Explore Plastic Surgery - Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

A tummy tuck is a common procedure that is used after childbirthing in women and significant weight loss in both sexes. Aside from the bariatric surgery patient, the vast majority of tummy tucks are done in women. Tummy tucks have a certain number of variables in their execution from a mini- vs a full skin excision and the use of liposuction from the abdomen out into various areas of the waistline and back.

Despite the many very successful results and happy patients that result from a tummy tuck procedure, infrequent complications can and do occur. Most of these result from either a misunderstanding of what the procedure can really do or an outcome that may require a revision to achieve the best aesthetic result.

Failed expectations occur in tummy tucks just like any other cosmetic plastic surgery procedure. One must realize that the more skin that is removed the better the result. But the greater the amount of skin removal, the longer the horizontal incision must be. It is not possible to remove a large amount of skin with a very small scar. A tummy tuck is all about understanding that one is getting a better body shape at the expense of a scar. Minimal scar tummy tucks (e.g., mini-tummy tucks) only work well in someone with a minimal stomach problem. In addition, a tummy tuck will not produce a six-pack look in any patient and may not create a completely flat stomach in all patients. How flat one’s stomach can get all depends on what you have to work with from the beginning.

Scar appearance and position are potential reasons for postoperative dissatisfaction. While many patients are concerned about undesired scar widening and thickening, it is actually very uncommon and is more of a risk in patients with intermediate skin pigmentation. (e.g., Asians, Hispanics) Almost invariably these ethnicities develop hyperpigmentation of the scar which is slow to fade if it ever does. African- Americans, despite more skin pigmentation, do not have this same concern and I have never seen a single case of keloid scar formation. Regardless of ethnicity, the most common scar problem is that of a dogear, a bunching of skin and fat on the side ends of the tummy tuck incisions. These can usually be resolved by a small excision of the dogear done under local anesthesia.

The too highly positioned scar is a more difficult revisional challenge. Patients need to understand that full tummy tuck scars will almost always end up higher than a mini-tummy tuck scar. That is what happens when more skin is removed and there is a greater ‘pull-up’ of the pubic skin and hairline. While it could have occurred from the way the tummy tuck was marked out before surgery, it is more likely the result of how much skin was removed. The price of the flattest stomach and no residual loose skin may be a higher scar. If too high, it is very difficult to move it lower more than an inch or so. This may or may not make a revisional procedure worth it.

Residual fullness in the upper abdomen after a tummy tuck is not rare. Unlike the result between the belly button and the pubis, the upper abdomen may not be quite as flat due to a residual fat thickness of the upper skin flap. This can easily be thinned out and made flatter with a secondary liposuction procedure. In many of my tummy tuck patients who have a very thick upper skin flap, I tell them beforehand that they will need liposuction of the upper abdomen 6 to 12 months after their tummy tuck if they want the flattest and most contoured result. While some plastic surgeons perform liposuction of it at the time of the tummy tuck, there is an increased risk of wound healing problems with the incision afterwards. I prefer to avoid that risk completely by delaying liposuction of that area until later if desired.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  Tummy tucks, or an abdominoplasty, is a proven method of abdominal reshaping. For the majority of women who have had children, a tummy tuck rather than liposuction alone will produce a better result. The main component of this procedure is the traditional removal of a segment of loose skin and fat which is a horizontally-oriented ellipse that is taken out below (mini-tummy tuck) or above the umbilicus. (full tummy tuck) This does result in the trade-off of a scar but it is usually horizontally placed in a low position which will lie within the camouflage of underwear or a swimsuit.

While many potential tummy tuck patients will have low horizontal c-sections scars, they can easily be incorporated within a limited or full abdominoplasty cut out pattern. Infrequently, a patient will present with a vertical scar between the belly button and the pubis from either child delivery or abdominal surgery. If a full tummy tuck is needed, the  vertical scar is not a problem as it will be removed in its entirety with the skin and fat segment that is removed. When a full tummy tuck is not needed, the vertical scar will then influence how the excess skin removal will be managed.

One method to create a vertical tummy tuck is to remove and tighten skin with an up and down elliptical excisional pattern. A second method is to do a traditional horizontal mini-tummy tuck and just leave the existing vertical scar, resulting in an inverted-T scar pattern. A third approach is to incorporate both a vertical and horizontal excision pattern, creating the same vertical scar but a shorter new horizontal scar.

