Tummy Tuck (Abdominoplasty)
Abdominoplasty, or a “tummy tuck,” is designed to correct abdominal wall and skin problems. A protruding abdomen may result from weak abdominal muscles, weight gain then loss, or pregnancy – especially with c-sections or twins. Aging, weight changes, and pregnancy may cause the skin to lose its elasticity. This results in a “prune belly” appearance or a hanging apron-like fold of skin called a pannus. These conditions may not respond well to diet or exercise or liposuction only.
With abdominoplasty, the abdominal wall muscles are tightened and excess fatty tissue and skin are removed to improve the body contour. The goal is a flatter abdomen without excess tissue. Realistic expectations are important.
Abdominoplasty is not a substitute for weight loss. Liposuction is often used quite effectively in combination with abdominoplasty to contour the waist and the hips.
Dr. Wigod considers age, weight and smoking habits when evaluating a candidate for this procedure. Ideally, the abdominoplasty patient has no significant health problems. Patients on a weight-loss plan should be close to their target weight before having the operation. Women planning future pregnancies should delay abdominoplasty, as pregnancy may promote further abdominal stretching. Abdominoplasty is considered a cosmetic surgery and insurance coverage will not be requested or accepted.
Abdominoplasty is performed using general anesthesia. The surgery may take 2-5 hours, depending on your overall condition. A full abdominoplasty addresses the upper and lower abdomen, while a mini abdominoplasty addresses the lower abdomen only.
The procedure is most commonly performed by making a low incision curving between the hips. A second incision is made around the belly button (umbilicus). The skin is then separated from the abdominal wall and lifted up to the ribs, exposing loose tissue covering the abdominal muscle. Loose, stretched out muscles are tightened together with sutures like an internal corset. Excess skin and fat are then removed. The skin is next lowered over the abdomen and the incisions are then sutured together. Finally, a new hole for the umbilicus is made and it is sutured into place. Drains are inserted to eliminate fluid buildup and an elastic binder is applied to the abdomen. A local anesthetic pain pump is used to ease your recovery.
Depending on your health, length of operation, and personal preference, you may have outpatient surgery or stay in the hospital overnight.
You will be discharged with an abdominal binder and your wounds will be dressed with gauze bandages. Dressings should be changed daily or when significantly soiled. You do not require dressings once you have no more drainage from your wound, but you should have a clean soft cotton garment in contact with the wound which is washed or changed daily. After your drains are removed, you will need to wear a close fitting compression garment until 6 weeks post op. The garment is similar to a girdle, put on like a leotard, and provides compression from the ribs to the pubis. Garments may be fitted and purchased at our office.
Your skin will be closed by a combination of absorbable and non-absorbable sutures. You may have some oozing which is not unusual. You may shower and wash your wound 24-48 hours after the operation. Your sutures will be clipped at 1-2 weeks post-op. While every effort is made to minimize it, scarring should be expected. It often takes 9-12 months before the scars begin to fade. Dr. Wigod recommends using silicone gel strips with your compression garment for the optimal result.
You will have a rubber tube, called a drain, exiting from each corner of your incision. They are there to allow controlled drainage from the wound and to decrease pain. Depending on many factors, these tubes may be removed from one to several weeks after the operation. The drains should be emptied every 8 hours and the drainage tracked in milliliters (cc’s). Your hospital nurse will instruct you. You may shower with the drains in place. If a drain is accidentally removed, notify Dr. Wigod during the next business day.
Your abdomen may feel tight for 1-2 weeks and feel numb and swollen for weeks to months post op. Recovery time depends on your physical condition prior to surgery, as well as your personal pain tolerance. Those with stronger abdominal muscles usually recover faster. Allow at least 1-2 weeks to recuperate before returning to work.
Recovery may be delayed by seroma (clear fluid collection between the skin and abdominal wall). Dr. Wigod leaves drains in place as long as necessary to avoid this problem. Patients may rarely have “dog-ears”- small amounts of extra tissue at the far ends of the abdominal closure. Dr. Wigod designs his closures to minimize this problem which may not be evident until weeks to months after the operation. If it occurs, however, the tissue may be easily removed in the office under local anesthetic. Other problems, such as delayed wound healing of the closure or umbilicus, bleeding, infection, or asymmetry, are unusual.
