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.

Background: Tummy tuck surgery, or abdominoplasty, provides an unparalleled amount of trunk reshaping. With excessive and loose abdominal skin caused by pregnancy or large amounts of weight loss, only cutting it out can really provide the desired amount of flattening and tightening improvement.

While a tummy tuck provides a great amount of abdominal tightening, the most significant location of its effect is around the waistline, directly where the closure/scar lies. This is exactly the area which shows the maximal effect of the tissue removal. It is very similar to that of wearing a belt and tightening it. This ‘banding’ effect creates the narrowest zone of abdominal circumference which may show fuller areas either above or below it.

One of the common areas of dissatisfaction in tummy tuck surgery is persistent fullness or tissue sag that remains below the scar line. The indentation caused by the tight abdominal scar line can make the pubic area stick out further than what lies above it. Or the pubic area may continue to have a sag because it was minimally lifted from the tummy tuck.

Evaluation of the pubic area prior to tummy tuck surgery is often overlooked, much to a patient’s dissatisfaction after surgery if fullness or sagging remain. Patients should not assume that a tummy tuck will always make the pubic area as lifted or as flat as the middle part of the abdomen.

Case Study: This 59 year-old female from Indianapolis wanted to finally do something about her expanding waistline. She never had much of a stomach until the past ten years where it has grown to the point of being uncomfortable in addition to also being aesthetically unpleasing. She thought about non-surgical methods of fat reduction and liposuction but came to the realization that only a tummy tuck will provide real improvement. In evaluating her for a tummy tuck, it was noted that she had a full or thicker pubis. As part of her tummy tuck, it was decided that liposuction of it should be done at the same time.

Under general anesthesia, she underwent a full tummy tuck where the excisional pattern was above the belly button. She has rectus fascial plication from the xiphoid process down to the pubis with permanent sutures. The upper abdominal skin flap was brought down to the lower one and closed. A new belly button hole was created and the original umbilical stalk brought through and shortened. The pubic area had tumescent infiltration and was then treated by liposuction, removing 55cc of aspirate. Her flanks and side of the waistline also underwent liposuction for narrowing.

Her result showed significant abdominal improvement and a flat pubis with a narrowed waistline. Liposuction can be very helpful in improving a tummy tuck result outside the zone of tissue excision. The pubic region should be one area considered for liposuction if needed to avoid a prominent postoperative bulge below the scar line.

Case Highlights:

1) Many patients with excess and loose abdominal tissue have pubic sagging or ptosis. This area should be evaluated before tummy tuck surgery to determine if modifications should be made to include its correction.

2) While a tummy tuck will provide some pubic lift, it may not be enough if the amount of pubic sagging or fullness is significant.

3) A modification of the incisional design and/or liposuction should be added to the tummy tuck for pubic reshaping if needed.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  The tummy tuck procedure is one of the common and successful body contouring surgery. Whether it is a woman who is battling the loose and stretched skin from pregnancies or either sex whose has developed a lower abdominal overhang after weight loss or bariatric surgery, the tummy tuck provides a permanent solution in just a few hours.

In a traditional full tummy tuck, skin and fat excision is the first part of the procedure. The amount of skin and fat removed extends vertically from above the belly button down to the pubis. The wide elliptical excision of skin and fat extends horizontally from one hip to the other hip. With its removal leaves a very large lower abdominal defect that easily accounts for 1/3 or more of the total abdominal surface area.

The coverage of this lower abdominal defect is the second part of a tummy tuck and is obviously necessary for its completion. This is done by using the remaining abdominal skin from above and bringing it down over the defect to meet the lower pubic skin. The ability of the upper abdominal skin flap to bridge this gap depends on two factors; actual tissue movement and skin elasticity and stretch. Skin flap movement comes from undermining and releasing attachments, often as far up as the bottom of the rib cage. Stretching of the skin depends on how much elasticity it has. While both factors contribute to allow this tissue coverage, which one is more significant?

