Breast Augmentation Information Resource for Southern California including Orange County, Los Angeles, Newport Beach, San Diego, and Beverly Hills.
Abdominoplasty (Tummy Tuck)
Consultation for Abdominoplasty
Outlined below is what to expect from your abdominoplasty consultation. Read carefully, as there are many suggestions that will not only save you time but will answer your questions, and help you convey to your plastic surgeon what you want to accomplish.
Health History
All cosmetic surgery consultations begin with a thorough health history. This is especially important if general anesthesia is being used, but it is also important in the use of local anesthesia. Abdominoplasty procedures are almost always performed under general anesthesia because of the extensive amount of tissue undermining necessary. Prior to meeting with Dr. Cruise, you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health that you will be asked about. Be sure to answer questions in detail so that Dr. Cruise and the anesthesiologist can be fully aware of the status of your he lath.
General Health
It is important to discuss general health problems before your surgery so that the procedure is as safe as possible. Be sure to mention any chronic illnesses or conditions, especially those of particular concern such as high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.
What will Dr. Cruise do if I have medical problems?
In short, he will make sure your health is optimized as much as possible to ensure your safety; this may include a referral to your private physician.
If you know you have a health problem, however, you can save time by bringing a letter from your private physician to your cosmetic consultation stating what the health problem is, how it is being treated, and whether you are able to tolerate general anesthesia safely. You should also bring a letter from any specialist you are consulting (cardiologist, kidney doctor, psychiatrist, etc. )
stating that you are able to tolerate surgery.
Because there is a higher incidence of blood clots in abdominoplasty procedures than in any other cosmetic procedure, be sure to let Dr. Cruise know if you have ever had a blood clot.
Past Surgical History
When you fill out the questionnaire, be sure to list all previous surgeries. Before abdominoplasty it is especially important to mention all abdominal surgeries including C-section, gall bladder, and hernia repair. Dr. Cruise also wants to know about any previous cosmetic surgeries, especially if you are dissatisfied with the results to the point that you are interested in revision. Of course it is also important to mention any problems you may have had with anesthesia during any previous surgery.
Medications
Be sure to list all your medications, including aspirin and over-the-counter medications, as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin-containing products at least 2 weeks before surgery. Tylenol is a good alternative. Here is a partial list of aspirin-containing products and other products to be avoided prior to surgery.
Allergies to Medications
For the best results, medications that cause allergic reactions should be avoided. It is important therefore that you provide information about any adverse reactions that you have had to medications. It is particularly important to mention any breathing problems. Although nausea is not considered to be an allergic reaction, it is important to mention it as well.
Smoking, Drinking and Drug Use
These will certainly affect your surgery and must be mentioned. Smoking before and after major procedures causes a profound decrease in wound healing, leads to worse scarring, and can even result in infection. To optimize healing and overall results, there should be no smoking for at least 3 weeks before and after a major procedure such as a face lift, neck lift, tummy tuck or breast lift. With procedures such as eyelid surgery, nose surgery, breast augmentation and liposuction, smoking also adversely affect the overall result. Since, however, these adverse effects are not always noticeable, smoking cessation is strongly advised but not mandatory.
Specific Abdominal Issues
During your consultation you must accurately describe any abdominal problems. Of particular concern is a history of abdominal hernia, and this must be addressed during your consultation. A small existing hernia can often be repaired during the abdominoplasty while a large hernia may need to be repaired with the help of a general surgeon. Another complicating issue that should be mentioned is previous abdominal surgery since the scars may affect the blood supply of the skin. Once again, any history of blood clot must be discussed.
What Do You Want To Change?
It is important that you have a clear idea of what you want changed when you come for consultation. No plastic surgeon wants to hear a patient say, "What do you think I need done?" If you do not have a clear idea, it might be helpful to look in a mirror and identify what bothers you. Be specific. You may also want to look at pictures of your younger self to see if something you want to change has always existed or if it is a part of aging. Bring the pictures to your consultation.
Common complaints are loose skin, excess fat, stretch marks (especially below the belly button), abdominal "pooch" below the navel, lack of a waist line, droopy buttocks, and disproportionately large waist compared to buttocks and/or breasts. All these complaints can be addressed by abdominoplasty, using different techniques.
Physical Exam
Abdominal cosmetic surgery can be broken down into the following 5 categories: liposuction alone, mini-abdominoplasty, standard abdominoplasty, extended abdominoplasty and circumferential abdominoplasty. The goal of the abdominal physical exam is to determine exactly what is causing your problem and what procedure will be most effective to correct it. Some problems can be treated with liposuction while others require a tummy tuck, and sometimes a combination of the two is the best choice.
