia to loosen the skin and fat layers without the need to separate any blood vessels whatsoever and utilizes a superficial excision of only the excess skin layers to achieve a tight, attractive abdomen. When needed, abdominal muscles (rectus muscles) are tightened through a narrow tunnel in the midline of the abdomen in an area typically devoid of significant blood vessels.
The impact of this new lipo-abdominoplasty procedure in cosmetic surgery is greater safety due to less separation of the abdominal wall blood supply, better cosmetic outcomes due to the safe integration of abdominal liposuction for maximum body contouring and, for the first time, the ability to perform awake abdominoplasty or abdominoplasty under local anesthesia in many patients thereby reducing the significant risks associated with general anesthesia and deep sedation. A discussion of the advantages of local anesthesia can be found at the link for liposuction under local anesthesia.
The tummy tuck is the procedure to remove excess fat and skin and to tighten underlying muscles in the abdomen. It also gets rid of loose or wrinkled skin and stretch marks. Both women and men can benefit from this extremely effective body contouring surgery.
Pregnancy, weight gain and weight loss have a devastating impact on a woman’s abdomen. Only rarely dieting and exercise can fully restore the abdomen wall to its flat desirable shape after the skin and muscles have been stretched to their limit. After losing weight men can also have difficulties regaining their youthful flat abdomen.
Liposuction is ideal to contour the abdomen for those who have good skin tone and excess fat that is resistant to diet and exercise, but the tummy tuck is a better procedure for women and men who have loose abdominal skin following pregnancy and weight loss.
Types of Tummy Tuck
Abdominal wall deformities have 3 components:
- Wrinkly or loose skin with stretch marks. This is usually the result of pregnancy, aging, or marked weight loss
- Excess fat tissue, usually more prominent in the lower abdomen
- Rectus Muscle Diastasis. The muscles of the anterior abdominal have separated. Exercise does not help in this situation (once the muscle relaxes, they separate and the tummy bulges out.)
Full tummy tuck, or abdominoplasty, addresses the 3 defective components (skin, fat, and muscle) so it benefits most patients who want a flat stomach and skin as tight as possible. Results, especially when combined with liposuction of the flanks, are dramatic. The procedure can be done totally under local anesthesia (tumescent technique), twilight anesthesia, or general anesthesia, depending on individual patient preference and needs. A relatively long incision in the bikini line just above the pubic area is made. A second incision is made around the belly button. The skin and fat as a unit are separated from the abdominal wall and lifted up the rib cage exposing the rectus muscles fascia (the sheath that covers the muscles and works as an inner girdle).
The fascia is then sutured in order to tighten loose or stretched out muscles located below the fascia. This step creates a tighter abdominal wall and a thinner waist. The skin is stretched down and the excess skin and fat are removed. A new opening is cut on the skin for the repositioning of the belly button. Usually drains are inserted to eliminate fluid and blood buildup. Every effort is made to hide the scars in the bikini area. The incision is then closed, and a firm dressing is then placed on the abdomen. Liposuction to remove excess fat from hips and flanks are often performed in conjunction with the tummy tuck for a better body contour.
Mini Tummy Tuck
A mini tummy tuck or partial abdominoplasty is best suited for patients who have a pouch below the belly button who do not have significant stretch marks, saggy skin, or a hooded belly button. The procedure is less invasive than a full tummy tuck. While a full tummy tuck involves an incision around the belly button and across the lower abdomen, a mini tummy tuck leaves the belly button intact and requires a smaller incision. The excess of skin and fat are removed and tightening of the muscles is performed. Liposuction is frequently employed with this procedure to remove excess fat above and below the belly button to enhance body contour.
A dermolipectomy is a procedure that removes skin and fat from the abdomen but does not tighten the muscles. It is indicated for slender women who have wrinkly or excess skin but good muscle tone. The scar is the same as a tummy tuck.
Limitations of a Tummy Tuck
The tummy tuck procedure will not remove stretch marks of your mid or upper abdomen (but it will shift them lower on your abdomen). There will be a scar extending across the lowest part of your abdomen, just above the bikini line. Also, there will be a second scar around your belly button, if the belly button requires transposition. These scars are commonly hidden by underwear or a swimming suit. The scars may worsen during the first 3 to 6 months as it heals, but this is normal. It takes approximately 9 months to a year before scars flatten out and lighten in color. Regardless, you are most likely to look and feel better with a flat abdomen and scars than you are with a bulging belly. Serious complications after tummy tuck surgery are uncommon. However, there are risks with any surgery and specific complications associated with this procedure.
The ideal candidate for tummy tuck surgery should meet most of the following criteria:
- Is close to their ideal body weight (within 30%)
- Wants to remove specific areas of loose skin or fat that is diet and exercise resistant
- Weight has been stable for 6 months or more
- Has good skin tone and elasticity
- Is emotionally stable
- Understands the risks of abdominoplasty surgery and scarring.