Case Study: This 52 year-old female was to undergo a combined abdominal and breast augmentation. The abdominal procedure was a full tummy tuck combined with liposuction of the flank or love handle area. She had a tattoo of a green frog just above the umbilicus which she wanted to preserve. She was aware, however, that it would change position from above the belly button to below it. How much it would move and what it would look like remained to be seen.

After her initial breast augmentation, a large skin and fat excision was done from the anterior superior iliac spine from one side to the other and going just above above the belly button but just below the base of the tattoo. A central tunnel was made under the upper abdominal skin flap to the xiphoid process. The rectus fascia was tightened and sutured together in the midline from below the xiphoid process down to the pubis. After the placement of a drain, the upper abdominal skin flap was stretched down to the lower incision line and closed. A new location of the original belly button stalk was made through the moved abdominakl skin flap above the frog tattoo.

While this was a standard tummy tuck and otherwise was uneventful, the change in the position of the frog tattoo was interesting. Not only did it move way down to just above the final incision line closure at the pubis, but the tattoo could be seen to be distorted and vertically elongated. This indicates that the stretch component of the upper abdominal skin flap closure of a tummy tuck is significant and probably equal to if not greater than actual skin flap movement.

Case Highlights:

1)      The fundamental principle of a tummy tuck is that the remaining upper abdominal skin flap must be freed and stretched downward to replace what was removed.

2)      In this patient with a pre-existing tattoo just above the belly button, the location of the tattoo after surgery confirms how much the upper abdominal skin flap actually moves

3)      The distortion of the tattoo shows that the downward movement of the skin flap depends on a combination of actual tissue movement and skin stretch.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

A tummy tuck or abdominoplasty is one of the most common and successful of all cosmetic body contouring procedures. Besides the obvious removal of a segment of lower abdominal skin and fat, the underlying muscles are frequently manipulated as well. Usually spoken of in terms of tightening, this part of a tummy tuck is often the most misunderstood part of the operation due to its relative obscurity from the outside.

Frequent questions about the internal tightening of a tummy tuck include whether the muscles are cut, how tight they are made and what the recovery will be like. (e.g., how long will it be before I can stand up straight?) Such questions, while understandable, reflect a basic misconception of how this part of the operation is really done.

While there are numerous abdominal muscles, the only ones that are manipulated in a tummy tuck as the central ones known as the rectus muscles. These are very big, wide and long muscles that run vertically from the lower edge of the rib cage all the way down to the pubic region. They are the largest of the abdominal muscles and make up the entire central part of the abdominal musculature. Like all muscle, they are encased ion fascia very much like a casing around sausage. This covering or fascia is very thick and stout in comparison to the muscle which is very soft and jelly-like.

While the paired rectus muscles normally meet in the midline, pregnancy can cause these vertically-oriented muscles to separate and a gap develop between them. This is most evident below the belly button but can also extend above the belly button as well. This gap does not mean that the abdominal contents are exposed as the overlying fascia remains attached but stretched. There is a resultant midline muscle deficiency but not a fascial separation. Occasionally a hernia may be present because of this separation around the bellybutton, which is a natural weak point of the fascia.

When these muscles are tightened during a tummy tuck, no muscle is ever cut. Rather, the rectus muscles are brought back together in the midline by sutures which sew the fascia, not the muscle together. Technically, this maneuver is a fascial tightening, not a true muscle tightening. When done properly and with care, there is minimal trauma or injury to the muscle tissue which lies immediately underneath these fascial sutures. What type and size of sutures used to do this midline rectus fascial tightening is a matter of a plastic surgeon’s preference.

How tight this fascial tightening or plication is done is usually no more than it takes to bring the muscle bellies back to touch in the midline. There is no advantage to trying to make them any closer or tighter than what their natural position would have been. Making them any tighter increases pain after surgery without any visible improvement in appearance. More tightening will also not give one a ‘six-pack’, as this is not possible no matter how the fascial suturing is done.