Liposuction
Liposuction alone is an excellent choice when there is a localized excess fat deposit but no excessive skin and the skin has the ability to shrink once the fat is removed. Patients with poor skin quality demonstrated by many stretch marks and cellulite are not good candidates for liposuction. For more information, see the liposuction section.
Often, patients believe that they can achieve a flat stomach simply by the removal of fat from that area. This may be true for some patients, but if there is a significant amount of excess skin or skin quality is poor, then liposuction alone may result in loose, hanging skin and often with waviness. If there is a significant amount of excess skin, it must be removed via a tummy tuck. Although non-plastic surgeons frequently perform liposuction on these patients, results can be disappointing.
On the other hand, patients with excess skin or poor quality skin are usually highly satisfied with the results of a tummy tuck. Even though the scars are very long, patients rarely complain. Once the patient and doctor decide that skin excision is necessary, then the next question is how far to the back should the excision go. The answer to that question is relatively straightforward.
Mini Abdominoplasty (Mini Tummy Tuck)
If your problem is limited to a small amount of loose skin and excess fat below the belly button (if you can pinch only an inch or two of loose skin), then mini-abdominoplasty may be all that is necessary for correction. In this procedure, the incision stays inside the hip bones and the belly button is not transplanted, as in a standard abdominoplasty, but is merely pulled downward toward the pubis. Abdominal muscles are tightened up to the level of the umbilicus. The mini abdominoplasty markedly improves the abdominal "pooch" and, as the name implies, creates a smaller scar than in a standard abdominoplasty. The tradeoff, however, is that the dramatic results you may desire are not always achieved.
Mini Abdominoplasty Incision.
Standard Abdominoplasty (Standard Tummy Tuck)
If there is more than an inch or two of excess skin below the belly button, then a standard abdominoplasty is probably necessary. This procedure effectively removes loose skin and excess fat, creating a flat stomach. It also helps to create a more defined hourglass-like waist, but results are not as dramatic as in an extended abdominoplasty. Below are the components of an abdominoplasty.
Skin Excision
In general, you can expect the scar to extend from hip to hip. Hydrocortisone 1% cream is useful to reduce redness, and the scars will fade in about 6 months. Although the scar will always remain visible, it can easily be hidden by underwear or a bikini. Patients rarely complain about the scar because the overall results are worth the tradeoff, one of which is that skin excision replaces any stretch marks located below the belly button with the better quality skin located above it. The stretch marks will be gone forever!
Standard Abdominoplasty Incision.
Keep in mind, it takes 1 to 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.
- Abdominal Muscle Tightening
Often, with age, weight gain, or pregnancy, the stomach muscles separate in the midline causing a diastases and lead to additional bulging. During the procedure muscles are sutured together in the midline; this helps to obtain the desired flat stomach.
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- 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, strange looking belly button. Because plastic surgeons create different types of belly buttons, you should be sure to discuss with Dr. Cruise your preference. Would you prefer a small rather than a 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 patients find natural and attractive.
- Liposuction
If you have a significant amount of extra skin, liposuction may be too dangerous to perform concomitantly with Abdominoplasty, since blood supply to the skin could be jeopardized. Many plastic surgeons insist that this be done as a second procedure. Yet in some patients who have good skin quality and who do not smoke cigarettes, limited liposuction is possible.
Extended Abdominoplasty (Extended Tummy Tuck)
Redundant skin toward the back can only be removed by extending the excision to include this area. This type of redundant skin can be identified by grasping the skin over the lateral waist and around to the flanks. In this procedure, the waist becomes the focal point of the body around which everything else is evaluated. There is an appearance of an hourglass figure, with a smaller waist, more attractive and curvy buttocks, and larger breasts.
The downside of the extended abdominoplasty is the additional operating time necessary, the additional cost, and of course the longer scar.
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| Extended Abdominoplasty Incision. | Extended Abdominoplasty Incision From Behind. |
Circumferential Abdominoplasty (Body Lift)
As its name implies, this procedure involves the circumference of the body. Another name for this procedure is body lift. It is used to lift the buttocks and thigh skin back into an attractive position, and it is commonly performed in patients who have lost massive amounts of weight (greater than 100 lbs.). It is not uncommon that patients who have undergone gastric bypass surgery are left with a significant amount of hanging skin that goes completely around the body; they are excellent candidates for circumferential abdominoplasty.
Circumferential Body Lift Incision.
Breast Augmentation Information Resource for Southern California including Newport Beach, Orange County, Los Angeles, San Diego, and Beverly Hills.