If you do not meet all of these criteria, but meet some of them, you may still be a good candidate for a tummy tuck. The traditional tummy tuck procedure is most suited for those who are close to their ideal body weight, but if you have a lot of fat in an isolated area, you may still be a good candidate.
If you intend to lose a lot of weight, wait until after your weight loss to schedule abdominoplasty surgery. If you plan on future pregnancies, you should wait to have surgery until you are done having children as pregnancy will stretch the abdomen again.
You are at increased risk for complications if you have diabetes, poor circulation, heart, lung, or liver disease, smoke, have a family history of blood clots, take certain medications, or if you are obese and probably should not have an abdominoplasty procedure.
Tummy Tuck Recovery
Anesthesia: Totally under local tumescent anesthesia, twilight anesthesia, general anesthesia
Length of Surgery: 1-3 hours
Pain level: Moderate, 3-8 days of pain medication
Numbness: 6 months or more
Bandages: Removed in 2-5 days
Drains: Removed between 2-10 days
Stitches: Removed in 5-7 days
Work: Return to desk job often 1 week
Exercise: May be resumed in 4 weeks
Final result: Evident after the scar heals 6-12 months
ISCG cosmetic surgeons technique for a safe office tummy tuck totally
under local anesthesia:
The Abdominolipoplasty Procedure
The traditional abdominoplasty procedures (full tummy tuck, mini-tummy tuck and dermolipectomy) are associated with a relatively high complication rate because of the required large undermining of the anterior abdominal flap that involves extensive trauma and compromise to the blood supply of the abdominal flap. General anesthesia or heavy twilight sedation is frequently required to complete the surgery because of the extensive tissue dissection and manipulation.
Drs. Pelosi have adopted a revolutionary minimally invasive approach to tummy tuck that can be safely and effectively perform as an office procedure totally under local tumescent anesthesia. The technique called Abdominolipoplasty combines two procedures: liposuction of the abdomen and the tummy tuck. By avoiding the use of general anesthesia or heavy sedation (and complications associated with this type of anesthesia) this new procedure offers an improved postoperative recovery.
In the past, traditional teaching held that performing abdominal liposuction at the same time of tummy tuck would further disrupt the blood supply, creating a significantly greater risk of necrosis of the inferior end of the flap.
Recent studies had clearly demonstrated that such a belief was erroneous. It is well established now that when one performs limited liposuction, the blood vessels remain intact and functional even though the fat is removed. The removal of the fat by liposuction leaves essentially an empty space eliminating the need to undermine. Because the skin overlying this empty space remains extremely mobile, we can remove as much skin, or more, as with a standard tummy tuck without the danger of losing blood supply.
The management of the belly button is identical in both procedures. The skin incisions and the amount of skin removed are also similar. The tightening of the muscles also can be performed with either procedure. However, with the technique used by Drs. Pelosi the amount of fat one can remove is greater, improving abdominal contour by thinning the fat layer considerably more than one can with the traditional tummy tuck while decreasing the risks of skin necrosis because the blood supply remains intact. Drs. Pelosi approach doesn’t require the routine use of suction drains - a standard requirement in traditional tummy tuck.
Performing the procedure totally under local tumescent anesthesia adds additional benefits over the traditional tummy tuck:
- Minimal bleeding due to the vasoconstriction created by the tumescent anesthesia. Traditional tummy tuck can be associated with profuse bleeding and even the need for blood transfusions and requires meticulous hemostasis throughout the procedure using electrocautery (which by itself creates blood vessel and tissue heat damage).
- The patient is wide awake and can ambulate, eat and drink during the surgery. That is virtually unheard of with standard tummy tuck. Following liposuction and before the tummy tuck, the patient is inspected in a standing position to draw the shape and size of the skin to be removed. This step eliminates guessing and improves the odds to achieve a body shape, contour line and a symmetrical skin incision. When the surgery is performed under general anesthesia or heavy sedation, the patient must stay lying down throughout the surgery which forces the surgeon to guess the shape and size of the skin removal.
- The operating time is significantly reduced because no bleeding is involved.
- The technique eliminates puckers of skin on either end of the scar (dog ears) because liposuction allows the creation of similar fat thickness in the superior and inferior borders of the flap.
- The postoperative period is similar as in the standard liposuction of the abdomen. The patient is able to stand up from the operating table, ambulate and dress herself/himself at the end of the procedure. This recovery is virtually unheard of with a standard tummy tuck under general anesthesia or heavy sedation. Due to its long lasting effects, tumescent anesthesia offers a minimum of 12 hours pain control following the surgery.
- In Drs. Pelosi hands the abdominoplasty totally under local tumescent anesthesia without undermining results in a shorter a more aesthetic looking scar when compared with the scar from traditional tummy tuck.
- This new approach creates a more youthful abdominal silhouette and more harmonious results while avoiding complications and the prolonged recovery time associated with the traditional tummy tuck.