It is this fascial tightening that induces much of the discomfort after tummy tuck surgery. It is also that which make can make it difficult to stand erect in the first few days after surgery. However if the fascial tightening is not overdone most patients can stand erect and their pain is not unduly severe.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

While tummy tucks have always been used to recontour the post-pregnancy body, they have grown in popularity over the past decade due to increased use of weight loss methods. (e.g., bariatric surgery) While it is major body surgery, it is tremendously effective at removing loose skin and fat from the abdomen and major complications with it are actually fairly rare. By far the most common complication is that of a seroma or fluid build-up after surgery. That is why drains are placed and used after surgery as a prevention method.

The occurrence of seromas after tummy tucks is very common. Even though drains are used for a week or two after surgery, they can still occur. I usually counsel my Indianapolis tummy tuck patients that up to 30% of patients will develop seromas two to three weeks after surgery despite the use of drains. The larger the tummy tuck and the greater amount of skin and fat removed, the more likely one will develop it. While drains are helpful, they definitely are not completely preventative of seromas.

While most seromas are treated non-surgically by needle aspiration, they pose a nuisance for patients. Most seromas will require multiple needle aspirations (taps) spaced a week apart for up to a month after drain removal. This causes an inconvenience for patients and some intermittent mild discomfort as the fluid accumulates.

Prevention or decreased incidence of this well recognized after tummy tuck problem has focused on two surgical techniques. Both center around the concept of the reduction of so called ‘dead space’. Closure of the size of the abdominal dead space through progressive tension sutures or quilting sutures has been found to be fairly effective as the tummy tuck is being closed. By suturing the underside of the skin back down to the abdominal wall closes down the space that has been made during the procedure. The other approach is to not make as much dead space to begin with. More limited upper abdominal flap dissection and the use of liposuction to help loosen and stretch it downward to bring the two skin edges together has also been found to be effective.

In the October 2011 issue of Plastic and Reconstructive Surgery, a clinical study was reported that employed both of these intraoperative maneuvers to decrease seroma formation after tummy tuck surgery. The authors approach was to use a longer tummy tuck incision, limited undermining of the upper abdominal skin flap to just the tunnel needed for rectus fascial plication with liposuction undermining out laterally, and the use of progressive tension sutures. These techniques enabled drains to not be used after surgery. To study the outcome of this tummy tuck approach, 113 patients over a 6 year period were studied. Postoperative seromas occurred in 10 of the patients. (9%)

While these tummy tuck techniques did not completely eliminate all seromas, the low incidence was fairly impressive given that drains were not used after surgery. Their results illustrate that drain-free tummy tucks are possible and actually have a lower seroma incidence than those in which drains are used in my experience.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The belly button, also known as the umbilicus, is a funnel-shaped scar located in the midline of the abdomen usually about 2/3s the distance between the chest and the pubic region. It is, of course, the remnant of where the umbilical cord was attached to the newborn. It is the only topographic aesthetic feature on an otherwise flat or round abdominal wall. While it has great variability in size and shape amongst humans, an inverted appearance that is not too large is desired.

In a tummy tuck, making a ‘new’ belly button is the last portion of the operation. It is new only from the perspective that it requires a skin incision through the abdominal skin flap which has been stretched down. The original stalk of the belly button is the same, its exit out through the skin is new. While a relatively small procedure in comparison to the scope of the overall tummy tuck, it is an important aesthetic feature that many patients may use to pass judgement on the results of their surgery.

When I am making a new belly button during a tummy tuck, the objectives are three-fold. First and most importantly, place the belly button in the midline directing on a vertical line between the xiphoid process and the pubis. Secondly, make the shape of the belly button vertical in orientation and not round or horizontal. This is accomplished by how the belly button is cut out from the original abdominal skin segment that was removed and the skin pattern made in the abdominal skin through which it reappears. (make it a vertical dome-shape) Lastly, keep the scar surrounding the belly button as hidden as possible by having it pulled inward.