Case Study: This is a 40 year-old female who had previous gynecological surgery done through a vertical incision. While she was not overweight or had a lot of loose skin or excessive fat, she wanted some abdominal and waistline refinement and to have her wide vertical scar revised.

She underwent a limited abdominoplasty procedure which used an inverted-T shape excision of skin and fat. Through this exposure the lower half of her abdominal muscles were plicated vertically. Liposuction was then done through the upper and lower abdomen as well as around into the flank areas.

She did have a small drain for five days after surgery and wore a compression band around her abdomen for ten days. She went on to heal without any problems other than a few skin irregularities in the upper abdominal area.

The vertical abdominal scar does not pose any significant problem for carrying out a tummy tuck, it just makes for some minor changes in how it is done. It could be variably performed by just doing liposuction and vertical scar revision in the thinner patient to a more traditional horizontal mini-tummy tuck that also removes an imverted-v segment of skin up to the belly button in those with more moderate skin and fat collections.  

Case Highlights:

1)      Tummy tucks produce significant changes in the shape of the abdomen by a horizontal ellipse of skin and fat. A vertical scar, however, can alter this traditional excisional approach.

2)      A vertical excision approach uses the existing scar and is, by definition,  a limited or mini-tummy tuck. Abdominal skin and muscle tightening is done vertically between the belly button and the pubis.

3)      A vertical tummy tuck can also incorporate some horizontal skin excision and have more of an anchor or inverted-T scar pattern.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

A tummy tuck remains as one of the most common and successful body contouring procedures. No other cosmetic procedure can change the shape of the abdomen as well, particularly when loose skin, stretch marks, and extra fat exist between the belly button and the pubic area. Cutting out loose skin and fat is the cornerstone of the operation which often has liposuction added in to improve bulging areas where the tummy tuck does not reach.

While there are different variations of tummy tucks, and no two are ever exactly alike, they are done with two basic approaches. Going by different names, they are essentially a mini- or limited tummy tuck and a fuller or complete tummy tuck. What such names refer to is where the location of the tissue cutout is done. A full tummy tuck removes an elliptical-shaped tissue segment from the pubis to above the belly button. A mini-tummy tuck removes less with an elliptical-shaped tissue segment taken below the belly button.

There are advantages and trade-offs to each procedure and some patients clearly would benefit by one or the other. But a fair number of patients could be done with either approach and the decision is not as clear cut. Understanding the scar trade-offs of each tummy tuck approach can help patients make a better informed decision. In the end, the only outcomes that patients care about are the scar and how good is the result afterwards.

One very important difference in tummy tucks is the final location of the horizontal scar. While every patient wants the lowest scar possible, not everyone can get it. The mini-tummy tuck is the most assured way to keep the scar as close to the pubic hairline as possible. Besides not having as long as a horizontal length to the scar (between the hips), it can be kept low because less tissue is removed. (cutout below the belly button) In a full tummy tuck, the initial incision may be marked low but it will end up higher due to the tension on the wound when it is closed. (larger cutout above the belly button) Since the incision is longer, it can end up above the panty or swimsuit line depending upon their style… particularly the tail ends of the incision. In addition, there will be a scar around the recreated bellybutton that does not result from a mini-tummy tuck.

While there are scar differences, they will almost always be differences in the abdominal result as well. With the greater cutout that comes with a full tummy tuck, the abdomen is more likely to be flatter and more stretch marks will be removed. In the mini-tummy tuck, liposuction is more extensively removed in the upper abdomen to make it flatter as a substitute for less skin and fat excisional removal.

For those abdominal patients that are what I call ‘tweeners’, (could do either tummy tuck approach or is between these two choices), one has to weigh how much scar can one tolerate for how much result. If scar is not an issue then a fuller tummy tuck is the best choice. But for those that have scar concerns, the mini-tummy tuck could be a better option.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The tummy tuck, or abdominoplasty, operation is the most successful method of waistline contouring for many patients. It is an absolute must operation in three specific situations, in loose skin and muscle from multiple pregnancies, in the presence of an overhanging abdominal pannus, and after massive weight loss. While pregnancies is an exclusive female qualifier, the abdominal sequelae from significant weight loss in not gender specific.

