Abdominal Rejuvenation

Most people that would like to have a tummy tuck actually need a liposuction since for most of them their problem is a fat deposit without an excess of skin. Liposuction done for the abdomen consists more of debulking than sculpting though both are combined for a better contour. After the liposuction you need to wait a good three months for the swelling to come down completely and for the skin to retract. The skin after the liposuction will always retract. The question is how much? In a large measure the amount of skin shrinkage has to do with the type of skin. If the skin has not lost its elasticity, a lot of retraction will take place and there will not be any excess of skin left, i.e., no need for a tummy tuck. The muscle, as opposed to the skin, if distended prior to liposuction, will remain distended. It is up to the patient to decide about a tightening of the muscle three to six months status-post liposuction.

Likewise if, three to six months status-post liposuction, there is redundant skin, a procedure can be done. (fig. 7)

fig. 7. Three views ofa patient that had liposuction anda tummy tuck in two stages.
First stage was liposuction. We can see the excess of skin resulted from liposuction.
A tummy tuck was performed six months later in a second stage.

A second surgery for an excess of skin or a distended muscle is decided on a case to case basis. It must be emphasized that often, after liposuction of the abdomen, due to skin shrinkage, there is no need for a skin procedure. It is difficult for patients to imagine that liposuction might take care of the skin without tummy tuck but we see it. However, it is not possible to say with certainty pre-operatively. That is the reason why we need to wait three to six months after the liposuction to know if anything else is required. Again, the result of the liposuction has less to do with the amount and the type of fat than the type of skin and the condition of the muscle. If the patient has good elastic skin and a non-distended muscle, a tummy tuck may not be needed. The liposuction will suffice.

In cases of full tummy tuck, after liposuction, the scars are more extensive than for a regular tummy tuck due to the amount of skin to be removed. It is the same problem we encounter in post-gastric bypass patients.

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.

The more the skin the more the scars. Sometimes the tummy tuck needs to be repeated to get rid of all the redundant skin. Likewise, a scar revision may be required to correct a bad scar due to bad skin.

A flat and smooth abdomen can be obtained only if skin and muscle have not lost their tone.

fig. 6. Patient had liposuction and breast augmentation in a first stage.
Followed by breast lift and tummy tuck in a second stage six months later.

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2 Stage Tummy Tuck - Before & After Photos

Patient 1

Before	After Stage 1 Liposuction	After Stage 2 Tummy Tuck

2 Stage Tummy Tuck & Liposuction

Patient 46462

Before	After