Tummy Tuck

Abdominoplasty is a surgical procedure that removes excess skin and fat from the abdomen—excess that cannot be eliminated through other means, such as diet or exercise. The surgery results in a flat abdomen while also strengthening the muscles. However, this is a major surgical procedure, so you should research it thoroughly before deciding to undergo it. Keep in mind that abdominoplasty is a body-contouring procedure and NOT a weight-loss method!

Candidates for Abdominoplasty

Patients can be both men and women who are in good physical condition and have no major health conditions. It should not be confused with liposuction, although the two procedures can be combined if the surgeon deems it necessary.
Women who have given birth and have loose skin with numerous stretch marks, as well as sagging muscles, may choose abdominoplasty as a way to remove excess skin, tighten the muscles, and regain their long-desired waistline. Patients who have lost a significant amount of weight require a tummy tuck to remove the excess skin resulting from weight loss.
Patients who plan to become pregnant again or who intend to lose more weight are not candidates for abdominoplasty, as both processes will compromise the outcome of the surgery. In these cases, it is best to postpone the surgery until after childbirth or until a stable weight has been maintained to maximize the results.

Benefits of the Surgery

The surgery helps achieve a perfectly flat, firm abdomen, a narrower waist (achieved by strengthening the abdominal muscles), as well as reducing or even eliminating stretch marks below the navel and improving the appearance of stretch marks above the navel. Self-confidence is greatly enhanced, as is the variety of clothing the patient can wear. The abdomen will no longer protrude, and unlike liposuction, which removes only excess fat, a tummy tuck removes both fat and skin. In obese patients who have lost a significant amount of weight, the sagging skin fold can lead to fungal infections; a tummy tuck resolves this problem by removing the abdominal skin.

The abdominal muscles are often less toned and more widely separated along the midline as a result of pregnancy or aging. Muscle laxity not only reduces muscle strength but also gives the overall impression of a sagging or distended abdomen. This condition is called rectus diastasis; in its early stages, it can be improved through exercise, but in advanced stages, only surgery can resolve it.The results of a tummy tuck are long-lasting as long as the patient does not become pregnant, does not experience significant weight fluctuations, and maintains a healthy lifestyle that tones the abdominal muscles. Otherwise, the skin will sag again, the muscles will lose their tone, and the surgery will need to be repeated. As one of the most extensive procedures in cosmetic surgery, abdominoplasty offers many benefits but also requires a longer recovery period (several weeks) to allow the body to heal the incisions and the muscles that were treated.Types of Abdominoplasty

Traditional/classic abdominoplasty—this is the most commonly performed procedure; it involves making a horizontal incision from one iliac crest to the other, as well as an incision around the navel, which is repositioned; It may be combined with liposuction.

Mini-abdominoplasty (partial abdominoplasty)—involves a shorter incision than traditional abdominoplasty, does not require repositioning the navel, and allows for the removal of only excess skin and fat below the navel; the results are not as dramatically improved as with a partial abdominoplasty, but recovery is also much faster.

Extended abdominoplasty—the incisions extend laterally on either side of the waist (but are still low enough to be hidden by a bikini) to allow for the removal of excess skin and fat from the hips.

Circumferential abdominoplasty – the incision goes all the way around the waist and allows for the removal of skin and fat from the abdomen, hips, buttocks, and thighs; It is particularly indicated in cases of post-bariatric surgery (following significant weight loss) and is actually part of a larger procedure called a “body lift” (total body lift).The patient plays a very important role in optimizing the surgical outcome and minimizing recovery time by following these guidelines:

1. 1. • diet
      • smoking
      • exercise
      • the presence of other medical conditions
      • medication use

Diet

Maintaining a healthy diet before (and after) surgery is very important for any type of surgical procedure, as it strengthens the immune system and promotes healing and a quick recovery. Taking vitamins can be helpful, but this should only be done with your doctor’s approval, as some vitamins are not recommended during this period (for example, vitamin E should not be taken for at least 2 weeks before surgery, as it increases the risk of intra- and postoperative bleeding; wheat germ, nuts, peanuts, and certain vegetable oils also contain significant amounts of vitamin E, so they should be avoided as much as possible). Candidates for abdominoplasty should be as close to their ideal weight as possible. Obese patients are at high risk for postoperative complications; therefore, weight loss through various methods is recommended prior to surgery. Drastic diets before surgery should be avoided, as they weaken the body and prevent normal recovery.

Quitting Smoking

Smoking increases the risk of complications regardless of the type of surgery performed. Nicotine reduces the amount of oxygen delivered to the cells via the bloodstream and, at the same time, causes blood vessels to constrict. This results in a reduced ability of cells to receive nutrients and, consequently, to recover. The healing process is significantly slowed down. For this reason, it is recommended to quit smoking at least 2 weeks before and after surgery. Smokers have a much higher risk of developing complications than nonsmokers, a fact that has been scientifically proven.