Though the recovery period is longer than that of other cosmetic procedures, abdominoplasty patients tend to be the most satisfied of any cosmetic surgery patients. Those who follow a proper exercise routine and healthy diet will benefit from abdominoplasty the most. Your body will continue to change gradually post op as the operation does not prevent aging or weight gain.
Liposuction is a very common and popular procedure for removal of fatty (adipose) tissue in isolated areas that do not respond to diet and exercise. These areas include the hips, thighs, abdomen, knees, ankles, face, neck and upper arms.
Liposuction is most successful in people with good skin tone who have isolated fatty deposits. It is not a treatment for obesity. Body contours made irregular by fat can be improved by this procedure; it cannot correct contours that are irregular for other reasons, such as muscle weakness or poor tissue tone. However, combined with other procedures such as abdominoplasty, liposuction can correct these other deformities with good results. The procedure can be repeated, if necessary. To maintain the safety of the procedure, there is a limit on how much can be done at one time. Dr. Wigod does not perform high volume liposuction.
Liposuction has potential to be used inappropriately in patients who want to minimize scars and avoid excisional body contouring surgery such as abdominoplasty. Liposuction in patients who would really be best treated by more extensive surgery may result in sub-optimal or even very poor results. Some cosmetic surgeons who are not Certified by the American Board of Plastic Surgery are not trained to perform more extensive surgery and therefore may not offer it as an alternative. As a fully trained surgeon, Dr. Wigod is able to perform all the surgical options and can therefore counsel you to make the most appropriate choice for an optimal outcome.
Liposuction is done under general anesthesia as an outpatient or an inpatient if combined with other procedures. The surgeon makes small (less than 1/2 inch), discreet incisions in the areas to be treated. A saltwater (saline) solution mixed with local anesthetic to decrease pain and epinephrine to decrease bleeding is then injected. This is called tumescent technique and is commonly used be most surgeons. A cannula (long, thin, hollow tube) attached to a suction machine is inserted through these small incisions. The cannula is then moved through the adipose tissue to be removed repeatedly in an even and methodical manner. The procedure may take an hour or more, depending on how many areas are involved.
There are several different methods surgeons may use when performing liposuction, including suction-assisted lipectomy (SAL), ultrasound-assisted lipectomy (UAL), power-assisted lipectomy (PAL), and laser-assisted lipectomy (e.g. Smart lipo). Each technique has its appropriate application and may yield good results when used by a well trained Plastic Surgeon. Dr. Wigod prefers using traditional liposuction, SAL. Because it is completely dependent on the surgeon’s movement, SAL feels to him more like using chisel to sculpt a statue as opposed to using a large chain saw or a small paring knife. When considering reliability, safety, and value, Dr. Wigod believes traditional liposuction still gives the best results in his patients. He is always open to using new techniques when they serve the interests of his patients better than his current methods.
Recovery from liposuction is relatively easy. Expect swelling and bruising in the following weeks, but activity is only limited by pain. You will wear special garments to apply pressure, minimize swelling and provide support while healing. These garments also assist in retraction of the skin. Stitches will be removed in a week. Avoid sweating and the sun until all bruising has subsided. A sunscreen should be used routinely; it is easy to get sunburned during recovery because of decreased sensation.
Results may be recognizable almost immediately, but will continue to improve as swelling subsides. Do not expect a final result until months after your operation. The results of liposuction are not permanent. If you were to gain a large amount of weight, you may regain weight in a previously treated area.
Cosmetic complications include contour irregularities, skin discoloration, asymmetry, scar tissue, tape burns, collection of blood or fluid under the skin and may be unavoidable. More uncommon complications include loss of sensation, skin breakdown, fat embolism, serious infection or shock.
Read more about liposuction from the American Society of Plastic Surgery »
Massive Weight Loss Reconstruction
Bariatric Surgery (gastric bypass or laparoscopic banding) can be highly successful in helping morbidly obese patients lose weight. After the procedure, patients are often able to enjoy not only significant weight loss but also greater mobility, relief of symptoms and a lower risk of weight-related disease. Unfortunately the patient’s stretched and inelastic skin does not improve as well and instead hangs loosely over the slimmer body. Patients who have had large weight losses without surgery may also encounter similar problems.