One of the keys to accomplishing some of these tummy tuck belly button goals is fascial suture fixation. Permanent sutures are placed at various locations around the belly button from the underside of its skin to the underside of the abdominal skin and then down to the abdominal fascia. By tying these sutures down, the entire belly button area (and central abdominal region) is pulled inward creating a funnel or ‘drain in the center of the floor’ effect.

These fascial sutures also distribute the pressure on all sides of the belly button and give it a more pleasing shape. The location of these sutures also creates a vertical shape by being placed at the 12, 4 and 8 o’clock positions. This creates a favorable contour feature of the abdomen and pulls the circular belly button scars inward to a more hidden location.

While the re-creation of a belly button is the smallest portion of performing a tummy tuck, it requires finesse and attention to some details to get more than just a round ‘mushroom’ of an umbilical result. These same belly button surgery principles can be applied to revisions of a prior unsatisfactory tummy tuck result as well.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

A tummy tuck or abdominoplasty is a well known body contouring procedure. It is used widely after childbirthing in women and significant weight loss in both men and women. While the number of men who undergo a tummy tuck has increased in the past decade due to bariatric surgery, the majority of tummy tuck patients are still women. Women seek the procedure to get rid of outer concerns of loose skin, fat and stretch marks as well as internal muscle tightening and repair of hernias.

While the tummy tuck operation has been given a lot of different and snappy names for marketing purposes, there are fundamentally only two different types. These types are differentiated by the amount of skin and fat removed and the resultant incisions/scar that results. A full tummy tuck removes an elliptical-shaped segment of skin and fat that is placed above the belly button and extends down to the pubis below. This is why the bellybutton ends up with a scar around it as it is made ‘anew’ in the skin flap which is pulled down to cover the abdominal wall defect. The mini- or limited tummy tuck removes a smaller elliptical-shaped tissue segment that is placed below the belly button. This is why the belly button does not end up with any scar around it. It may be allowed to ‘float’ lower but it remains uncut from the outside.

For many women, the decision between a full or mini- tummy tuck is quite clear. When one’s stomach tissues are quite floppy, loose skin extends well above the belly button, or when skin hangs over the waistline, the need for a full tummy tuck is clear. Conversely, when the amount of loose abdominal skin is not more than a pinchable few inches or the stretch marks and loose skin clearly lies mainly below the belly button, no more than a mini- tummy tuck is needed.

But some tummy tuck patients are what I call a ‘tweaner’. Their abdominal tissue problems do not lie clearly in either category and they could have either a full or a mini-tummy tuck. The choice between the two tummy tuck options is not clear and, hence, they are in between the two operations.

When faced with this choice, it can be difficult to decide and one must look at their comparative benefits and liabilities. The key to making that decision is to understand what can be achieved for what trade-off. A full tummy tuck will remove the most skin and fat and get the flattest result. But it does so at the trade-off of a long horizontal scar that will run from one hip to the other. But the real scar concern to be aware of is that it will end up higher than most patients will like and it will pull the pubic hairline up higher. That is the price of the flattest and tightest result in the tweaner patient.

A mini-tummy tuck will not completely remove all loose skin and fat and, while every patient is different, will remove less than 50% of what a full tummy tuck does. But it offers the benefit of a shorter horizontal scar that will remain lower and can be kept just at the level of the top of the pubic hairline. (without stretching it out) That is the benefit of less tissue removed in the tweaner patient.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  Tummy tucks, or an abdominoplasty, is one of the successfully proven methods of abdominal and waistline contouring. The foundation of a tummy tuck is the removal of a segment of loose skin and fat, a horizontal ellipse that is taken out below (mini-tummy tuck) or above the umbilicus. (full tummy tuck) Other adjunctive techniques that contribute to the final result of a tummy tuck include rectus muscle plication and liposuction.

