Mommy Make Over Abdominal Rejuvenation


Abdominal Rejuvenation - Tummy Tuck

Stacey mommy makeover

Whether it occurred as a result of pregnancy, childbirth or massive weight loss, loose hanging abdominal skin is one of the most frustrating problems for both men and women. This is because it persists no matter how much diet and exercise you do. This is why abdominoplasty continues to enjoy an extremely high level of patient satisfaction. Simply put, there is no other way to get rid of this excess skin.

Why does skin laxity occur? Often it is a combination of things but the top of the list includes childbirth. During pregnancy, the abdominal skin is often stretched beyond its ability to snap back. This leaves the women with loose skin as well as stretch marks.

The other common reasons are massive weight loss or constant fluctuation and aging. With age, the skin loses its elastic recoil and stretches. Regardless of the reason, abdominoplasty is an extremely effective way to get rid of this excess skin. The key is to make the result as beautiful as possible with the least amount of scarring.

When you have your mommy makeover consultation make sure you discuss your concerns and desired goals for surgery. Keep in mind there many excellent plastic surgeons who do things slightly differently. Still, the principle remains the same: Do the least invasive surgery necessary. 

There are many advantages to doing the least invasive tummy tuck as long as the problem areas are properly corrected. This includes smaller incision, often less obvious incision, less downtime and often less money. Remember, however, it is not wise to try to "get away" with a smaller procedure when a larger one is necessary.

Below are the different types of tummy tucks outlining their advantages and disadvantages.

Mini Abdominoplasty (AKA Mini Tummy Tuck)

The Mini Tummy Tuck is the least invasive abdominoplasty. More importantly, it allows Dr. Cruise to place the incision so the scar is completely unnoticeable with even the most revealing clothing. Dr. Cruise's mini tummy tuck has evolved to the point where the incision lies right at the top of the pubic hair. The length of the incision is usually within the pelvic bones.

Mini Abdominoplasty Incision. Notice how low and short the incision can ideally be positioned.
Mini Abdominoplasty Incision. Notice how low and short the incision can ideally be positioned.

A significant advantage of the mini abdominoplasty is that there is no incision around the umbilicus. This is very important to Dr. Cruise and his patients, as the umbilicus with standard plastic surgery technique is usually the most telltale sign of a tummy tuck.

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.

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              Mini Abdominoplasty. Correction of abdominal 'pooch'. - 4 months post-op. Patient mid. 30s, Mother of 2

The mini tummy tuck is ideal when the excess skin is located primarily below the umbilicus. If there is some redundant skin above the belly button, but not enough to perform a standard tummy tuck, a modified mini tummy tuck may be performed - with release of the umbilicus. Here, the umbilicus is released from its cord and is moved down slightly, usually less than an inch. By doing this, the excess skin above the umbilicus is tightened. This nicely changes the belly button from a horizontal appearance to a more youthful vertical appearance.

The abdominal muscles below the belly button can still be tightened with a mini tummy tuck. This is more than acceptable as this is where the vast majority of the muscle looseness is located.

The mini tummy tuck has its limitations. If you lower the belly button too much than it will look unnaturally low. This can only be determined during your consultation with an experienced plastic surgeon.

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Mini Tummy Tuck with Umbilicus Release. Patient 39-y-o. Three months post-op. Notice the tightening of the excess skin below and above the belly button. Notice the more youthful appearance of the belly button with no scarring around it.

Standard Abdominoplasty (Standard Tummy Tuck)

The standard abdominoplasty is the most common abdominoplasty. It does an excellent job in eliminating the excess skin and 'abdominal pooch' both above and below the umbilicus especially in women who have given birth. It is necessary when there is a significant amount of excess skin within the upper abdomen. Remember, the determining factor of whether you need a mini or a standard abdominoplasty is the amount of excess skin ABOVE the belly button.

Standard Abdominoplasty Incision
Standard Abdominoplasty Incision

By definition, the umbilicus has to be transposed in a standard abdominoplasty. This means that the excess abdominal skin is pulled down so far that a new hole must be created in the pulled down skin to accommodate the umbilicus. Remember, the cord of the umbilicus stays attached to the abdominal wall.