Regular exercise

It helps increase your metabolic rate and strengthen your muscles, preventing weight gain—especially during the postoperative period when you’re less active. After surgery, your doctor will recommend taking light walks to prevent blood clots from forming in your legs; however, being in good physical condition helps build muscle in your lower limbs and prevent blood clots. Another reason to exercise: the best candidates for a tummy tuck are within 15% of their ideal weight. Tummy tuck surgery can lead to significant improvements in body appearance by removing fat deposits and excess skin that cannot be eliminated by any other method, but it is not a weight-loss method and is under no circumstances recommended for obese patients (unless they have lost weight first!). Obese patients face a very high risk of complications. Likewise, weight loss after abdominoplasty can also compromise the results of the surgery, causing the skin to sag again and necessitating another operation. Therefore, maintaining a stable, ideal weight before surgery is extremely important.

Other Medical Issues

These should be discussed with your surgeon, as abdominoplasty is major surgery and complications must be avoided and prevented as much as possible. If you have a cold or other temporary illnesses, the surgery should be postponed due to the risk of infection.

Medications

Be sure to tell the surgeon performing the surgery about all medications you take occasionally or regularly, as these can have negative effects and lead to serious complications. Some medications that are normally beneficial to the body must be discontinued in this case. For example, vitamin E and aspirin (as well as its derivatives) must be discontinued at least 2 weeks before surgery because they increase the risk of bleeding. Also, birth control pills and certain hormones must be discontinued, as they promote the formation of blood clots in the blood vessels. Before the surgery, you should arrange for someone to pick you up from the clinic or hospital and have someone stay with you for the first 2–3 days at home, as it will be difficult for you to get out of bed.The surgery is usually performed under general anesthesia (although in cases of mini-abdominoplasty, it can also be done under local anesthesia and sedation). It is important for the patient to sleep in order to relax the abdominal muscles. The surgery can last between 2 and 5 hours, depending on the complexity of the procedure.

1. The stages of the surgery are as follows:
   • Incisions
   • Muscle tightening
   • Removal of excess skin
   • Closure (suturing) of the incisions

It is very important for the patient to fully understand what to expect from a tummy tuck and what the surgery entails. A mini-tummy tuck takes about 1½ hours, while a full tummy tuck can take between 2 and 5 hours. Although the location of the incisions is carefully planned to be as inconspicuous as possible, the scars left behind by an abdominoplasty are inevitable and will never disappear. The incisions are necessary to remove excess skin and to tighten the abdominal muscles. Following the doctor’s instructions can lead to optimal scar healing, with the least visible scarring possible.

Incisions

The types of incisions made vary depending on the type of abdominoplasty performed. In a mini-tummy tuck, the incision is shorter, while in a classic tummy tuck, the incision is longer and horizontal, extending from one iliac crest to the other and positioned low enough to be hidden inside a bikini or swimsuit. A circumferential abdominoplasty involves a circular incision, both in the front and back, to remove the excess skin that hangs in a circular pattern. Another incision will be made around the navel, as the position of the skin will be altered. The resulting scar around the navel will vary in shape depending on the surgeon’s preference, technique, and experience. In some cases, when there is not enough skin and laxity to excise all the tissue below the navel, a small vertical scar is necessary, extending from the horizontal incision.

Muscle Tightening

Muscle laxity is common as we age, after childbirth, or following significant weight loss. Muscle tightening is performed using strong sutures, following specific techniques, and allows the muscles to be drawn together along the midline. This procedure results in a flat, toned abdomen, as well as a narrower waistline for the patient.

Removal of Excess Skin

After the skin is detached from the abdominal wall up to the level of the ribs, it is pulled downward, and all excess skin is excised. Some surgeons use liposuction performed prior to the procedure as a complementary method to remove localized fat deposits both below the navel and, especially, above it. In this way, the skin above the navel—which, when stretched, will end up below it—will be thinner and contain less fat. As the excess skin is removed, the stretch marks below the navel are also eliminated, while those above are stretched, significantly improving their appearance.

Closure (Suturing) of the Incisions

The skin is sutured in several stages using various types of suture material. In most cases, drains are also used to collect secreted fluids; if these fluids were to remain inside the body, they could lead to infections. The drains are removed after a few days, up to a week, and the sutures after 14 days. After the surgery, the surgical site will be bandaged. A compression garment (a special elastic bandage) must be worn for at least 4 weeks. Physical activity must be severely restricted after abdominoplasty, which can be quite difficult for active individuals. Recovery from this type of surgery is usually lengthy and requires a great deal of patience on the patient’s part. Since the surgery is extensive and involves a large area of skin excision with muscle tightening—and possibly liposuction as well—the time required for the body to heal and adapt to the changes is quite long.

Recovery depends largely on each individual patient, as well as on how well the patient follows the doctor’s instructions. In general, a rest period of about two weeks away from work is sufficient.

