tummy tuck/ abdominoplasty

Tummy Tuck, or abdominoplasty surgery, slims, tones and sculpts the abdominal area for a youthful, taut look. Excess skin and fat are removed during the surgical procedure and any separation of the rectus diastasis muscles is repaired. Although the surgery can’t completely get rid of stretch marks, they can be removed along with the excess skin or lowered as the remaining abdominal skin is pulled downwards. Liposuction or fat grafts can be combined with Tummy Tuck surgery to reshape and contour the stomach for the best end result.

Tummy Tuck surgery can be customized for each patient in line with their individual needs by using different abdominoplasty techniques, which are explained in detail in the next section. The technique used will determine the size of the resulting scar and where it is located; as a general rule, the larger amount of skin that needs to be removed then the larger the scar.

The most successful tummy tuck surgeries ensure natural placement of the belly button and, where possible, strategically placed scars that won’t be overly visible when swimwear is worn.

There are different types of Tummy Tuck surgery available. The surgeon will advise on the appropriate technique for each individual case; this will depend on how much excess skin needs to be removed and the extent of any underlying muscle damage:

• Conventional abdominoplastyor the ‘traditional tummy tuck’ is the most common procedure. An incision is made in the bikini line and around the belly button, the latter being repositioned during the surgery.
• Mini abdominoplasty, or the ‘mini tummy tuck’is a less intensive version of the surgery, designed to correct smaller amounts loose skin below the belly along with correction of lax and bulging muscle. A small incision is made along the bikini line, similar to that of a cesarean section, to remove the loose skin immediately above, and muscular repair is performed via a small incision above the belly button.
• Endoscopic tummy tuck is a variation of the mini tummy tuck. A small incision is made in the bikini line and, by means of a minute telescope inserted through the belly button, the surgeon can repair and close the gap in the diastases recti muscles. The benefit is minimal scarring and a shorter recovery time.
• Lipoabdominoplastyor ‘LABP’ combines the traditional or mini tummy tuck procedure with 3-D liposuction to flatten the tummy, get rid of love handles and sculpt the waist. Liposuction is performed first to get rid of the excess fat for a smoother contour once the tissue is pulled down, then an incision is made and the skin tightened before being sutured into place.
• Reverse abdominoplastyis recommended for patients with excess skin located around the upper abdominal area, above the navel. An incision is placed under the breasts in order to remove the excess and tighten the remaining skin.
• Circumferential abdominoplastyis usually performed for patients who have lost a large amount of weight and are left with significant excess skin and sagging around the stomach, sides and back, and on the buttocks. An incision is made all around the waistline, from the front to the back, in order to remove the loose skin and lift the buttocks.
• Fleur de Lis abdominoplastyis an extensive procedure used for patients left with a lot of excess skin both above and below the belly button, which is usually the case following weight loss of 50lb or more. Incisions are made in the bikini line and along the centre of the abdomen to remove excess skin located in both vertical and horizontal directions.

• Upper abdominal area
• Lower abdominal area
• Both upper and lower abdominals
• The ‘belt line’ – around the midriff from front to back
• Entire stomach, lower back and buttocks
• The underlying abdominal muscles

Tummy tuck surgery requires a significant commitment, both in terms of recovery time and wound maintenance post-surgery. It necessitates at least two weeks from work and resumption of normal activities, including being able to drive, and full recovery will take around six weeks. It is a major surgical procedure that will alter your shape and can have a psychological impact, so careful thought needs to be given prior to going ahead.

At Cocoona, we ask for you to conduct a self-evaluation to help you assess if you are one hundred per cent ready, both physically and mentally, for Tummy Tuck surgery. You should ask yourself the following questions:

• Have I exhausted all the non-surgical options, such as diet and exercise, to improve my shape?
• Am I clear about which problem areas can be treated with a Tummy Tuck and to what extent?
• Do I have realistic expectations about what a Tummy Tuck can achieve?
• Do I fully understand the surgical procedure, how long it will take and what I need to do after the surgery to promote healing and recovery?
• Am I prepared to maintain my weight after surgery by following a healthy diet and exercise routine to help maintain the results?

Once you have clarity on the above, the next step is to find the right surgeon and clinic. These are of paramount importance.

You need a surgeon who is experienced in performing Tummy Tuck surgery, has a sound reputation and proven results. You should also look for a surgeon who will give you honest and realistic advice on what you can and can’t achieve with this procedure.

A good clinic is one that has an experienced and highly skilled surgical team, licensed aestheticist(s), well trained nursing staff, an excellent reputation, and a low complication rate. Of course, the clinic also needs to be licensed with the relevant authorities for the country or region it is situated in. At Cocoona, we tick all these boxes.

Depending on which Tummy Tuck surgical procedure has been recommended for you, the surgery will be performed either under general anaesthetic or light sedation (twilight anaethesia) and local anaethesia.

Your surgeon will be able to specify which type of anesthesia will be required in your individual case.

• Women who have had multiple pregnancies and are suffering from excess skin with loss of elasticity and separation of the rectus muscle, or an abdominal hernia that causes the abdomen to ‘bulge’
• Women who have finished having children; any subsequent pregnancies will undo the results of Tummy Tuck surgery
• Men and women who have lost a lot of weight (50lb or more), usually from bariatric surgery, who have loose, sagging and excess flaps of skin in the abdominal area and/or waistline
• In some cases, liposuction or another procedure may be more suitable, so it is important to be guided by a qualified surgeon who is experienced in performing Tummy Tuck surgery

The results of Tummy Tuck surgery should be long-lasting so long as excess weight gain and pregnancy are avoided. If you do gain a large amount of weight or get pregnant after the undergoing Tummy Tuck surgery then the rectus muscles and skin will be stretched out again, effectively undoing the results of the previous surgery.

Most Tummy Tuck surgeries are performed on an outpatient basis or, where more intensive procedures are required, the patient should not need to stay in hospital for more than a night or two. Either way, the patient will need to see the surgeon on a regular basis during their recovery period for wound management and check-ups; the first of which will be 24-48 hours post-surgery for dressings and drains to be removed and a compression garment fitted.

While gentle walking is encouraged immediately after surgery to promote healing, you will not be able to drive, exercise or return to work/normal activity for about two weeks. A moderate exercise regime can be resumed within three to four weeks, and more vigorous exercise after six weeks or so. You should be fully recovered and back to normal within four to six weeks.

Once you are clear about your reasons for Tummy Tuck surgery and have decided to proceed, call us to fix an appointment.

On the appointed day, the expert surgeon who will perform the Tummy Tuck surgery will consult with you. During the consultation, you should expect the following:

• Discussion about why you have opted for Tummy Tuck surgery and what your goals are in relation to the procedure
• Understanding your medical history
• Evaluating your health status
• The options available for your Tummy Tuck surgery
• An examination of the area or areas to be treated, measurements (if relevant) and potentially, photography to record what the area or areas look like prior to the procedure being undertaken
• Explanation of the options, steps involved, future treatment, risks, and potential complications, if any

Feeling apprehensive before the surgery takes place is entirely normal. Be sure to discuss any fears or concerns you have with your surgeon and don’t hesitate to ask any questions related to the results you hope to achieve.

Being well informed is being well prepared. Apart from checking that your clinic and doctors have the necessary skills, knowledge and experience, here are some more areas that you should explore:

• How many years of experience do you have as a Plastic Surgeon?
• How many Tummy Tuck surgeries have you done?
• Where will the surgery be conducted?
• Is the clinic prepared and certified to undertake Tummy Tuck surgery?
• What are the most common complications experienced by your patients? And how were they handled?
• Do you have a “before” and “after” photo album of Tummy Tuck surgeries?
• Am I a good candidate for Tummy Tuck surgery?
• What can I expect after the surgery?
• What precautions would I need to take before and after the surgery?
• How many days will I take to recover fully?
• What should I do for a quick recovery?
• Will the shape and appearance of the area to be treated change over time? If yes, how?
• What are the risks involved in this surgery?
• What treatment option/ technique will be used for me?

Please feel free to add any more questions that you wish to this list before your consultation.

After your initial consultation, you will need to make the final decision regarding your surgeon. Never choose your surgeon simply based on how much the treatment will cost. Instead, focus on the following:

License & certification – is the surgeon licensed and certified to conduct Tummy Tuck surgery by a reputable body?

Expertise & experience – the number of years of experience/ how many Tummy Tuck surgeries the surgeon has performed previously

Before/ after pictures – evidencing their capability of past performance

Clarity on possible results – whether they are providing you with realistic expectations and honest feedback

Professionalism & comfort factor – if you feel comfortable with the professionalism and manners of a surgeon, and feel you can trust him/her with your face and body, then that’s the surgeon you should consider

Safety philosophy – if the surgeon is ready to put you at risk by recommending or agreeing to perform multiple unrelated surgeries and/or procedures on the same day or within a short period of time, you should refuse to proceed and go elsewhere.

Patient testimonials & reviews – A good reputation and a large number of positive patient testimonials and reviews on independent forums should be an important consideration in your process of choosing the right surgeon

Keep in mind that there are hidden costs in the long term and greater risks (including threat to life), associated with a surgery where costs, safety and skills are compromised. Always be wary of a plastic surgeon or clinic that is offering very low costs and/ or miraculous results.

After your initial consultation with the surgeon, once you are satisfied with the outcome of the ensuing discussions and have confirmed that you will go ahead with your chosen consultant, a date will be fixed for the procedure.

Tummy Tuck surgery can be on an outpatient basis for some patients but may necessitate a stay in hospital for one to two nights for those undergoing more intensive forms of the surgery. In the unlikely event of complications, an overnight stay may be required for outpatients, or inpatients may face a longer stay, should the attending doctor make the recommendation. Before you come in for your procedure, we recommend that you plan accordingly.

Here are some of the important steps that you must take before the procedure:

• Discuss all medication and vitamins that you regularly use with your consultant to see if you should stop taking them before surgery and, if so, for how long. For example, any medications and vitamins that interfere with your body’s blood clotting ability, such as Vitamin E, will need to be stopped completely prior to surgery.
• Smokers should quit two months prior to surgery; smoking interferes with the efficiency of blood flow to the skin which may have an impact on achieving optimal results and increase the risk of complications.
• You should be in the best possible health and at a stable weight; ensuring that you follow a healthy, balanced diet prior to surgery will help you to be in optimal physical condition to help promote the best outcome

Our surgeon and patient counselor will guide you thoroughly about what you need to do so that you are completely at ease and ready for surgery and beyond.

• Immediately after the surgery, dressings will be placed on your stomach where the incision or incisions have been made, with small drains in place to expel fluid.
• The drains are usually removed within 24-48 hours post-surgery, at which point the dressings will be replaced with a compression garment to help avoid fluid build-up. You should expect to wear the compression garment for around six weeks.
• You will be encouraged to walk around within a few hours of the surgery to help promote healing
• You should expect some discomfort and pain after the surgery. This will be controlled with a pain management plan, which will be explained to you by your surgeon, and you will be given a course of antibiotics to help avoid infection.
• Engaging your abdominal muscles during the recovery period will result in moderate pain. A nurse will teach you how to get up from a prone or sitting position with minimal use of the abdominal muscles to avoid unnecessary discomfort.
• Depending on the type of Tummy Tuck surgery performed, you can either expect to go home on the same day (for less intensive procedures, such as the Mini Tummy Tuck) or stay in hospital for between one to two nights (for more intensive procedures, such as Circumferential and Fleur de Lis abdominoplasty)
• Once discharged, you will need to have regular follow ups with your surgeon to check on your healing and care for the wound.
• You will be able to shower after 48-72 hours post-surgery.
• Moderate exercise is usually resumed within three to four weeks. Any vigorous exercise or heavy lifting must be avoided for a minimum of six weeks.
• A complete recovery is usual within four to six weeks, although this may be longer for more intensive procedures.