You may notice with the passage of time you formed a tummy. This can be due to many factors: excess or loose skin, excess fat, or stretching of the abdominal fascia and muscles. Significant weight loss and pregnancy can stretch the abdominal muscles and skin beyond the point they can return to normal. A healthy diet and regular workouts may not correct the problem.
An abdominoplasty (tummy tuck) works in two ways.
First, is the deep layer- the stuff you cannot see. Under the skin the abdominal rectus muscles are tightened, like an internal corset. These muscles separate during pregnancy or major weight gain, causing a loosening of the rectus muscles. This separation is called a “diastasis.” You cannot fix a diastasis by sit ups. Doing core exercises will strengthen the muscle, but cannot pull it back together, as no muscle crosses the midline. This separation is why your belly pooches, particularly at the end of the day, after a big meal, or if you are bloated. You can see the degree of looseness when you suck it in and then really let it out. The muscle tightening helps narrow your waist and firm your abdominal wall. Sometimes the muscle loosening is combined with a hernia, most frequently near the belly button. A hernia is an actual hole in the fascia, changing your innie to an outie, and is less common.
Second, an abdominoplasty removes excess skin and fat. Frequently we remove all the skin between the belly button and the pubis. The scar looks like an extended C-section scar with a scar around the belly button. The length of the scar depends on the amount of skin and fat removed. Removing skin will rid stretch marks and wrinkling of the lower abdomen, and flatten and tighten the contour of the entire abdomen. Commonly I liposuction the love handles, pubis, and inner thigh as part of the contouring with tummy tuck.
"You can't have surgery without scars but I know Dr. Greenberg did everything she could minimize the scars and put them low so I can easily hide them." - K.G., Boulder CreekView More Testimonials*Individual results may vary
Abdominoplasties come in all shapes and sizes, just like the women who need them. From biggest surgery to smallest:
Full abdominoplasty. Also called Tummy tuck. This procedure provides maximal tightening of the muscles and skin. There are two scars: one incision from about hip to hip and one around the belly button. In my practice, the muscles are tightened in a two layer repair, using permanent sutures in an interrupted fashion for maximal strength, running from the pubic bone up to the ribs. The skin is then tightened, usually removing all of the skin between the pubic area and belly button, trying to place the scar as low as possible. This can be combined with other procedures like liposuction of the flanks, pubis, and inner thigh. If you have hanging skin, volumes of loose skin, or loose skin above the belly button, this may be what you need.
Mini abdominoplasty. Also called a mini tummy tuck or hybrid tummy tuck. The incision for a mini can be placed as low as you want to go. The scar length varies– from short like a C-section, to longer from hip to hip. The longer the scar, the more skin is removed. (And most are not the short C-section kind. Sorry!) It does not have an incision at the belly button. Because the scar is low and there is no scar at the belly button, it is good for bikinis and low rider jeans. Remember it does minimal tightening of the skin centrally above the belly button, so if you have issues with loose skin and muscle above the belly button, then a full abdominoplasty is a better choice. It does tighten the skin of the lower belly. You can combine with liposuction of anywhere you want, including the upper abdomen. You can also combine with tightening of the muscle, though it can be difficult to reach the upper muscle near the ribcage if you are long waisted.
Floating belly button. This is not a common surgery. It involves no scar on the skin of the belly button, just one in the lower abdomen. Your belly button is like a mushroom. During a normal tummy tuck the belly button does not move- the skin does. In this surgery, the stalk of the belly button is cut, and the belly button floats down toward the pubic area attached only to the skin. This allows tightening of the upper abdomen and lower abdomen skin. The issue is it lowers the position of the belly button, so it is only good for those with high belly buttons to begin with, and the belly button is no longer connected to the stalk. If you ever need a laparoscopic procedure, they cannot use the port through the belly button as this connection is gone.
Muscle tightening only. This is for the women who have good skin tone, no fat, but have loosened muscles after babies (When you aren’t sucking it in you look five months pregnant, and when you suck it in you go FLAT.) A lot of my Bay Area women fall into this category. The skin incision can be short when you do this. NOTE: If when you suck in your belly the skin hangs and is wrinkled, then you likely need some form of skin tightening. The more skin tightening, the longer the scar. See mini tummy tuck description above.