Massive weight loss, as defined by a 75 lb or greater drop in body weight, can be the result of either bariatric surgery or tremendous motivation and diet and exercise. When someone loses this much weight, an inevitable amount of loose skin will develop along the waistline and into the hip area. Loose skin develops both above and below the bellybutton. But the amount of loose skin and how the abdominal area looks is somewhat different between men and women. Women usually have much more loose skin and a more protruding stomach after extreme weight loss due to muscle laxity from prior pregnancies and more stretched out skin to start with. Men, due to thicker skin that has not lost as much elasticity and an undisrupted abdominal muscle wall, do not usually end up with as much loose skin.

Because of these differences, the male tummy tuck after weight loss is done differently than that of a female in most cases. The amount of skin resection is less in extent and in design. As an elliptical horizontal cut out, it may stay below or go above the belly button depending on whether there is significant loose skin above the belly button. Skin hanging over the belly button calls for a supraumbilical resection pattern.

The most significant difference in the male tummy tuck is the lack of a need to do any muscle manipulation in most cases. Unless there is a hernia present from bariatric surgery, the muscle wall will be intact. In men that have lost weight through non-surgical means, the muscle wall will appear as if they had been slim and in shape all of their lives. This also means the patient will experience less pain after surgery that they initially envisioned. It is the suturing of the muscle (technically the overlying fascia) that causes the greatest amount of pain from a tummy tuck operation.

In many cases, the final scar does not need to extend much beyond the front part of the hips as the skin excess does not extend back that far. But it is important to avoid a dogear deformity, a common problem at the tail end of tummy tuck scars, so the cut out and scar may go back further into the back if need be. Liposuction of the flanks may also be needed, but in the extreme weight loss patient that is usually not necessary. The need in the male is primarily skin removal.

The male tummy tuck after weight loss is in many ways a scaled down version of that which is used in women. The need for less extensive skin removal and no muscle suturing makes most male abdominal contouring a more ‘simple’ tummy tuck.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

A tummy tuck, or abdominoplasty, is one of the most common body contouring procedures. It is unrivaled for what it can do to the waistline when there is loose skin and excess fat for which there is no other satisfactory solution. Despite the success of the procedure, it is not complication free. The most common postoperative problem in tummy tucks, in my experience, has been that of fluid collections.

Known as seromas, these fluid collections accumulate in a characteristic time period of two to three weeks after surgery. Even though drains are placed in most tummy tucks and are used up to 10 days after surgery, seromas can still develop later. Seromas occur due to internal unhealed surfaces that express mainly lymphatic fluid somewhat like that of a brushburn. Compression garments and keeping one from getting too active helps but about a third of patients will still get some amount of seroma fluid in the first month after surgery.

While not one dies so to speak from a seroma, it is an inconvenience for the patient and most certainly can be uncomfortable. They will require intermittent drainage in the office and doing it just once rarely solves it. My usual experience in tummy tuck seromas is that once they develop, it will take a month of abdominal tapping before the fluid no longer accumulates. (as the internal surfaces have healed and stopped leaking fluid)

Several techniques have been developed in the past few years to decrease these abdominal seroma problems. One such method is that of quilting sutures. These sutures are done by sewing together the underside of the skin flap to the fascia of the abdominal muscles just prior to skin closure. It can be done using individual sutures at multiple points or using a running barbed suture which is placed in a series of rows. This method does work for seroma reduction but is tedious and time consuming which does add to the cost of the operation. There is also the possibility that the quilting points may cause some visible skin indentations where the sutures are placed.

Another technique for seroma reduction is in how the tummy tuck is performed. Rather than wide undermining of the upper abdominal skin flap the whole way up to the rib margins, a combination of liposuction and more limited skin flap raising is done. This preserves more attachments in the upper half of the abdomen and therefore makes less non-adherent tissue surfaces that have to heal…what we would call in plastic surgery less ‘dead space’. The sewing of the abdominal muscles (rectus muscle fascial plication) is done through a narrow tunnel up to the xiphoid process rather than the full raising of the upper abdominal skin flap. This technique requires a liberal use of liposuction throughout the upper abdomen with less tissue undermining. This not only preserves tissue attachments but also keeps a better blood supply into the skin flap for incisional healing.

While I like the quilting suture method for seroma reduction, the concept of ‘don’t detach as much to start with’ seems even better. While it may not be ideal for some tummy tucks, I use the ‘lipoabdominoplasty’ method more and more. As has been demonstrated by many other plastic surgeons around the world, the postoperative incidence of seroma is definitely less.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Abdominoplasty, or a “tummy tuck,” is a well known procedure in plastic surgery that tightens loose rectus muscles and removes excess abdominal skin and fat. This recontouring of the abdominal wall area is exclusively done for cosmetic purposes to create a more flat and firm abdomen.

