Abdominoplasty (Tummy Tuck)

If you are in the Inland Empire and looking for a wonderful doctor to perform your tummy tuck surgery, come discover Alexander Carli, M.D. and his supportive staff at the Magnolia Surgical Center! Located in Riverside, this tummy tuck expert is a highly-qualified Inland Empire plastic surgeon with a board certification from the American Board of Plastic Surgery (ABPS) and a fellow of the American College of Surgeons.

Ideal Candidates

A tummy tuck, also known as "abdominoplasty," is designed for those who have difficulty achieving the flat stomach they desire by natural means. Ideal candidates are those who:

Diet and exercise regularly but cannot eliminate extra fat deposits and loose sagging abdominal skin
Have stretched out their abdominal muscles as a result of pregnancy
Have lost skin elasticity, most commonly from age or significant weight loss

It is also important to have realistic goals, be aware of possible risks, and be in good physical and mental health. Abdominoplasty is designed to smooth and flatten the abdomen when the muscles of the abdomen have become distended and the skin is loose. The surgery consists of making incisions either horizontally above the pubic area outward toward the hips or a smaller incision above the pubic area and incisions vertically up both hips, as if you would be wearing a French-cut bikini. Working through the incision, your surgeon may tighten the underlying muscles by pulling them together and stitching them in place, and any excess skin will be trimmed. After surgery, Dr. Carli usually recommends his patients have a one-night stay at the hospital, after which you will go home. A large bulky dressing is applied and drains will be in place fore a few days. The first week after surgery you will need to walk hunched over to avoid any tension to the suture lines. After two weeks you may resume most normal activities, but any strenuous activities such as exercise must wait approximately three months. During this time you are required to wear a corset.

The surgery itself is about 2.5 hours under general anesthesia, after which you will be in recovery for about 2 hours before Dr. Carli and his staff transport you to the hospital, if you require hospitalization.

Prior to surgery, lab work will be performed and possibly an EKG and/or chest x-ray. These tests are included in the price of your procedure. You will also receive a medication bag with pain meds, antibiotics, sleeping pills, and nausea medicine. After your dressings and drains have been removed, a compression girdle must be purchased and worn day and night for 3 weeks, then at night only for 3 more weeks. You will see quite a difference after surgery, and as the months pass your incision line will fade. Abdominoplasty produces long-Iasting results. Unless you gain or lose a significant amount of weight, you should expect to retain your new shape for many years.

Within the past 2 years, I can use a One stage alternative. To patients that are in good health and motivated, I now offer a one stage approach, liposuction / tummy tuck combined in one setting.

Indeed, a recent anticoagulant, ARIXTRA, has the precious properties of being potent without significant risk of bleed post-op. It is the difference with Heparin and the like, Lovenol for example. It is injected once per 24 hours with a very small needle, making its use easy for anybody. It is started about 8 hours after surgery and continued until the patient is fully ambulating, usually 5 days. Its cost is covered by Insurance, PPO or HMO. On the 4th post-op day, a Doppler study (sort of x-ray, non-invasive) is done, that was scheduled pre-operatively. It is covered by PPO insurances. Otherwise, its cost is about $400.

These precautions are taken, because the blood clot is the most serious complication of that surgery. It must be emphasized that Arixtra is no substitute for early mobilization (start walking with or without walker or help on the day of surgery and increase the distance every day, 4-5 times a day minimum).

It doesn't replace wearing compressive stockings that are on, when you wake up and must stay on for 10 days. Today, patients understand and comply by these instructions, making the one stage approach very safe.

INSTRUCTIONS FOR ABDOMINOPLASTY (TUMMY TUCK)

The following information has been compiled for your Pre and Post operative care. These guidelines are based on experience and thousands of operations. No matter how minor or insignificant these instructions may appear to you, EACH IS IMPORTANT to the ultimate success of your surgery.

Read them well and follow carefully

STOP TAKING BIRTH CONTROL PILLS, INJECTIONS, AND HORMONES SIX (6) WEEKS PRIOR TO SURGERY. It is known that the coagulability of the blood will increase while doing so, thereby causing blood clots after surgery.
ABSOULUTLY NO SMOKING ONE MONTH PRIOR TO AND AFTER SURGERY. Please inform Dr. Carli and Staff of ALL MEDICATIONS including vitamins, herbals, supplements, etc., you have taken recently or are currently taking either prescribed or over-the-counter, any ALLERGIES, and any Medical/Psychological condition(s).

If you are being treated for ANY condition(s) by a Medical or Psychological doctor, you are required to get clearance (Dr.'s Note) by the treating physician prior to surgery. The Dr.'s Note must say that there are NO CONTRAINDICATIONS FOR SURGERY in regards to the condition(s) they are treating you for.