Hospitalization usually lasts 2–3 days. Swelling and moderate abdominal pain are normal and are managed with medication. Bed rest is recommended, but walking should be started as soon as possible after surgery (short walks) to prevent blood clots from forming in the blood vessels. Initially, walk with your body leaning forward at a 45-degree angle. The body should be gradually straightened over the next few days (to prevent straining the abdomen and causing the incisions to open). Light exercise is recommended one week after surgery, as it aids in faster healing. More intense physical activity may be resumed only at least six weeks after surgery.

After surgery, it is best to avoid abdominal bloating (avoid foods that cause bloating, prevent constipation, and limit coughing). A compression garment should be worn for several weeks after surgery (4–5 weeks).

The resulting scars
are red and firm for the first 2–3 months. The formation of unsightly scars is prevented both by the surgeon (suturing technique, suture material used, and avoiding tension sutures) as well as by the methods the patient follows afterward (using various scar-healing creams, avoiding sun exposure on the scars for 9 months, using silicone patches, avoiding smoking, which impedes healing, and, if necessary, using corticosteroid injections as directed by the surgeon, particularly in patients predisposed to developing hypertrophic scars or keloids). Smoking generally leads to the formation of atrophic, widened scars, and patients who smoke are at a much higher risk of developing complications than non-smokers. The scars are longer the more skin that had to be removed.

Abdominoplasty is an extremely effective method for body contouring and achieving a flat, firm abdomen; however, it is not a weight-loss method, nor does it guarantee weight maintenance after surgery. To avoid gaining weight after surgery, patients must maintain a healthy lifestyle, including a balanced diet and regular exercise. Exercise after surgery is recommended and helps reduce swelling, maintain muscle tone, and prevent blood clots from forming in the blood vessels. After a tummy tuck, patients feel great about their new look, gain self-confidence, and can wear a much wider variety of clothes.

The results of a tummy tuck theoretically last for many years, but as patients age, the skin and muscles begin to sag again. The appearance does not return to what it was before the surgery, but some of the effects of the surgery may fade within a few years. This process can be slowed through regular exercise and a healthy lifestyle.Swelling—tummy tuck surgery is not a simple cosmetic procedure, but rather a major surgical intervention, the most extensive procedure in cosmetic surgery; Postoperative swelling is to be expected, and its extent depends on the type of procedure performed as well as the patient’s physiology; a special compression garment helps reduce swelling and increase comfort; In addition, light movement promotes blood circulation and stimulates venous return, which in turn reduces swelling and accelerates the healing process. These complications can be prevented by taking anticoagulant medication, wearing compression stockings during and after surgery, and performing light walking exercises in the room as soon as possible after surgery, followed by walks after about one week. However, strenuous physical exercise (jogging, fitness) should not be resumed until at least 6 weeks have passed.

Infections: A skilled surgeon takes all necessary precautions to prevent infection (aseptic and antiseptic measures before and during surgery, sterile dressings, and prophylactic and postoperative antibiotic therapy). An infection manifests as fever, chills, sweating, and localized red, warm wounds with discharge. An infection delays the healing process and recovery and can result in more prominent scars. Treatment consists of intravenous antibiotics and drainage. Therefore, infection must be prevented by all means, and if the patient has a cold before surgery, the procedure must be postponed, as the risk of infection is significantly increased in such cases.

Skin necrosis and delayed healing—these occur when the skin has been sutured under tension and when the patient’s underlying condition delays healing (e.g., diabetes, smoking)Thrombosis and embolisms (the formation of blood clots in blood vessels and their potential migration to the lungs)—any surgical procedure that uses general anesthesia and lasts longer than 10 minutes carries this risk. The risk increases the longer the surgery lasts (see abdominoplasty) and the more the patient has a personal medical history of conditions such as cardiovascular disease or diabetes. In addition, birth control pills, hormonal medications, and being over 40 years of age increase the risk of thrombosis and embolism. These complications can be prevented by using anticoagulant medication, wearing compression stockings during and after surgery, and performing light walking exercises in the room as soon as possible after surgery, followed by walks after about one week. However, strenuous physical exercise (jogging, fitness) should not be resumed until at least 6 weeks have passed.

Infections—a good surgeon takes all necessary precautions to prevent infection (aseptic and antiseptic measures before and during surgery, sterile dressings, and prophylactic and postoperative antibiotic therapy). An infection manifests as fever, chills, sweating, and localized red, warm wounds with discharge. An infection delays the healing process and recovery and can result in more prominent scars. Treatment consists of intravenous antibiotics and drainage. Therefore, infection must be prevented by all means, and if the patient has a cold before surgery, the procedure must be postponed, as the risk of infection is significantly increased in such cases.

Skin necrosis and delayed healing—these occur when the skin has been sutured under tension and when the patient’s physiological condition delays healing (e.g., diabetes, smoking). Before