A panniculectomy, a cousin to the abdominoplasty, is different in that it involves exclusively the removal of a large and/or long overhanging apron of skin and fat in the lower abdominal area. While the pannus produces a stretching of the tissues from the anterior abdominal wall, such effects are not treated by any form of muscle plication as in a tummy tuck. The abdominal pannus occurs exclusively in morbidly obese individuals or following substantial weight loss, most commonly bariatric surgery. For the sake of classification, although this doesn’t change how it is treated,  abdominal pannuses are graded by the American Society of Plastic Surgeons as follows:

 Grade 1: pannus covers hairline and mons pubis but not the genitals  

 Grade 2: pannus covers genitals and upper thigh crease

 Grade 3: pannus covers upper thigh

 Grade 4: pannus covers mid-thigh

 Grade 5: pannus covers knees and below

Unlike an abdominoplasty, a panniculectomy is performed for functional or medical reasons. As a result, it is often covered by insurance. There is little question that Grade 3 through 5 pannuses are almost always covered. Debate frequently ensues from the insurance company in the medical merits of removing Grade 1 and 2 types. This is where documentation of its medical problems is really important. Without adequate written evidence of symptoms, these lower grade abdominal panniculectomies will be viewed as a cosmetic procedure.There is little question that a massive overhanging apron of fat and skin creates chronic and unremitting skin problems underneath it. In addition to the need for enhanced personal hygiene (which is very difficult), treatment of these skin conditions may require antifungal creams and powders and occasionally antibiotics.

Not infrequently, there may be a need for a panniculectomy to be done with other abdominal and pelvic procedures such as hernia repair, hysterectomy, and even gastric bypass surgery. While it may seem obvious that getting rid of an obstructive pannus could only benefit the results of these surgeries, the insurance companies rarely see it this way. Citing that there is ‘insufficient scientific literature’ to support any benefit, these combined procedures are usually denied. How they can not easily see that such benefits  as improved surgical access and less risks for wound healing problems after surgery is a mystery to me. Such concomitant coverage can be obtained if the documentation of skin problems is first obtained however.

Interestingly, an abdominal panniculectomy is not considered medically necessary when the main reason it is being performed is to relieve back, hip and knee pain. Even though the sheer weight of grade 4 and 5 pannuses clearly strain these areas, this consideration alone is insufficient for medical coverage. I have performed over the years numerous panniculectomies that were requested by an orthopedic surgeon to first be done before they would consider knee replacement surgery. Apparently, the musculoskeletal problems that it causes by orthopedic specialists is not sufficient evidence for medical coverage.

One procedure that is never needed and certainly not medically covered as part of a panniculectomy is liposuction. In fact, thinning out of an abdominal skin flap with liposuction can impact its blood supply and create wound healing problems. The wound edges in closing a panniculectomy are already compromised from chronic swelling and lymphedema in many cases. Adding liposuction to it may be ill-advised.

Dr. Barry Eppley

http://www.eppleyplasticsugery.com

Indianapolis, Indiana

Background: A tummy tuck, or abdominoplasty, is one of the best and most reliable body contouring procedures. For many women after childbirth or for men and women after extreme weight loss, a classic tummy tuck procedure can make a world of difference. But unlike the many marketing ads and images, the sheer size of the procedure and the tissues removed does not give everyone a perfect waistline or result. For some patients after surgery, and for all patients considering it, the reality is that revisional surgery or touch-ups may be desired or needed.

This 48 year-old female was tired of her full and hanging belly. While she was not  a diet or exercising fiend,  she felt that she was never going to get rid of this problem. As a result, she inquired about a tummy tuck or abdominoplasty. With the amount of skin and fat that she had, and that it hung down over her pubic region, a full or complete tummy tuck was the best option. She was ore than willing to accept a long horizontal scar as a trade-off. (as well as a scar around her new belly button)

She underwent the full abdominoplasty procedure with successful results, giving her a tighter and more narrow waistline. Over two years after the procedure, she inquired about making some minor improvements to the result. Specifically, she wanted the fullness of the pubic region reduced. A protruding pubic area after a tummy tuck is quite common. This is because the tightness of the scar around the waistline above the pubis makes its fullness stand out. While it was always that full, it only became apparent when it was lifted and juxtaposed against a tighter waistline scar. Also, the central tummy tuck scar remained wider and more red than the rest of the scar. This is commonly seen as the middle of the scar was originally exposed to more tension during the tummy tuck closure than the sides of the wound.

