Southlake plastic surgeon Dr. Michael Bogdan is frequently asked many similar questions about tummy tuck by people from the DFW area who are considering the procedure. To address some of these recurring issues, he has answered many of these common questions below:
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This patient got a mini abdominoplasty as part of a mommy makeover because she had only minor concerns in the area. See more before-and-after photos of Dr. Bogdan's real tummy tuck patients in our photo gallery.Before & After Photos
Liposuction (whatever method is used) primarily removes fat from below the skin surface and provides a small amount of skin tightening due to scar contracture.
A Tummy Tuck does several things:
A tummy tuck removes excess skin from the abdomen and doing so requires the creation of a scar. The exact location of the scar is something that should be discussed in detail - once you have the scar, you can't change your mind and move it! This is something worth considering, as most of the time tummy tuck scar location is dictated by clothing preference. If you liked French-cut one-piece bathing suits, the scar would be designed like a sharp smile to stay off your hip. However, this is not the current fashion. Now, low-cut two-piece bathing suits are in, as well as low cut pants. So you would want a very low, almost horizontal scar. Everything is a compromise, but if you take the time to consider all of your clothing preferences, you can decide which scar will be best for you.
Technically, an Endoscopic Tummy Tuck is done for people who really want to minimize the scar on the abdomen, and just need muscular tightening. From a surgical standpoint, the operation takes about the same length of time as a traditional tummy tuck, and therefore the price is about the same. From the patent's standpoint, the recovery period is the same for both operations. (The muscular repair is the uncomfortable part of both the normal tummy tuck and the endoscopic tummy tuck that requires such a long period of absence from strenuous activities).
Since it costs about the same as a traditional tummy tuck, and has the same (uncomfortable and long) recovery period, most patients agree it is not worth skipping the benefit of removing all of the loose abdominal skin that occurs with a regular tummy tuck. The skin removal gives added flattening to the abdominal wall, and helps with the hip contouring.
Bringing the rectus muscles back together is a major component of a standard tummy tuck (the other component being removal of excess skin). With the use of an endoscope, the diastasis can be repaired through a mini tummy tuck scar. This version of the operation results in a scar the length of a c-section scar, but does not allow for the removal of much skin. As such, it is only appropriate for patients who really have significant abdominal wall laxity but not skin excess. As these two processes tend to go hand-in-hand, appropriate candidates for the mini procedure are rare.
Yes, a tummy tuck will remove a significant amount of stretch marks on your abdomen--most cases all stretch marks below the belly button can be removed. The stretch marks that are above your belly button will still be present, but will migrate down to the lower portion of your abdomen.
Yes. If you are in good health and are undergoing a "routine" hysterectomy, a tummy tuck can be performed at the same time. This does require coordination between myself and your gynecologist, so we can discuss our plans and be certain the procedure can be performed safely. Sometimes it is not appropriate to combine the operations. In these cases, it is still beneficial to coordinate the plan before hand, as we can discuss the type of scar to be utilized such that your gynecologist will have full exposure for the hysterectomy component of the operation, and can later be fully removed in a follow-up tummy tuck.
Yes. It is actually fairly common to combine a tummy tuck with some sort of breast enhancement operation, to the point where this operation is termed a "Mommy Makeover". Children predictably affect both the breasts and abdomen, so it makes sense that women considering abdominal improvement would also desire breast enhancement. Any of the breast operations (Breast Augmentation, Breast Lift, or Breast Reduction) can be combined with a tummy tuck. Typical surgical times for the Mommy Makeover operation range from 4 to 6 hours.
A tummy tuck is a type of body contouring surgery, and will help "re-drape" your skin to match your underlying muscular framework. Generally, patients who are interested in a tummy tuck are bothered by skin excess, stretch marks, and/or abdominal wall laxity. All of these can be addressed by the procedure, but the amount of skin removed depends on the elasticity of skin, and how thick it is. If your weight changes significantly after a tummy tuck (gain or loss), you will be "undoing" the results. That being said, you should first attain your realistic, maintainable, goal weight before proceeding with body contouring. In general, I prefer my patients to have a BMI (Body Mass Index) of 30 or less for body contouring, but in patients who have undergone massive weight loss, it is sometimes appropriate to proceed at higher BMIs.