Mommy Makeover: A mommy makeover combining any of the above with breast surgery (like breast augmentation, breast lift, or breast reduction), or other body contouring procedures like full body liposuction or the Brazilian butt lift (fat grafting to the buttock.)
There is no right answer to which is the right surgery for you. Dr. Greenberg strongly recommends you have an evaluation by a plastic surgeon versed in all the different types of body contouring surgery, so they can help you pick the right procedures for you. Sometimes you have to choose between tight skin and scar. Not all women will make the same choice.
Tummy tucks are frequently combined with:
Be careful! Dr. Greenberg has seen many people who try to do less invasive procedures like Coolsculpt or liposuction when they needed an abdominoplasty. These women are left with wrinkled, dimpled skin, and then seek out a plastic surgeon to “fix” it. Some of these issues cannot be fixed. Again, she strongly recommends at least one evaluation by a board certified plastic surgeon before you decide on your course of treatment.
The abdomen is made of three basic components. SKIN. MUSCLE. FAT. Usually your issue is due to a combination. If fat is the biggest issue, then liposuction is the best choice. When you have loose skin or muscle, liposuction won’t fix those issues and may make the skin looseness worse. So tightening procedures like abdominoplasty are needed to fix skin and muscle issues.
Diastasis is the separation of the rectus muscles, usually from pregnancy. You can try to help it with abdominal strengthening exercises, but for many the only fix is to repair the separation surgically.
Hernia is an actual hole in the abdominal wall. The most common site is the belly button, and many can be repaired at the time of abdominoplasty.
TUMMY TUCKS AND THE WEEK AFTER. TEMPORARY BUYERS REMORSE?
COMPARING ABDOMINOPLASTY TECHNIQUES
WHAT SCAR TREATMENTS ARE AVAILABLE FOLLOWING AN ABDOMINOPLASTY?
LIPOSUCTION AND TUMMY TUCK AT THE SAME TIME?
LIPOSUCTION AND TUMMY TUCK DO NOT CAUSE FAT TO MOVE ELSEWHERE ON YOUR BODY
Tummy tucks hurt. And they hurt not because of the big scar, but because of the tightening of your muscles- the diastasis. Frequently surgery is combined with other body contouring procedures like liposuction or fat grafting, or with breast surgery like breast augmentation, lift or reduction for the mommy makeover. Recovery varies from person to person. Dr. Greenberg has patients who are up and about, fully dressed, driving, in makeup and going to work at a week. She has others who need two weeks. Please plan for two weeks of help. If you have the ability to work from home, take one week off, and then one week at home.
Dr. Greenberg does many techniques to limit pain, lower swelling and bruising, and help your recovery. This is a time to take a *time out* from you life. Read a book, watch Game of Thrones from episode one, work on that Shutterfly photo album you haven’t done. Rest. You will be back to full activity faster if you treat your body well and let it heal. I love my Bay Area overachieving patients who defy all norms, but this is one area where you need to give your body the time to heal.
The abdominoplasty procedure is done under general anesthesia in one of two surgical facilities near my office. The surgery facility in Palo Alto is outpatient; the Menlo Park facility has the capability of an overnight stay. Surgery lasts about three hours. I use a long acting injection called Exparel, or I use a pain pump placed during surgery (which drips numbing medication internally). Both last for about 3 days. I find it reduces postoperative pain significantly.
I frequently combine abdominoplasty with liposuction or other cosmetic surgery procedures such as breast augmentation, breast reduction, breast lift, or eyelid surgery. Depending upon the length and size of surgery, an overnight stay may be required. Abdominoplasty can be combined with non-cosmetic procedures, such as hysterectomy or umbilical and ventral hernia repair. When this is done, the surgery is done usually at Menlo Park Surgical or Sequoia Hospital. Recovery takes two to three weeks. People who are still losing significant weight or who are planning another pregnancy should wait. If you are actively smoking, you need to stop at least one month before doing this surgery.
Tummy tucks vary in cost because of two factors:
Cost for just a full tummy tuck is around $15,000. If you are combining it with another major surgery like breast surgery, eyelid surgery, or body liposuction, the cost will go up depending on the other procedure. When you are healthy, there is savings in cost and recovery time to combine the procedures.
Tummy tucks have a lot of things we do on the inside which you do not see. What are differences between doctors?
I have many blogs on tummy tucks. HERE. Please use the search tool bar if you have specific questions. I likely have blogged about it before.