Two Weeks Prior to Surgery

Surgical fee paid in full by the due date listed on the FEE SCHEDULE.
Do not sunburn or over-expose yourself to sunrays.
Do not take Aspirin (Anacin or Bufferin) or Ibuprofen (Advil, Motrin, Nuprin, etc.), or any medications containing these drugs or any other anti-inflammatory drugs (SEE ATTACHED LIST), two (2) weeks prior to and two (2) weeks after surgery; these will promote bleeding. If you are a CHRONIC ASPIRIN USER, you will need to discontinue one (1) month prior to surgery. No Vitamin E. It is okay to take Tylenol.
Abdominal binder: You will need to purchase a corset in order to apply compression to your abdomen two weeks prior to surgery. You need to wear the corset 24 hours a day during that time preoperatively. The need to wear the corset preoperatively is based on the intra-abdominal pressure. The corset, by increasing your intra- abdominal pressure prepares your lungs and your abdominal veins for the pressure resulting from the muscle tightening. This preparation decreases the risk of complication due to the increase of the intra-abdominal pressure. The corset is cumbersome, but IMPORTANT. Then starting two (2) weeks after surgery AND ONLY AFTER Dr. Carli's instruction (Post-op) you will need to wear a corset daily for 2-3 months. Dr. Carli will advise you on the type to get.

PRE-OPERATIVE

Diet before surgery: NOTHING TO EAT OR DRINK AFTER MIDNIGHT THE NIGHT BEFORE SURGERY (No gum, water, mints, etc.). You may brush your teeth the morning of surgery, but spit the water out. Do not swallow it.
Laboratory work: You must have your laboratory work completed prior to surgery. A request laboratory slip will be given to you with the appropriate "Carli Panel" checked.
Medications: As a service to our patients, your medications will be given to you on the day of your surgery. Written instructions will be provided and discussed in detail by the nurse. Or, you can purchase your prescriptions at the pharmacy of your choice. We are unable to dispense Narcotics and some antibiotics. You will be given a prescription for these on the day of surgery.
Clothing on the day of surgery: Wear freshly laundered, loose fitting, clothing which is easy to slip on and off with minimal use of your arms, clothing that buttons-up or zips-up, in the front. (i.e. sweatsuit, jogging suit, pajamas). Bring flat shoes and warm socks to wear home. Do not wear any jewelry the day of surgery, since it will have to be removed for the operation and may be misplaced in our office. We cannot assume responsibility for these items. Do not wear contact lenses, make-up, or dark nail polish.
Showering: Using the Surgical Prep provided, wash your body from your shoulders down to your upper legs with ½ of the bottle the night before surgery, and ½ the morning of surgery. Allow the prep to remain on your skin for about 10 minutes prior to rinsing off. Do not wear any moisturizers, hair spray, perfumes, deodorant, etc. on the day of surgery.
Illness: If you develop any signs or symptoms of a cold, cough, flu, fever, sore throat, rash, boils, or infection prior to surgery, please notify the office immediately.