To me the incision around the belly button is the most tell tale sign of a tummy tuck. Therefore, it is critical to do everything possible to make it look un-operated on. The key is to make sure the it is small, recessed, and as natural as possible. This is done by creating a flap inferiorly to hide the incision. In addition, it helps to suture the incision inward to create an "inny" so that the incision is hidden inside.

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Standard way of placing an incision around the opening for belly button. The incision is made in the shape of simple circle. The incision does not recess inward, therefore, is more apparent.

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Modifications can be performed to hide the incision inside and allow the new belly button to be much more attractive and natural appearing. (Courtesy of Dr. Cruise)

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Notice marked improvement of pooch below umbilicus and flattening of stomach. Dr. Cruise's Standard Abdominoplasty. Frontal view shows significant improvement in 'hour-glass' waist.

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 usually be addressed with liposuction. Liposuction will usually be done at the same time as the tummy tuck. Liposuction of the abdomen at the same time as tummy tuck, however, is more controversial. Many plastic surgeons, including myself, will not aggressively perform liposuction of the abdomen at the same time. This puts a tremendous burden on the abdominal blood supply and can lead to wound healing problems and even skin death. The burden is because the skin is elevated off the abdominal wall during a tummy tuck. Now, take this elevated skin and traumatize it further by liposuction. You can see how the effects are cumulative.

This does not mean that liposuction can not be done at the same time. It does need to be done less aggressively.

I prefer to do liposuction of the abdomen six weeks after the tummy tuck under local anesthesia. You might think, "Local anesthesia. Liposuction is painful. I don't want to feel pain!"

Normally, this may be true. After a tummy tuck, however, the abdomen is very numb for at least the first 3 months. I like to take advantage of this numbness by doing liposuction comfortably under local anesthesia alone. It is very cost effective as an O.R. is not necessary. There is little down time. In addition, I do not have to worry about compromising the blood supply as the tummy tuck is already healed. As always, other plastic surgeons may handle this issue differently. The important thing is for you to understand abdominal blood supply and safety.

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

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Mother of two with loose skin and significant rippling from previous liposuction. Notice how the abdominoplasty not only tightens the skin but, also, reduces the rippling. Notice natural appearing belly button. On the right picture notice the flattening of the abdomen.

Extended Abdominoplasty, AKA Extend Tummy Tuck

The extended abdominoplasty is exactly what it sounds like. It is a standard tummy tuck with an incision that extends farther out laterally over the hips .Sometimes, the incision may need to go toward the back.

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Extended Abdominoplasty Incision

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Extended Abdominoplasty Incision 

                   The determining factor is how far the hanging skin goes. The incision must go at least to this level.

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Extended Tummy Tuck on a 42-yr. old female after massive weight loss. Six months post-op. Notice that the incision extends as far as the crease does on the pre-operative picture.

As mentioned above, Dr. Cruise tries to keep the incision as short as possible. But, when it is necessary, the incision must go as far as the abdominal crease goes. Once again, what always goes through his mind is, "how can he keep this incision as low as possible." This is very important so that the incision is not visible in ordinary pants. The incision, however, has to go higher in an extended tummy tuck compared to a standard tummy tuck. This may make it difficult to wear low rise jeans as the incision may possibly be visible when bending over. Normal clothing should be fine.

The amazing thing about the extended abdominoplasty is the dramatic improvement these patients undergo. These patients are used to having this hanging skin wrapped around their waist. Often, they feel trapped by it. They tell Dr. Cruise that it doesn't even feel like it belongs to them; as if it were a foreign body. When this is removed they feel as if a weight as been removed. This weight is emotional as much as it is physical.

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                                         Notice the dramatic improvement in her waistline and abdominal flattening.

The Extended Abdominoplasty gives hope to the patient who is not a candidate for a standard abdominoplasty. Gastric bypass patients frequently fit into this category. These patients are especially satisfying to me. They have already been through a very long journey during their surgery and subsequent massive weight loss. Still, they feel trapped by this excess hanging skin that just will not go away. Often, this is demoralizing. Fortunately, procedures such as the extended tummy tuck can get them to where they feel comfortable and even excited about their body.

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

Liposuction with Abdominoplasty

The most common area that needs liposuction in tummy tuck patients is the flank. The flank area is the area that begins above the hips and extends toward the back right above the buttock. The reason why it is important to address is that it may look more pronounced AFTER a tummy tuck than before. Once the stomach is flat and the excess skin is gone than the flanks become more obvious.

The other area that often needs to be addressed is the abdomen itself. Many tummy tuck patients do not realize that the tummy tuck itself will not get rid of the excess fat. This is why it is best to get closer to your ideal body weight before considering an abdominoplasty. The less fat you have the better your results will be. Typically, Dr. Cruise tells patients they should be within 30lbs of their ideal body weight. This does not mean that heavier people can not benefit from the procedure because they can. But, the best results are with thinner patients.

As mentioned above, liposuction of the abdomen at the same time as a tummy tuck increases the chances of wound healing problems. It may even cause skin death. This is because, with a tummy tuck, the skin is separated from the underlying abdominal wall. The skin at the bottom is dependent on a blood flow that comes from above. If this area is liposuctioned at the same time then the blood flow may be jeopardized. For this reason, Dr. Cruise does not aggressively perform liposuction at the same time. This is not to say it can't be done. If it is done, you must know the risks. Dr. Cruise does routinely, however, perform liposuction of the abdomen with mini-tummy tucks. This is because the blood supply is not compromised as much as with a standard tummy tuck.

Tightening the Abdominal Muscles

Why do we need to tighten the muscles? The most common reason is that the muscles have been stretched and separated by pregnancy. Normally, the rectus abdominus run parallel to themselves from the rib cage to the pubis. During pregnancy, the expanding baby separates these muscles in the midline. During an abdominoplasty, the muscles can be sutured back to where they should be.

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Abdomen and Separation of the
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Restoring Muscles to their
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The abdominal muscles can also be tightened with a mini tummy tuck but only the muscles below the belly button. This is more than acceptable, as it is below the belly button that the problem is most significant.

Tightening the muscles has the additional benefit of improving the bulge located just below the belly button. It can not, however, correct bulging do to intra abdominal fat. This can only be corrected with diet and exercise.

Improving Your Waistline

An abdominoplasty does a spectacular job of flattening the stomach and getting rid of loose skin. It is not specifically designed to contour the waist. With modifications, however, the waistline can be improved. It is done be purposefully gathering the skin laterally and pulling it inward toward the midline. This gathering can significantly improve the waist but only in patients within approximately 30 lbs of their ideal body weight. With heavier people, the contouring is less effective.

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                   Example of liposuction of flanks and how it improves the overall shape of the waistline and buttocks.

Perhaps the most powerful way to improve the waistline is to have liposuction of the flanks at the same time. Often, this is very important as both men and women tend to accumulate fat in this region. By removing this fat not only is the waistline improved but so is the contour of the buttocks.

Creating a Natural Belly Button

The most telltale sign of a tummy tuck is the incision around the belly button. For this reason, Dr. Cruise has spent a great deal of time figuring a way out to make it so the new belly button appears natural. The reason why it is so important is that the lower incision can be easily hidden with almost any clothing. The belly button, on the other hand, is often exposed with sexy or fashionable clothing. A poorly performed belly button will make it so you cannot wear revealing clothing.

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The standard way of placing an incision around the opening for the belly button. The incision is made in the shape of a simple circle.

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Modifications can be performed to hide the incision inside and allow the new belly button to be much more attractive and natural appearing. (Courtesy of Dr. Cruise)

A natural appearing belly button can be accomplished and needs to be a priority for any plastic surgeon. The key is to make sure it is small, recessed, and as natural as possible. This is done by creating a flap inferiorly to hide the incision. In addition, it helps to suture the incision inward to create an "inny" so that the incision is hidden inside.

Low Incision Placement

Standard plastic surgery technique does not emphasize the importance of where the incision is located. It makes sense that the lower the incision is the more hidden it becomes. This is why Dr. Cruise likes the mini-abdominoplasty so much. It allows him to place the incision much lower than a standard abdominoplasty. Even a standard tummy tuck incision can be kept low with proper technique. 

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          Before/After of 42 yr. old woman after mini-tummy tuck. Notice the incision is easily hidden even by lowrise underwear.

Post Op Abdominoplasty Scar Management

Having worked in a Burn Unit for over 3 years, Dr. Cruise understands the importance of scar management.  It is important to follow this as it will affect the overall result. Some of the information on my post op regiment is outlined in the after surgery segment of this website.

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