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Mini Tummy Tuck with Umbilicus Release. Client 39 year old. Three months post-op. Notice the tightening of the excess skin below and above the belly button. Notice the more youthful appearance of the belly button with no scarring around it.
Standard Abdominoplasty (Standard Tummy Tuck)
The standard abdominoplasty is the most common abdominoplasty. It does an excellent job in eliminating the excess skin and 'abdominal pooch' both above and below the umbilicus especially in women who have given birth. It is necessary when there is a significant amount of excess skin within the upper abdomen. Remember, the determining factor of whether you need a mini or a standard abdominoplasty is the amount of excess skin ABOVE the belly button.
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Standard Abdominoplasty Incision. |
By definition, the umbilicus has to be transposed in a standard abdominoplasty. This means that the excess abdominal skin is pulled down so far that a new hole must be created in the pulled down skin to accommodate the umbilicus. Remember, the cord of the umbilicus stays attached to the abdominal wall.
The incision around the belly button is the most tell tale sign of a tummy tuck. Therefore, it is critical to do everything possible to make it look un-operated on. The key is to make sure the it is small, recessed, and as natural as possible. This is done by creating a flap inferiorly to hide the incision. In addition, it helps to suture the incision inward to create an "inny" so that the incision is hidden inside.
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| Standard way of placing an incision around the opening for belly button. The incision is made in the shape of simple circle. The incision does not recess inward, therefore, is more apparent. |
Modifications can be performed to hide the incision inside and allow the new belly button to be much more attractive and natural appearing.
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Standard Abdominoplasty. Frontal view shows significant improvement in 'hour-glass' waist.
In addition, a properly performed standard abdominoplasty will help create an hour-glass waist line. The only thing a standard abdominoplasty will not do well is treat fat deposits in the flank area. This can usually be addressed with liposuction. Liposuction will usually be done at the same time as the tummy tuck. Liposuction of the abdomen at the same time as tummy tuck, however, is more controversial. Many cosmetic surgeons will not aggressively perform liposuction of the abdomen at the same time. This puts a tremendous burden on the abdominal blood supply and can lead to wound healing problems and even skin death. The burden is because the skin is elevated off the abdominal wall during a tummy tuck. Now, take this elevated skin and traumatise it further by liposuction. You can see how the effects are cumulative.
This does not mean that liposuction can not be done at the same time. It does need to be done less aggressively.
We prefer to do liposuction of the abdomen six weeks after the tummy tuck under local anesthesia. You might think, "Local anesthesia. Liposuction is painful. I don't want to feel pain!"
Normally, this may be true. After a tummy tuck, however, the abdomen is very numb for at least the first three months. We like to take advantage of this numbness by doing liposuction comfortably under local anesthesia alone. It is very cost effective as a surgical theatre is not necessary. There is little down time. In addition, we do not have to worry about compromising the blood supply as the tummy tuck is already healed. As always, other cosmetic surgeons may handle this issue differently. The important thing is for you to understand abdominal blood supply and safety.
 
Notice marked improvement of pooch below umbilicus and flattening of stomach.
 
 
Mother of two with loose skin and significant rippling from previous liposuction. Notice how the abdominoplasty not only tightens the skin but, also, reduces the rippling. Notice natural appearing belly button and the flattening of the abdomen.
Extended Abdominoplasty, AKA Extend Tummy Tuck
The extended abdominoplasty is exactly what it sounds like. It is a standard tummy tuck with an incision that extends farther out laterally over the hips. Sometimes, the incision may need to go toward the back.
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Extended Abdominoplasty Incision.
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Extended Abdominoplasty Incision From Behind.
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The determining factor is how far the hanging skin goes. The incision must go at least to this level.
 
 
Extended Tummy Tuck on a 37 year old male after massive weight loss. Six months post-op. Notice that the incision extends as far as the crease does on the pre-operative picture.
As mentioned above, we try to keep the incision as short as possible. But, when it is necessary, the incision must go as far as the abdominal crease goes. We always try to keep the incision as low as possible. This is very important so that the incision is not visible in ordinary trousers. The incision, however, has to go higher in an extended tummy tuck compared to a standard tummy tuck. This may make it difficult to wear low rise jeans as the incision may possibly be visible when bending over. Normal clothing should be fine.
The amazing thing about the extended abdominoplasty is the dramatic improvement these clients undergo. These clients are used to having this hanging skin wrapped around their waist. Often, they feel trapped by it. They tell me that it doesn't even feel like it belongs to them; as if it were a foreign body. When this is removed they feel as if a weight as been removed. This weight is emotional as much as it is physical.
 
 
Extended Abdominoplasty. Notice the dramatic improvement in waist line and abdominal flattening. Notice the significant improvement of waistline, hips, and flanks.
The extended Abdominoplasty gives hope to the client who is not a candidate for a standard abdominoplasty. Gastric bypass clients frequently fit into this category. These clients are especially satisfying to work with. They have already been through a very long journey during their surgery and subsequent massive weight loss. Still, they feel trapped by this excess hanging skin that just will not go away. Often, this is demoralising. Fortunately, procedures such as the extended tummy tuck can get them to where they feel comfortable and even excited about their body.
Circumferential Abdominoplasty, AKA Body Lift
The circumferential body lift is a very aggressive procedure and is reserved for those clients with a significant amount of redundant skin that goes all the way around to the back. The body lift is being done more and more because of the increase in gastric bypass clients. It can produce dramatic improvements in these clients. The down side is that it usually requires an overnight stay to make sure everything is OK.
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Circumferential Body Lift Incision |
That was a lot of information just going over the different types of abdominoplasties. Lets get into some of the quicker topics covered during your tummy tuck consultation.
3. Liposuction with Abdominoplasty
The most common area that needs liposuction in tummy tuck clients is the flank. The flank area is the area that begins above the hips and extends toward the back right above the buttock. The reason why it is important to address is because it may look more pronounced AFTER a tummy tuck than before. Once the stomach is flat and the excess skin is gone than the flanks become more obvious.
The other area that often needs to be addressed is the abdomen itself. Many tummy tuck clients do not realise that the tummy tuck itself will not get rid of the excess fat. This is why it is best to get closer to your ideal body weight before considering abdominoplasty. The less fat you have the better your results will be. Typically, we advise clients that they should be within 2 stone of their ideal body weight. This does not mean that heavier people can not benefit from the procedure because they can. But, the best results are with thinner patients.
As mentioned above, liposuction of the abdomen at the same time as a tummy tuck increases the chances of wound healing problems. It may even cause skin death. This is because with a tummy tuck, the skin is separated from the underlying abdominal wall. The skin at the bottom is dependent on a blood flow that comes from above. If this area is liposuctioned at the same time then the blood flow may be jeopardised. For this reason, we do not aggressively perform liposuction at the same time. This is not to say it can't be done. If it is done, you must know the risks. We do routinely, however, perform liposuction of the abdomen with mini-tummy tucks. This is because the blood supply is not compromised as much as with a standard tummy tuck.
4. Tightening the Abdominal Muscles
Why do we need to tighten the muscles? The most common reason is because the muscles have been stretched and separated by pregnancy. Normally, the rectums abdominus run parallel to themselves from the rib cage to the pubis. During pregnancy, the expanding baby separates these muscles in the midline. During abdominoplasty the muscles can be sutured back to where they should be.
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Abdomen and Separation of Muscles After Pregnancy
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Restoring Muscles to their Pre-pregnancy Position
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The abdominal muscles can also be tightened with a mini tummy tuck but only the muscles below the belly button. This is more than acceptable, as it is below the belly button that the problem is most significant.
Tightening the muscles has the additional benefit of improving the bulge located just below the belly button. It can not, however, correct bulging do to intra abdominal fat. This can only be corrected with diet and exercise.
5. Improving Waist Line
An abdominoplasty does a spectacular job of flattening the stomach and getting rid of loose skin. It is not specifically designed to contour the waist. With modifications, however, the waist line can be improved. It is done be purposefully gathering the skin laterally and pulling it inward toward the midline. This gathering can significantly improve the waist but only on clients within approximately 2 stone of their ideal body weight. With heavier people the contouring is less effective.
 
Notice significant improvement in waist.
Perhaps the most powerful way to improve the waist line is to have liposuction of the flanks at the same time. Often, this is very important as both men and women tend to accumulate fat in this region. By removing this fat not only is the waist line improved but so is the contour of the buttocks.
 
Example of liposuction of flanks and how it improves the overall shape of the waistline and buttocks.
6. Creating a Natural Belly Button
The most tell tale sign of a tummy tuck is the incision around the belly button. For this reason, we have spent a great deal of time figuring a way out to make it so the new belly button appears natural. The reason why it is so important is because the lower incision can be easily hidden with almost any clothing. The belly button, on the other hand, is often exposed with sexy or fashionable clothing. A poorly performed belly button will make it so you can not wear revealing clothing.
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| Standard way of placing an incision around the opening for belly button. The incision is made in the shape of simple circle. The incision does not recess inward, therefore, is more apparent. |
Modifications can be performed to hide the incision inside and allow the new belly button to be much more attractive and natural appearing.
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A natural appearing belly button can be accomplished and needs to be a priority with your cosmetic surgeon. The key is to make sure the it is small, recessed, and as natural as possible. This is done by creating a flap inferiorly to hide the incision. In addition, it helps to suture the incision inward to create an "inny" so that the incision is hidden inside.
7. Keeping the Incision as Low as Possible
Standard costmetic surgery technique does not emphasise the importance of where the incision is located. It makes sense that the lower the incision is the more hidden it becomes. This is why we like the mini-abdominoplasty so much. It allows us to put the incision much lower than a standard abdominoplasty. Even a standard tummy tuck incision can be kept low with proper technique. You should emphasise to your cosmetic surgeon to keep the incision as low as possible.
 
 
Mini Tummy Tuck with Umbilicus Release. Notice how the incision is easily hidden even by low rise underwear.
8. Pubic Lift
Some people who are considering abdominoplasty also have a sagging pubic area. The area around the genitalia has dropped similar to how a breast sags. If you do not have this problem then you will not know what I am talking about. Those who do have this problem are often too embarrassed to talk about it. The good news is that this is often significantly helped with abdominoplasty.
 
During an abdominoplasty the entire abdomen is tightened. This means that even the pubic area is elevated back up into its proper position. If you have this problem be sure to bring this up at your consultation. Your cosmetic surgeon can alter your tummy tuck accordingly to address this issue.
9. Post Op Scar Management
Your cosmetic surgeon will go over his regimen for scar control. It is important to follow this as it will effect the overall result. Your post op regimen is outlined in the after the procedure segment of this web site.
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Your cosmetic surgery procedure will take place at the Queen Anne Medical Centre, just off of Harley Street in the heart of London's premier medical district. The Queen Anne houses an ultra-modern, state of the art medical facility behind an elegant façade in historic Queen Anne Street. |
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Tummy tuck | Abdominoplasty prices are indicative. A price for your specific needs will be quoted to you at your free consultation. Financing is available for Tummy tuck | Abdominoplasty procedures. Tummy tuck | Adbominoplasty consultations are available at all our London based clinics.
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