Liposuction is an important part of a tummy tuck and is used in almost all cases. Liposuction can reach fat areas that lie beyond the excision and pull of the abdominal tissue that is removed. Few patients that need an abdominoplasty don’t have fat bulges in adjoining areas. One very common area of fat excess is in the upper abdominal area between the belly button and the bottom of the rib cage. This is outside of the area of the skin and fat that is cut out and can have quite a thick fat layer. Some of this thickness is thinned out as the skin is pulled down from below. But this initial fat thickness is the reason some tummy tuck patients have a residual upper abdominal bulge that is not as flat as the lower abdomen after surgery.

Some plastic surgeons will liposuction the upper abdomen during a tummy tuck to thin it out while others will not for fear of impairing the blood supply to the healing skin and incision below. My preferred approach is the latter as necrosis of the lower skin flap, while uncommon, is a nightmare for all involved should it occur.

The long-term results of most tummy tucks are based on how successful one is at keeping fat from re-accumulating and thickening the skin flaps and the contour of the waistline. Unless a woman gets pregnant after a tummy tuck, skin excess will not be recreated.   

Case Study: This is a 48 year-old female who had a full tummy tuck over 6 years ago. As she has gotten older and gone through menopause, she felt she had gotten ‘thicker’ though the waistline and abdominal area. She wanted to redefine her waistline again through liposuction and become overall more sculpted again.

Smartlipo was used to perform her liposuction due to the anticipation that she would have some scar from her prior surgery. Her entire upper and lower abdomen and her flanks into her back were initially treated with 30,000 joules of energy prior to suctioning. A total of 2,200cc of aspirate was obtained which was more than I would have thought going into the procedure.

After three weeks most of her swelling and the little bit of bruising which had occurred was largely gone. Her recovery from her secondary liposuction compared to her original tummy tuck was in her estimation a ‘1’ compared to the first ‘10’.

Every patient who undergoes a tummy tuck should be aware that secondary liposuction may be desired. Whether it is to thin out a still full upper abdominal area or to take down fat reaccumulations years later, touchups or revisions using liposuction can be beneficial I preoperatively advise all of my patients of this potential reality. While a tummy tuck is a great procedure, it is not always perfect nor is it always completely permanent.

Case Highlights:

1)      Tummy tucks produce significant changes in the contour of the abdomen and around the waistline. Having a completely flat abdomen, particularly the upper part, may not always be possible given the thickness of fat tissue in this part of the abdominal skin flap.

2)      The residual thickness of fat in the upper abdomen or the accumulation of fat with weight gain after a tummy tuck, even years later, can mar a well-defined waistline and abdominal shape.

3)      Liposuction may be needed after a tummy tuck as a secondary procedure to thin out the abdominal skin flap to obtain optimal contouring or may need to be much later to restore the previous shape of a tummy tuck from fat re-accumulation.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: A tummy tuck is the most successful body contouring operation in plastic surgery that we know. Its dramatic removal of excess skin and fat, and vertical rectus muscle tightening, produces an outcome that patient’s can not otherwise achieve on their own. While there is a resultant scar, that is a worthwhile trade-off in the properly selected patient.

Liposuction is, more times than not, a part of a tummy tuck (abdominoplasty) procedure. It is integral for most patients to treat the flanks or the muffin top areas that are otherwise out of the zone of skin and fat excision. The sides of the tummy tuck into the back are almost always treated by liposuction to give more of a 270 degree waistline result rather than just a 180 degree improvement. There are just a small number of patients who get just a tummy tuck alone.

But not all areas of the abdomen can be treated with liposuction at the same time as a tummy tuck. The upper abdominal area and its sides (the upper skin flap of the tummy tuck) is usually not treated due to potential concerns about disrupting the blood supply and causing wound healing problems at the incision. While undermining and pulling down the upper abdominal skin flap does thin out its thickness (like stretching out an accordion), it may still leave some patients with fullness above the new belly button after their tummy tuck.  