Post-bariatric plastic surgery combines reconstructive and cosmetic techniques to tighten, lift and contour sagging areas for a more attractive appearance. The patient may choose to treat the breasts, abdomen, buttocks, thighs, arms, neck, face or other areas. This type of surgery is relatively new and challenging and should only be performed by experienced Plastic Surgeons. More information is presented below on thigh lifts and brachioplasty, procedures unique to post massive weight loss patient treatment. While more difficult, abdominal, breast, and face procedures on post bariatric surgery patients are similar in concept. For more information on these areas are presented elsewhere on this site.
Dr. Wigod has a particular interest in post massive weight loss reconstruction and has given many educational talks on the subject to groups in the Treasure Valley. Over time, he has developed approaches to maximize results and minimize risks for his patients. Most often, these procedures are staged over 1 to 3 operations. Insurance does not cover body reduction surgery, so Mark D. Wigod, M.D., P.A. will not request or accept insurance payment.
Lateral and Medial Thigh Lift
Weight changes may result in excess skin along the inner and outer thigh and the buttocks. A lateral thigh lift uses incisions which extend from the hips around to the back to remove outer excess tissue and to lift the buttocks. This procedure is indicated only for patients with significant excess skin problems as the operation requires difficult to hide scars. Lateral thigh lift is usually combined with abdominoplasty. A medial thigh lift uses incisions made in the groin crease and inside of the leg to remove inner excess tissue. This procedure is usually performed by itself.
Lateral thigh lift recovery is well tolerated. When combined with abdominoplasty, however, overnight hospital stay is recommended. Return to work is variable, but is usually 2-3 weeks. Any problems are usually related to delayed wound healing, prolonged drainage, or poor scarring. As with all cosmetic surgery, realistic and motivated patients are usually very happy with their results.
Arm lift, or brachioplasty, is indicated for patients who have extra upper arm skin and fat. An incision is made starting at the elbow and is extended to the armpit along the lowest hanging part of the arm. Incisions may be extended below the elbow or onto the side of the chest for those patients who have problems extending to these areas. Excess tissue is removed and the wound is closed with a combination of absorbable. The arms are then wrapped with light dressing.
Brachioplasty may be performed alone, or in conjunction with other procedures. Surgery usually lasts 3 to 4 hours. Since arm skin is significantly tightened, the hands must be observed to make sure there is no post-operative nerve or blood vessel compression. Other problems may include delayed wound healing, prolonged drainage, or poor scarring. The procedure is indicated only for patients with significant excess skin as the operation unavoidably leaves difficult to hide scars. Return to work is variable, but is usually 1-2 weeks. As with all body contouring surgery, minimal procedures such as liposuction only or short scar techniques give minimal results in poorly selected patients.
Becoming a mother can be one of the most rewarding experiences of a woman’s life. Unfortunately, pregnancy and breast-feeding often result in unwanted changes to a woman’s body, such as drooping breasts, stretch marks, and a sagging tummy that no amount of exercise and dieting can fix. Loose muscles and stretched skin improve somewhat over time, but the body never completely returns to the way it was before pregnancy.
Previously, women were resigned to living with these unwanted changes in their bodies. Now, however, more and more women are seeking out Plastic Surgeons to rejuvenate their breasts and abdomens to the youthful firmness they enjoyed before having children. These procedures are collectively called “mommy makeovers” or post-maternity breast and body reshaping. Operations on each area may be performed by themselves or concurrently to minimize cost as well as recovery time. Single operations are usually done as an outpatient, but combined ones often require an overnight stay. Please see individual sections on Cosmetic Breast Surgery and Cosmetic Body Surgery for further details.
Whether you are considering a single breast or body procedure or a mommy makeover package, these and other plastic surgery procedures can help you restore and rejuvenate your body after having children.
To schedule a consultation or for more Body Cosmetic information, please visit our contact page or call our office at 208.377.9515.