One other common tummy tuck sequelae is that the pubic hairline will be right up against the tummy tuck scar. This is unavoidable and will exist in all tummy tuck procedures. The only way to make a hair-free zone between the scar and the pubic hairline is to undergo laser hair treatments.

She underwent a simple revisional procedure consisting of pubic liposuction and central scar excision to optimize her result. The marks in the presurgical photo for her revision show the area of horizontal scar excision and the oblique markings for the area of pubic liposuction.

Case Highlights:

- Tummy tuck surgery can make a dramatic difference in one’s waistline shape and frontal trunk contour. But it can not solve every minor detail of the abdominal problem and there are almost always residual minor issues of scar and tissue redundancies.

- Revision of tummy tucks are not rare and can be done as early as three to six months after the original surgery depending upon the type of concern.

- Scar revision (scar narrowing), excision of dog ears at the sides of the tummy tuck scar, belly button adjustment, and pubic and abdominal liposuction are secondary tummy tuck options for obtaining an optimal result.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Background: A tummy tuck, or abdominoplasty, is one of the great plastic surgery body contouring procedures. It can do for many patients what no diet and exercise program can…get rid of loose skin and fat along the waistline. While there is always the trade-off of a scar (and a significant recovery), the results usually justify those significant trade-offs.

Like most every other plastic surgery procedure, a tummy tuck can be done multiple ways. The amount of loose skin and fat removed can be adjusted through either a more limited resection of tissues (limited or mini-tummy tuck) and a more complete or full tummy tuck. What differentiates these two variations is the amount or length of horizontal scar that is needed to complete the tissue resection. Mini-tummy tucks remove tissues below the belly button and result in a shorter horizontal scar and no scar around the belly button. A full tummy tuck includes a resection of abdominal tissues that extends to just above the belly button, ultimately resulting in a longer low horizontal scar and a scar around the new belly button.

This 32 year-old female, who is serving in the military, wanted improvement in her abdominal region. After the delivery of her twins a year ago, she has been unable to get her tummy back in any reasonable shape. She had a very large amount of abdominal muscle looseness (laxity) which accounted for a significant amount of her tummy protrusion. She also had loose skin with an extreme number of stretch marks around her belly button and throughout her entire lower abdomen.

In discussing her tummy tuck options, she was what I call in my Indianapolis plastic surgery practice a ‘tweaner’. This means she could have either a smaller or a larger procedure, in this case being either a mini- vs. a full tummy tuck. She had enough loose skin and stretch marks to justify a full tummy tuck to get all of them out. But by doing so, she would have a scar that went past her hips. With a mini-tummy tuck, her scar would be less but a significant portion of her stretch marks would remain. With her tummy tuck option, her abdominal muscles would be sutured back together. Which one is best for her? As you can see, her approach will make a big improvement but each one has trade-offs.

Because she did not want a longer scar, she was willing to accept  much of stretch marks to remain. She opted for the mini-tummy tuck which included liposuction through the entire abdomen and into the flank (back) areas. She had a drain for a week and wore a binder for two weeks. She returned to her service duties in three weeks and exercise four weeks after surgery.

Case Highlights:

1)      The decision between the two tummy tuck options in the ‘tweaner patient’ is a

   balance between much scar one can tolerate  vs the amount of improvement that

   one expects.

2)      Scars are always a consideration in a tummy tuck procedure. Once they are

      placed, there is no way to remove them. A long tummy tuck scar is not a

      choice if it would bother someone as much as the original abdominal problem.

3)      While the scar may be different between a mini- vs. a full tummy tuck, the

      recovery is not much different. The concern about recovery should be the least

      consideration when making a decision between the tummy tuck options.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Without question, the number one concern of bariatric surgery patients after their weight loss is abdominal reshaping. When the weight loss is in the neighborhood of 75 to 100 lbs., the abdominal skin does not redrape or shrink back down. Rather, a large amount of redundant skin results which both hangs and has multiple rolls.

The traditional tummy tuck or abdominoplasty is almost always inadequate to create the best abdominal result in the massive weight loss patient. This is because the excess skin exists in a true three-dimensional fashion, being excessive in both horizontal and vertical dimensions. As a result, I almost always use the combined vertical and horizontal tummy tuck procedure known as the fleur-de-lis abdominoplasty in my Indianapolis plastic surgery practice for bariatric patients. This results in abdominal scars that have a midline vertical and a low horizontal line, known as the anchor scar pattern. Adding the vertical part to the traditional tummy tuck does require more surgery time for dissection and closure, but most relevantly increases the amount of deep space underneath the skin after closure.