In general, before considering body contouring surgery, patients should be at a stable weight (for several months) that is within 10% of their personal goal weight. If you gain or lose weight after the procedure, you will be altering the results. (If you lose a significant amount of weight, your skin will look lax, and if you gain a lot, you will be stretching out your skin). Your "personal goal weight" is something that is fluid and changes with time. When someone is first starting to consider losing weight, they can look at a height chart and pick a goal weight. The a good way to do this is to use the BMI scale. However, once a large amount of weight has been lost, and you have started a healthy exercise regime, you may find that your weight loss plateaus. If you keep your weight stable for a number of months, while having a healthy diet and maintainable exercise program, it is then reasonable to reassess your goal weight. The BMI charts are a nice guide and tool, but there is no number set in stone as to when you should consider body contouring. My preference for body contouring surgery is a BMI less than 30, because the surgical risks are low and the cosmetic results can be quite striking. However, in patients who have undergone massive weight loss, body contouring surgery may be completely appropriate at higher BMIs due to the significant amount of skin excess.
Your body is a very complicated system that is fine tuned to function normally. At the risk of over simplifying things a bit, there is a normal way your body handles fluids internally, and surgery can disrupt this system. The arterial system brings fluid (blood) to tissues to provide oxygen and healing cells, and the venous system removes this fluid. The system is not perfect, and normally some of the fluid leaks into the surrounding tissues. To account for this, there is a third fluid management system (the lymphatic system) in your body whose job is to scavenge up this extra fluid, and return it to the intravascular space. When a tummy tuck is performed, a significant amount of the lymphatic drainage channels are divided, and these take a long time to hook back up and function normally.
The majority of swelling resolves within 2 months, a small amount takes up to a year.
A tummy tuck is a major procedure that requires "lifting up" your stomach skin (which divides the lymphatic drainage vessels from under the skin surface), pulling it down to reset the tension of the skin, and then the excess is removed. Basically, the skin from the tummy tuck scar up to your ribcage is in a new environment, where it can only drain fluid "up" and to the sides. Until new lymphatic connections occur across the scar line and down to the stomach muscles, all of the swelling fluid has to run against gravity to get out of the skin. This is one of the reasons that we suggest patients wear compression garments for a period of time after surgery - these garments assist with the "uphill" removal of fluid.
A simple way to judge how you are doing is to look at the indentations that elastic clothing create on your trunk. On the front, you will see more of a lasting impression than on your back / flank region (even though there is even pressure all the way around your body). This is a way you can monitor the swelling, and you can expect it to go away over several months. After a few months, most of what patients consider "noticeable" swelling has resolved.
Recovery after a tummy tuck really depends on the type of work that you perform. You can not go back to work while taking narcotic pain medicine, as that would be the equivalent of drinking alcohol at work! Since everyone has a different appreciation of pain, this length of time varies. In general, patients need pain medicine for a minimum of 3 days, and most are off medications by 5 to 10 days. After stopping pain meds, patients can work from home immediately, and return to desk-type of jobs between 10 to 14 days from surgery. Because of the abdominal wall tightening component of the operation, I restrict patients from heavy lifting and strenuous exercise for 6 weeks. If your job requires a significant amount of physical activity, you may have to take 6 weeks off of work, or modify your work activities. For example, a professional rodeo rider will be taking much more time off of work than a computer programmer.
I allow my patients to begin some light "movement" exercises (elliptical machine, cycling [NOT spin classes!]) at 3 weeks after surgery, but no impact or weight activities until 6 weeks after the operation. The reasoning behind this is that enough healing has occurred after 2-3 weeks that we are very unlikely to develop seromas or hematomas, but the muscular repair in the midline is not strong enough to be challenged until almost 2 months after surgery. At that time, it is unlikely that the muscular tightening component of the operation could get damaged or undone. At 6 weeks, patients should move into their exercise regime slowly, as they are a bit deconditioned. Patients should remember that muscular discomfort tends to show up 2 days after starting a new exercise, so I recommend that they take it easy and slow, and likely within 2 weeks they will be near their normal routine.
If you would like to learn more about abdominoplasty, request a consultation with Dr. Michael Bogdan, a board-certified plastic surgeon who has received advanced surgical training in some of the nation's most highly regarded residency and fellowship programs. Or, you can call our office at (817) 442-1236 to schedule your appointment.
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