POST-OP INSTRUCTIONS

Do not drive home: On the day of surgery, someone MUST drive you to the office. For extensive tummy tucks (full), Dr. Carli may require you to stay overnight at Corona Regional Medical Center. For less extensive tummy tucks (mini), you may not be required to stay over night, depending on Dr. Carli's recommendation. If overnight care is not required; a responsible adult MUST take you home after surgery. A responsible adult MUST stay with you on the first night.
During the first 24 hours: Quiet rest is recommended immediately after surgery for the first night. Sleep in a bed, elevated with two (2) pillows and one (1) pillow behind your knees. You MUST engage in light to moderate physical activities by the second post-op day. Walking around in a cool setting is mandatory by the second post-op day. Early ambulation (walking) helps prevent blood clots. When walking, stay hunched over to avoid tension on the suture lines, continue to do so for one (1) week, after surgery.
Diet: After surgery, drinking generous amounts of water and fluids will prevent dehydration. Light meals are recommended for the first day after surgery. Then, you should resume your usual diet. Do not take medications on an empty stomach (It can make you nauseated).
Activities: For the first week you must walk hunched over to avoid tension on the suture lines. You must walk around in a cool setting, starting on the second post-op day. Early ambulation (walking) prevents blood clots. After two (2) weeks, you may resume most normal activities, except for strenuous things, such as weight lifting, tennis, golf, swimming, or vigorous exercise for at least 3 months.
Showering: For the first few days you must sponge bathe. After the drains are removed and the incisions have closed; you may shower briefly in lukewarm water. Dr. Carli will advise you on when to shower. Once your dressings are removed by Dr. Carli, it is important to apply Bacitracin ointment three (3) times a day and before and after you shower, especially to the drain sites. Do not soak in a bath, swimming pool, etc. for 3-4 weeks after surgery.
Abdominal binder: You will need to purchase a corset in order to apply compression to your abdomen two weeks prior to surgery. Then starting two (2) weeks after surgery AND ONLY AFTER Dr. Carli's instruction (Post-op) you will need to wear a corset daily for 2-3 months. Dr. Carli will advise you on the type to get.
Medication: Take all medications as instructed until completed. If you become ill after taking medications or develop a rash, please notify us IMMEDIATELY.
Wound care/Dressings: A large bulky dressing is worn for about 5-7 days after surgery. Do not remove it. Once Dr. Carli removes the dressing, apply Bacitracin ointment three (3) times a day and before and after showers.
Suture/Drain Removal: The sutures will be inside your body and will dissolve on their own. You will have drains coming from your lower abdomen following surgery. The drains will be removed after approximately 5-7 days. It is important to apply Bacitracin ointment to incision and drain sites prior to and after showering.
Discomfort, swelling, and bruising: You may experience mild to moderate amount of discomfort for the first couple of weeks. For relief of pain, we will prescribe pain medication for you. After the first week you may take Extra-Strength Tylenol as needed. Do not take any medications with Aspirin or Ibuprofen. Most of the bruising disappears about 2-3 weeks after surgery. Swelling usually decreases significantly within 2-3 weeks. For all of the swelling to subside, it usually takes about 2-3 months. Some patients may remain swollen longer. The ultimate result may take up to 6 months to be achieved. There may be some feelings of numbness or tightness, which will disappear after a few months.
Call the office: If you experience any fever, excessive pain, excessive bleeding, continuous bleeding, unusual discharge from incisions or excessive swelling.
Scars: Avoid sun exposure for 6 months to 1 year after surgery. Be patient while awaiting final healing. It takes several months for a scar to revise itself. The best results are always observed after proper healing, not after only a few days. An Abdominoplasty does leave noticeable, permanent scars, although they'll be covered by your underwear or bathing suit. If desired, you could get a decorative tattoo to conceal the lower abdominal scar. You could start with a Henna tattoo (temporary) and if you like it you could switch to a permanent tattoo.
Foley Catheter: A foley catheter will be inserted during surgery and will remain in for 24 - 48 hours after surgery.
Anti-Embolism stockings: You will be fitted with anti-embolism stockings to increase your blood circulation and help prevent blood clots after your surgery. The stockings are to be worn for ten (10) days after surgery and can be removed for 30 minutes several times a day. You may launder them during this time.
Arixtra injections (Anticoagulant): Dr. Carli will give you a prescription to be filled at any pharmacy for Arixtra (Fondaparinux) 2.5mg injections sub-cutaneously once a day, starting 8 hours after surgery. You will continue to take the injections until you are fully ambulating (walking), usually about 3-5 days. A nurse will instruct you on how to administer the injections on the day of surgery. Once you are fully ambulating, switch to taking (1) one Baby Aspirin 81mg tablet daily for (7) seven days. You can purchase this over-the-counter. This will help to prevent blood clots.
Ultrasound: It is mandatory on the fourth post-op day for you to have an ultrasound of the lower extremities to rule-out a possible blood clot. If you have a PPO Insurance, the test is usually covered. Otherwise, the cost is $400.00 and must be paid prior to surgery.
Alcoholic beverages: Alcohol is permissible. There are even some medical studies indicating that moderate amounts can help prevent blood clots. But, NO ALCOHOL THREE (3) DAYS PRIOR TO SURGERY OR WHILE ON PAIN MEDICATIONS.
Constipation: If needed, you may use any brand of laxative or enema from over-the-counter. Use as directed.
Itching: Some patients experience itching staring after 48 hours, which is not unusual. You can purchase Benadryl, 25mg, over-the-counter and take as needed.
Follow-up appointments: Please keep all follow-up appointments. We will schedule your follow-up appointments for you during your office visits. Even though you feel you are progressing well, please keep your post-op appointments. The doctor is very interested in you getting the best results possible and there may be some things that he can suggest; enhancing your results. You are welcome to return to our office for follow-up visits at NO CHARGE. Please contact us if you are unable to keep any of your appointments, to reschedule.

PLEASE DO NOT TREAT YOURSELF CONTRARY TO DR. CARLI'S INSTRUCTIONS. PLEASE NOTIFY DR. CARLI OF ANY POST-OPERATIVE PROBLEMS OR CONCERNS.

Feeling happy with your body is important; therefore, individuals with flabby, excess skin may want to consider undergoing a tummy tuck. Inland Empire physician Dr. Alexander Carli can help to determine if this procedure is best for your body during the initial consultation. This is a perfect time to ask any questions you may have, and learn about its risks, side effects, and benefits. This one-on-one meeting also gives you the chance to become familiar with the medical professionals of Magnolia Surgery Center in Riverside, and learn about cosmetic surgery.

During an initial consultation at his Riverside office, Dr. Carli will explain the details associated with the tummy tuck procedure. He will answer any questions you may have and show you before and after photos of previous tummy tuck patients.

To schedule an appointment, call our office at (951) 688-8660 or feel free to fill out our online contact form.


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