Case Study: This 46 year-old female had previously undergone a tummy tuck two years ago. While she had excellent improvement in her abdominal shape, making a significant reversal of the effects of two pregnancies from years ago, she still wanted further flattening and a better shape. She had several inches of thickness of the upper abdomen out into the back area. How much of this was residual fat not treated during her tummy tuck (leftover fat) or was fat that had been gained after surgery was unknown.

Liposuction using a Smartlipo technique was done over the entire upper and lower abdomen, waistline and flanks, and into the back rolls. A total of 1700ccs of aspirate (1.7 liters) was removed. This was performed under general anesthesia in one hour as an outpatient procedure.

Her postoperative recovery was fairly minimal. (as compared to a tummy tuck) Smartlipo causes a leaking of fluids from the small entrance sites for a day or two. She wore an abdominal binder for two weeks afterwards. Her result is now as good as her shape can ever be.

For some tummy tuck patients, secondary liposuction can provide another degree of improvement. For those patients that may benefit from a second stage liposuction after their tummy tuck, this can usually be predicted beforehand. The thickness of the upper abdominal fat is a good indicator.

Case Highlights:

1)      As effective as a tummy tuck is at reshaping the abdominal area, the thickness of fat of the redraped skin is not usually thinned out. Optimal abdominal and waistline reshaping for some patients may require secondary liposuction.

2)      Liposuction after a tummy tuck can be done as early as 6 months after a tummy tuck. Complete healing of the tummy tuck is necessary before inducing the tissue trauma of liposuction.

3)      Secondary liposuction can maximize the effects of a previous tummy tuck and is much easier procedure to undergo and recover afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

What are the specifics of the abdominoplasty procedure?

Most abdominoplasty or tummy tuck procedures consist of three parts. The skin removal on the outside is the obvious first part as it is marked before going back to surgery. With the skin cut out comes the removal of the underlying fat right down to the muscle. Sometimes additional fat is removed by liposuction in other parts of the abdomen and around the waistline areas. The second part is the sewing together of the rectus muscles down the middle, both above and below the belly button. The third and last part of the skin closure and the making of a new belly button hole. Because of these different parts, tummy tucks can be tailored to include some or all of these elements as needed.

Can scars in the abdominal region, such as those from Cesarean sections or appendicitis, be corrected during surgery?

Yes. One of the great advantages of a tummy tuck is that old c-section and appendectomy scars can be removed as part of the skin cut out. They are ‘traded out’ for one single fine line scar that runs in a low horizontal orientation.

After losing a lot of weight, my tummy hangs out. Can you fix this?

Such an overhang, often called unflatteringly as a pannus, can be completely removed in a tummy tuck. That overhang can become completely flat. The weight loss has ‘deflated the balloon’ so to speak, creating this skin overhang.

Is there much pain following a tummy tuck?

That will depend on how ‘big’ the tummy tuck is and whether the muscle is being sewn together or not. Most of the pain from a tummy tuck comes from the manipulation of the muscles. The skin and fat removal is not particularly painful. In those tummy tucks where muscle is not being sewn together, there will be much less pain that one would anticipate.

Can a tummy tuck be combined with liposuction?

Yes. Liposuction is usually part of most tummy tucks. Whether it is thinning out the upper abdomen or helping get rid of the ‘muffin tops’ along the sides of the waistline, it is an integral part of the operation. Tummy tucks today are more accurately described as lipoabdominoplasties to reflect the multimodality approach to abdominal contouring.

Can I have work done on my breasts done at the same time as a tummy tuck?

Yes. More complete trunk contouring is when both breast and abdominal procedures are done at the same time. The dual effect of enlarging and lifting breasts while narrowing and flattening the waistline can produce a dramatic result. Both procedures done together can still be performed as an outpatient.

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