Overview

Example of Dr. Cruise's extended abdominoplasty.

Another name for abdominoplasty is tummy tuck. Because of its effectiveness at creating a tight, flat abdomen it is one of the most common procedures performed in plastic surgery. It removes excess abdominal skin and fat utilizing an incision just above the pubic bone, similar to a c-section but longer.

Today's society places strong emphasis on a slender, youthful appearance of the abdomen. This is especially true in the warm and sunny climate of Southern California, where fashion trends often reveal the mid drift area. It is particularly frustrating for women who have given birth or have lost a significant amount of weight. Often, they are left with a loose, stretched-out stomach that frequently has stretch marks. No matter how much exercise, what type of diet, or what kind of cream is applied, the redundant skin never goes away. The reason is because the skin has lost its elasticity and can no longer shrink back.

 

The same patient in profile. Notice both flat stomach and creation of hour-glass figure.

The good news is that a properly performed abdominoplasty can remove not only the redundant skin but also significant portion of the stretch marks. When the correct operation is matched to the right patient, satisfaction is extremely high. There is a price to pay, however. The operation cannot be done without leaving a long scar that often extends across the lower abdomen, just above the pubic bone. If preformed properly, this scar is positioned so that it is easily hidden by even a small bikini, and certainly by underwear.

The type of abdominoplasty performed can be divided into 4 types: mini, standard, extended, and the most aggressive being a complete, circumferential body lift. The most appropriate procedure for you is determined during your consultation with Dr. Cruise. He will assess your skin excess, skin quality, fat excess, fat distribution and body-type. He will also take into consideration your goals to decide what is best for you.

 

Mini Abdominoplasty, AKA Mini Tummy Tuck

The mini-abdominoplasty is the least involved variation. The incision is relatively short, staying within the pelvic bones. It is slightly longer than a c-section incision. It usually does not involve repositioning of the umbilicus. The best candidate for this procedure typically has redundant skin and an abdominal 'pooch' located below the umbilicus. Laxity of the abdominal wall below the umbilicus (a. k. a. abdominal pooch) can be dramatically flattened with a mini abdominoplasty.

Mini Abdominoplasty Incision.

 

Standard Abdominoplasty AKA Standard Tummy Tuck

Dr. Cruise's Standard Abdominoplasty. Frontal view shows significant improvement in 'hour-glass' waist.

The standard abdominoplasty is the most common abdominoplasty. It does an excellent job in eliminating the 'abdominal pooch' below the umbilicus especially in women who have given birth. In the process it produces a much flatter stomach. Dr. Cruise goes several steps further by tightening the underlying muscles in two places to flatten the stomach and narrow the waist line. An additional bonus is the removal of all the stretch marks located below the umbilicus which is where most stretch marks occur.

 

Notice marked improvement of pooch below umbilicus and flattening of stomach.

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 be addressed with either liposuction or by performing an extended abdominoplasty. If there is only a small or moderate amount of flank fat then liposuction is the best course. If you have a significant amount of flank fat then an extended abdominoplasty would most likely be best.

 

Before and After of mother of two with loose, hanging abdominal skin. Dr. Cruise pays particular attention to an attractive umbilicus.

 

 

 

 

 

 

 

 

Picture after the procedure with exposed incision . Dr Cruise felt it was imperative to enlarged this picture to demonstrate a typical scar after an abdominoplasty. Notice also the scar around the umbilicus

The standard abdominoplasty leaves a scar from hip to hip and requires repositioning of the umbilicus to avoid positioning it too low on the abdomen. In addition to removing skin and fat, Dr. Cruise also has developed various techniques to tighten the underlying musculature. This allows him to tighten the abdominal wall even further, thus, creating a sculpted look.

 

Standard Abdominoplasty Incision.

Extended Abdominoplasty, AKA Extend Tummy Tuck

Extended Abdominoplasty as pioneered by Dr. Cruise

The extended abdominoplasty is a procedure that Dr. Cruise has championed in the world of plastic surgery. After doing hundreds of standard abdominoplasties Dr. Cruise noticed in certain patients that although the abdomen was markedly improved, the flank and back area still had deposits and folds of extra skin and fat. This compromised the overall result. Therefore, he began extending the procedure posteriorly in patients who had significant fat deposits in the love handle region. The results were nothing less than spectacular. No other procedure can produce such an impressive waist line even in patients who never had an attractive waist line in their youth.

 

Extended Abdominoplasty. Notice the significant improvement of waistline, hips, and flanks.

See the example above and to the right as well as those in the Before/After section. This procedure is only necessary when there is a significant amount of fat in the love handle and upper hip region.

The extended abdominplasty gives hope to the patient who is not a candidate for a standard abdominoplasty.

The incision for the extended abdominoplasty goes to the back of the hip area. Dr. Cruise has developed techniques to keep the incision low so that even low-rise clothing can be worn without scar exposure. See below for incision placement.

Extended Abdominoplasty Incision.

Circumferential Abdominoplasty, AKA Body Lift

The circumferential body lift is a very aggressive procedure and is reserved for those patients with a significant amount of redundant skin posteriorly. Another indication for this procedure, as Dr. Cruise has pioneered, is the patient with flabby hips and droopy buttocks. The hips and buttocks can be markedly elevated to give a sleeker more youthful appearance. It must be mentioned, however, that this more aggressive operation will leave a circumferential scar and is more complicated. This will be discussed during your consultation.

Circumfential Body Lift Incision.

 

Dr. Cruise's philosophy regarding abdominoplasty

Each patient must be individualized regarding the length of incision to prevent a dog-ear and still be sure to obtain the desired contour. The incision should be properly placed so that it is well concealed within the underwear and/or bikini line. To further enhance the result, I find it very helpful to use liposuction to remove additional fat that could not be removed otherwise. I will sculpt a central valley that runs from the rib cage to the pubis highlighting the abdominal muscles. I also like to use liposuction to remove the extra fat from the flank region. Another area where I take great pride is the inset of the new bellybutton. Typically, this is done without much thought. I, however, feel that it is important to have the bellybutton slightly recessed and tilted downward. This gives a very sexy look.

Benefits

The benefits of a properly performed abdominoplasty are breathtaking. The most impressive of which is the removal of the loose flabby abdominal skin that most patients thought would never go away. The procedure dramatically flattens the abdomen creating a sleeker, more attractive figure. An added benefit is that the skin removed is usually the skin that contains stretch marks. You can check this on yourself by simply looking at the area below your bellybutton. Most likely, this is the area where stretch marks are located, if you have any at all. The majority of these stretch marks can be completely removed. In addition to the skin, fat, and stretch mark removal, the underlying muscles are tightened. This markedly flattens the stomach, enhances the contour, and provides a more hourglass figure.

Possible complications

Outlined below are the most common and significant complications associated with the procedure.

• Large scar - It is important to realize that all abdominoplasties leave long scars. The total length of a scar depends on the amount of redundant fat and skin one has within the flank area. This is discussed further with a doctor prior to the operation.

• Blood clot - Blood clot formation after abdominoplasty is more common than with other cosmetic surgery procedures. This can be minimized by wearing compressive stockings and making sure the patient walks around immediately after the operation.

• Infection and wound healing problems.

• Fluid or blood collection within the wound.

• Asymmetry and/or contour irregularities.

Prior to surgery

• Medications. Certain medications thin blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should discontinued.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help you sleep.

• Smoking. You must not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. This is especially true with abdominoplasty. It also affects your airway, what makes anesthesia much more difficult. Patients who cannot quit smoking can have just a limited abdominoplasty or none at all. After all, patients' safety is our biggest concern.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please discuss all medications with Dr. Cruise and the anesthesiologist.

• Arrival. It is important to arrive on time so everything goes as planned. Please be sure to have someone else drive you.

Consultation

• General Health

• Past Surgical History

• Medications

• Allergies to Medications

• Smoking, Drinking and Drug Use

• Liposuction

• Mini Abdominoplasty, AKA Mini Tummy Tuck

Mini Abdominoplasty Incision.

• Standard Abdominoplasty, AKA Standard Tummy Tuck

• Skin Excision

In general, you can expect the scar to extend from hip to hip. The scars do not fade until about 6 months and will always remain visible. Hydrocortisone 1% cream does a good job of limiting the redness. The good news is that the scar can easily be hidden by underwear or a bikini; patients rarely complain about it. The trade off is more than worth it. Another big advantage with skin excision is that the stretch marks located below the bellybutton will be gone forever! The better quality skin located above the bellybutton is brought down in its place.

Keep in mind, it takes 1-2 years for an abdominoplasty scar to soften and lighten. Dr. Cruise uses a topical combination of Silicone, Vitamin E, and Steroid to minimize scarring.

 

Actual After picture with incision exposed. Typical scar after an abdominplasty. Notice also the scar around the umbilicus. Your scar may vary. Some become almost undetectable, other may form thicker, more noticeable scars.

 

Often, with age, weight gain, or pregnancy the stomach muscles separate in the midline causing a diastases. This leads to additional bulging. Therefore, muscle tightening is very helpful in obtaining a desirable, flat stomach. The stomach muscles are tightened during the procedure by suturing them together in the midline.

• Belly Button Transposition

It is usually necessary to transplant the belly button because of the large amount of skin that is removed. Failure to transplant would lead to an unnaturally low location that would look strange. Different plastic surgeons create different types of belly buttons. You should be sure to discuss with Dr. Cruise your preference. Do you prefer a small vs. moderately sized bellybutton? Would you prefer a round one or one that is slightly longer vertically than horizontally? In some patients, it is possible to create a “hooded” appearance which some people find attractive.

• Liposuction

Performing liposuction on the abdomen at the same time as the abdominoplasty can be dangerous. Many plastic surgeons will not perform them together as it may jeopardize the blood supply to the skin. In some patients limited liposuction is possible. These are generally patients with good skin quality and who do not smoke cigarettes. If you have a significant amount of extra skin then liposuction may be too dangerous to perform concomitantly and would have to be done as a second procedure.

• Extended Abdominoplasty, AKA Extended Tummy Tuck

Extended abdominoplasty incision.

 

 

 

 

 

Frontal view of extended abdominoplasty.

 

 

 

 

• Circumferential Abdominoplasty, AKA Body Lift

Circumferential body lift incision.

Anesthesia

ICRS uses only board certified anesthesiologists to make sure that you have the best anesthesia possible. The anesthesiologist will discuss what type of anesthesia is best for you. General anesthesia is the most common choice for abdominoplasty. Local anesthesia and sedation are not possible with abdominoplasty because it would be too uncomfortable for the patient.

After the procedure

Immediately. Normally, you will go home about 2 hours after surgery. Prior to leaving, the nurse will make sure that you are able to walk in a flexed forward position. She will make sure that your pain is well controlled and the abdominal binder is in place. You will have a drain in place to remove excess fluid. It usually stays in place for 1-3 weeks and then it is removed without pain. You will leave with a pain killer and an antibiotic.

That evening. You must take it easy and make sure you take your pain medication as necessary. There is no need to have pain. In fact, taking pain medication will allow you to walk, eat, and feel relatively normal. This allows you to heal faster. It is important to walk around at least a little bit to get the blood circulating. It might be hard to believe, but walking will make you feel better and help the anesthesia wear off faster. It is essential that you walk in a flexed forward position.

When laying down, or sleeping, it is important to maintain the flexed forward position. This is best accomplished by placing large pillows under your feet and your head.

The next day. It is important to walk around as much as possible with the abdominal binder on. The abdominal binder plays an important role in protecting the incision as well as minimizing swelling. For this reason, it is a good idea to keep the binder on at all times except when showering for the first week. You must remember, it takes 6 weeks for the major swelling to subside and 6 months for it to go away completely.

You should shower with someone helping you the day after surgery. Simply remove the binder and the bandages and let the cool shower water rinse over you. Be sure to remain flexed forward. Use regular soap gently. Do not worry about the drain. Simply, hold it and wash around it. While you are showering, have someone wash and dry the binder for you. Afterward, reapply some new gauze and put the binder back on.

First week. You will have your first postoperative visit 1 week after the operation. Dr. Cruise may remove your drain and make sure the operated area is healing well. If you are still draining a lot (greater than 50 cc's), the drain will remain for at least one more week. You will be still quite swollen but walking around will be easier.

Afterward. After one week, Dr. Cruise encourages you to buy a comfortable, but firm, girdle-type garment that covers the body from thighs to the rib cage. Three weeks after the operation, you should begin to apply Scarguard to the incision. Scarguard is a steroid, vitamin E, and silicone combination that significantly improves the scar. It can be ordered online or bought at CVS. You should not use it before 3 weeks after surgery because it may impede wound healing.

Recovery time

As mentioned above, you will be encouraged to walk around the very next day. Returning to work can be somewhat variable depending on your job. If your job is sedentary you will be able to return to work in 10 to 14 days. If your job is labor intensive it may take up to 6 weeks to return. Expect to have bruising and swelling. You may resume light exercise that does not require abdominal activity at approximately the 4th week. Abdominal activity, however, should not be attempted prior to 8 weeks and should only be done when there is absolutely no pain. The majority of the bruising and swelling will have subsided by 3 weeks but complete resolution will take at least 6 months to occur. Typically, scars heal in a very methodical manner. For the first 6 to 8 weeks the scar becomes red as the body heals. After that stage, however, the scar becomes much less red and thinner. By one year, the scar is usually very light and easily hidden by underwear or a bikini.