In theory, the fleur-de-lis abdominoplasty should be associated with more complications than a traditional abdominoplasty. It takes longer to do and has incisions that meet at an inverted-T area. It also removes a very large segment of skin which leaves more dead space uinderneath. To investigate if this seemingly truth is reality, the May 2010 issue of Plastic and Reconstructive Surgery published a study conducted by the University of Pittsburgh Division of Plastic Surgery on this very question. Over 400 abdominoplasty patient were evaluated of whom 154 (31%) had a fleur-de-lis abdominoplasty operation. The overall abdominal complication rate was 26%. This included all types of complications of which 5% would be considered major. (requiring further surgery) Traditional horizontal excision abdominoplasties and fleur-de-lis abdominoplasties were very similar in complication rates with the exception of a higher rate of wound infections in the more extensive abdominoplasty.

My Indianapolis plastic surgery experience is slightly different than that reported in this very extensive and thorough study. I have seen no greater incidence of wound infection between the two types but have certainly seen more wound openings/separations at the inverted-T area. A traditional abdominoplasty does not have this zone and, as a result, significant wound openings are very uncommon. The dead space in the fleur-de-lis abdominoplasty is managed with an extra drain and I am more conservative about their removal, keeping at least one in place for two weeks after surgery.

The fleur-de-lis creates a better abdominal result in the bariatric patient if they feel that the trade-off of a vertical scar is worth an improved upper abdominal area. In days gone by with open gastric bypass surgery, a vertical scar already was present so the decision for the fleur-de-lis was easy. With laparoscopic gastric bypass today, the patient must consider a new obvious vertical scar.

Another consideration for bariatric patients considering the fleur-de-lis abdominoplasty is insurance coverage. If one’s health insurance will provide an abdominoplasty coverage, that does not include the vertical component of the fleur-de-lis. The insurance company covers the horizontal abdominal excision only. There will be an extra out-of-pocket charge for adding the vertical component to the procedure.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Abdominoplasty or tummy tuck is one of the top five cosmetic procedures for women but is performed much less frequently in men. Because men do not get pregnant, their abdominal skin does not suffer as much loss of elasticity and can ‘snap’ back better after weight loss. Men are also less tolerant of a low abdominal scar than women who may already have had a c-section.

Even though it is far less than women,  more men are considering or undergoing tummy tuck surgery than ever before. Some of this is fueled by the large increase in bariatric surgeries which has equal distributions between men and women. Another mitigating factor is that men are increasingly concerned about their appearance and are willing to go to greater lengths to get the best body shape as possible.

There are some significant differences between a male and a female tummy tuck that affects recovery from the procedure. Most importantly, muscle plication is rarely done or needed. In my Indianapolis plastic surgery practice, I have never done muscle tightening in a man. Men do not suffer from rectus diastasis, again due to never being pregnant. As a result, there is no cosmetic or functional advantage to sewing the rectus muscles tighter.

Because the rectus muscles don’t need tightening, undermining of an abdominal skin flap to do so is not needed. This enables just the overhanging loose skin and fat to be removed in a direct cut out fashion. The need for prolonged use of drains is reduced because there is less undermined skin space.

The avoidance of muscle manipulation also impacts one very important aspect of recovery…a significant reduction in pain after surgery. Sewing muscle is the single main contributor to postoperative tummy tuck pain and the restriction in standing up straight right afterwards. The removal of skin and fat causes surprisingly little pain for most people. At best it gives some incisional discomfort but not severe or restrictive pain.

The length of the incision line in men is determined by how much loose skin exists and how far back it goes from the hips…if it does at all. Unlike women, most male tummy tucks require skin and fat removal at least between the front edge of the hips. (anterior superior iliac crests) Most men wouldn’t undergo a tummy tuck if the amount of skin removal would be less than that amount. In some cases, the skin removed may go into the back area of significant weight loss has occurred.

Men should not fear a tummy tuck because of how they perceive it to be done in women. The male tummy tuck is simpler to do and less involved. The lack of a  need to tighten the abdominal muscles makes for less pain after surgery and a reduced need for prolonged drain use.    

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis