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Posts Tagged ‘extended tummy tuck’

The Body Lift or Extended Tummy Tuck

Thursday, February 11th, 2016

 

A tummy tuck is a well recognized body contouring operation because it has been around for many years. It is generally perceived as a hip to hip excisional and tightening abdominal operation as it only affects the front side of the torso. The term ‘body lift’ however is less well defined in the eye of the patient and can be open to interpretation.

It is recognized that a body lift is more than just a tummy tuck but how much more can be debated. It is an operation that is closely associated with managing the abundant loose and hanging tissues in the extreme weight loss patient, whether the weight loss was surgically induced or not. In this context, a body lift is a circumferential or 360 degree operation removing tissues completely around the waistline.

Body Lift Dr Barry Eppley IndianapolisBut a modification of the body lift can be used in non-weight loss patients. Rather than going completely around the waistline or 360 degrees, the excision extends about halfway between the spine and the side of the waist. (270 or 300 degrees) This captures more loose skin that might otherwise not be adequately addressed by liposuction. This extended skin excision is best done in patients with poor quality skin with little contractile ability around into the back, when a large skin rolls extends into the back and/or when sagging skin exists over the outer thighs.

In the February 2016 issue of the journal Plastic and Reconstructive Surgery, an article was printed entitled the ‘Cosmetic Body Lift’. In this paper the author reviewed 72 patients over a ten year period who had a body lift defined as a  270 degree extended lipoabdominoplasty. (tummy tuck) The amount of liposuction aspirate removed was just over 3,000cc. Complications included a near 3% incidence of seroma (drains were used),  a 4% infection occurrence, and skin necrosis in 4%.  No hematomas occurred. One patient developed a deep vein thrombosis. (DVT) Secondary revisions were done in 18%

Extended Tummy Tuck of Body Lift Indianapolis Dr Barry EppleyThis series demonstrates that the body lift procedure in non-weight loss patients can be done safely and with a similar low rate of complications as that of standard tummy tuck. The critical question for most patients who may benefit from having this ‘bigger’ tummy tuck is whether the extra scar length is perceived as a good trade-off.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Extended Tummy Tuck

Friday, January 22nd, 2016

 

Background: The well known tummy tuck or abdominoplasty procedure is most commonly used in women who have had abdominal shape changes due to pregnancy or some moderate weight loss. But since the era of bariatric surgery, large amounts of weight loss have created skin excesses who require modified forms of tummy tuck surgery.

Since the skin rolls often extend around the hips in extreme weight loss patients, a tummy tuck must go beyond its normal parameters to adequately remove it. Such an extended tummy tuck design can have an extension anywhere from the back of the hips to the whole way around the back. (known as a belt lipectomy or a circumferential tummy tuck) While these type of tummy tucks are extensive, the severe weight loss has made the tissues relatively thin and straightforward to manipulate.

More moderate weight loss patients (35 to 50 lbs for example) generate abdominal skin rolls but they are often thicker. Manipulating these thicker abdominal and back tissues is more difficult because the tissues are ‘stiffer’ and slightly hard to move. Liposuction is usually used concurrently with the tummy tuck to help thin the tissues and help create a better overall result.

Case Study: This 44 year-old female wanted to get rid of her abdominal overhang and narrow her waistline around into her back. She had lost about 50 lbs on her own with diet and exercise. She was now at a weight which she felt was comfortable and able to be maintained.

Realistic Extended Tummy Tuck result front view Dr Barry EppleyUnder general anesthesia, she had a large extended tummy tuck done exclusively from the supine position. Liposuction was performed in the pubic region as well as the flanks into the back and the upper abdomen, removing 2.2 liters of aspirate.

Realistic Tummy Tuck result oblique view Dr Barry Eppley IndianapolisRealistic Extended Tummy Tuck result side view Dr Barry Eppley IndianapolisHer postoperative results at one year after surgery show a dramatic change in the shape of her stomach and her waistline. While her stomach was not flat, it was not predicted to be so before surgery. Her thicker abdominal tissues, which could only be modestly treated by liposuction due to safety concerns, as bound to leave her with an abdominal convexity above the the most narrow portion of her stomach at the waistline where her scar was located.

Moderate weight loss patients with thick skin rolls pose challenges in tummy tuck surgery that bariatric or more extreme weight loss patients do not. These thicker skin rolls require more extended incisions. Liposuction will have a impact on the size of the sin rolls and the wasitline shape but a secondary lipsuction surgery may still be needed to maximize the reduction in the subcutaneous fat layer. This is why, when possible, that patients should maximize their weight loss before undergoing tummy tuck when possible.

Highlights:

  1. A conventional tummy tuck is often not enough to adequately improve abdominal rolls that extend around the waistline.
  2. An extended tummy tuck is usually needed in women that have lost some weight but still remain with significant fat layers and skin rolls.

3. A extended tummy tuck removes skin and fat around the hip area into the back.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Extended Tummy Tuck in the Partial Weight Loss Patient

Sunday, October 11th, 2015

 

Background: There is no more effective procedure in abdominal reshaping than tummy tuck surgery. What separates a tummy tuck from liposuction is that all tissue components of the abdominal fullness are treated as opposed to just fat removal. (liposuction) Tummy tuck surgery can fundamentally be separated into two basic types; normal or close to normal weight women who have abdominal changes from pregnancy and the associated weight gain/loss and originally overweight men and women that have lost some or all of their excess weight. The basic difference between the two is in the amount of  residual abdominal skin and fat that remains and whether any other tissue redundancies exist around it.

Large weight loss tummy tucks have to manage a much larger amount of tissue excision. There is usually an abdominal overhang (aka pannus) that extends around the waistline into the back. This problem alone means that the traditional tummy tuck must be extended with longer resultant scars that go into the back. This may or may not solve a vertical tissue excess and this is where the debate of whether the additional scars from a fleur-del-lis tummy tuck is worth it.

One of the common questions in tummy tuck surgery is how much weight needs to be lost before the procedure. In the bariatric surgery patient the amount of weight loss is often maximal due to the bariatric surgery. In the non-bariatric surgery patient, however, patients can still have excess weight but they are frustrated with their pannus and its inability to change. Psychologically they have hit the proverbial wall and are desperate for some positive change. This may prompt them to seek surgery. The surgeon must decide if now is the right now and whether further weight loss is needed.

Case Study: This 44 year old female had lost 55 lbs and came in to be seen for a tummy tuck. Besides her abdominal pannus she still had a fair amount of intraperitoneal fat with a large and firm abdominal bulge above her belly button. She was advised that further weight loss would be better but she wanted to do something now. She was counseled that she would not have a flat abdomen after the surgery and that further liposuction would be needed 3 to 6 months after the tummy tuck to have a better abdominal shaping result.

Extended Tummy Tuck results front view Dr Barry Eppley IndianapolisUnder general anesthesia she had an extended tummy tuck with an incision that ran around her waistline in a 300 degree fashion. In addition prior to doing the tummy tuck her upper abdomen and flanks were treated with liposuction removing 1.8 liters of aspirate.

Extended Tummy Tuck result oblique view Dr Barry Eppley IndianapolisExtended Tummy Tuck results side view Dr Barry Eppley IndianapolisHer results show a dramatic improvement with the elimination of her abdominal overhang. But it is a result that could have been better had she lost more weight before the surgery. Her large intraperitoneal fat reservoir limits how much upper abdominal fullness can be reduced. She will undoubtably require secondary liposuction of her abdomen after she is completely healed to get a better result.

Highlights:

1) Tummy tuck surgery should follow after one has lost the most weight that they can.

2) Tummy tucks in incomplete weight loss patients should be perceived a excisional procedures to get rid of tissue overhangs rather than producing a sculpted result.

3) Extended tummy tucks are often needed after moderate to large amounts of weight loss to chase the excess tissue around the waistline into the back.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Extended Tummy Tuck

Sunday, August 23rd, 2015

 

Background: Tummy tuck surgery is one of the most common and successful types of body contouring surgeries. It is used in many post-pregnancy and weight loss women to correct the effects of having babies and the changes that process can induce on one’s body in the mid-section area. This type of tummy tuck usually induce the debate between whether one should have a fully or mini-type of tummy tuck.

But women with a high BMI (body mass index) and significant weight for their height often requires a different type of tummy tuck. Even with weight loss a high BMI creates a roll or rolls of skin and fat that a frontal-based tummy tuck alone can not properly address. The tissue redundancies extend well beyond the frontal hip points and well into the back. This requires that the extent of the tummy tuck excision go around the waistline and become closer to a 270 to 300 degree tummy tuck rather than a traditional 180 degree frontal tummy tuck.

With an extended tummy tuck comes the realization that there will be a longer scar into the back area. This location of a tummy tuck scar often does not look as good as any tummy tuck scar on the abdominal side and there is no real natural skin fold to hide it. For those patients that need it, however, this is usually perceived as an inconsequential trade-off in most cases. It is often also necessary that liposuction be performed in and around the back and waistline area to maximize the contouring effect.

Case Study: This 42 year old female had lost 50 lbs of weight on her own but could not get rid of the rest of her stomach and back rolls. Despite her best effort at exercise she could just not budge her body shape to get any better.

Extended Tummy Tuck results front view Dr Barry Eppley IndianapolisUnder general anesthesia, she had an extended tummy tuck performed with a large horizontal excision of skin and fat from the abdominal area which extended into the back stopping just shy of the midline spine. Her abdominal and flank skin and fat that was removed weight 9 lbs. Liposuction was then performed on her back and lateral chest wall rolls to remove another 1.5 liters of fat aspirate.

Extended Tummy Tuck results oblique view Dr Barry Eppley IndianapolisExtended Tummy Tuck results side view Dr Barry Eppley IndianapolisRecovery time for her extended tummy tuck took a full three weeks to be able to return to any work and a full 8 weeks for a truly complete recovery. Complete recovery is defined as the incision being completely healed with no open areas or sutures that would extrude. And that she was finally back to a full return to all activities including any type of exercise.

An extended tummy tuck is often needed for the patient who has undergone a lot of weight loss or who still carries a fair amount of weight with a high BMI. The resultant scars will be much longer than a standard tummy tuck but is worth the trade-off for a better circumferential waistline reshaping result.

Highlights:

1) Many types of tummy tucks exceed the scope of the traditionally perceived ‘full tummy tuck’.

2) Patients who have lost a lot of weight and started out fairly big before weight loss need an extended type of tummy tuck.

3) Extended tummy tucks create longer scars that wrap around the waistline to lessen the chance of significant skin redundancies and large dog ear deformities.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Extended Tummy Tuck for the Double Roll Abdominal Deformity

Friday, February 13th, 2015

 

Background: Tummy tuck surgery is one of the most popular of all body contouring surgeries. While it usually results in a hip to hip scar in a traditional tummy tuck surgery, most women consider this a very acceptable trade-off for the abdominal flattening result obtained. While the abdominal scar can have its own aesthetic issues such as placement, shape and width, scar revision can often make improvements if needed.

What many people do not realize is there are many different variations of tummy tuck surgery. It is often seen as an operation consisting of only a full and mini- tummy tuck choice. But that is a simplistic approach to an operation that has up to eight (8) different tummy tuck types. The choice of tummy tuck is determined by how much abdominal skin and fat need to be removed and haw far around into the back the excision need to be done.

The ‘double roll’ abdominal deformity consist of two distinct abdominal skin and fat rolls. The larger roll is at the lower abdominal area between the belly button and the pubic and creates varying degrees of waistline overhang. The smaller second roll lies above the belly button and creates a smaller overhang that partially obscures the belly button. The double roll abdominal deformity almost always result from moderate weight loss, although not necessarily from bariatric surgery

Case Study: This 42 year-old female wanted to improve her abdominal shape after multiple pregnancies and a 40 lb weight loss. She had lost about the most weight that she could and had hit the ‘wall’ when it came to making any further abdominal reduction/reshaping on her own.

Extended Tummy Tuck result frnt view Dr Barry Eppley IndianapolisExtendedTummy Tuck results side view Dr Barry Eppley IndianapolisUnder general anesthesia, a large horizontal ellipse of skin and fat was marked out which went above the belly button. It was removed in a full thickness fashion down to the abdominal wall. The central part of the upper abdominal flap was undermined so that midline rectus fascial plication could be done. The upper abdominal skin flap was brought down to close to the lower pubic side of the excision. To adequately work out the large ‘dog ears’ that resulted at the ends of the incisional closure, further ellipses of skin and fat resulted in the abdominal closure extending around the hips creasting a near 300 degree wrap around the waistline.

Extdnded Tummy Tuck results oblique view Dr Barry Eppley IndianapolisSuch extended tummy tucks are needed when there is more than one abdominal roll. Single abdominal rolls can be removed and the length of the scar kept to just around the hip area. But when the vertical ellipse of abdominal skin is more extensive as occurs in double rolls, the eventual length of the tummy tuck scar will find its ways into the back.

Case Highlights:

1) The double roll abdominal deformity requires an extended tummy tuck to adequately remove the loose abdominal skin and fat and create a near flat abdomen.

2) The extended tummy tuck creates a long incision and resultant scar that goes beyond the hips onto the back.

3) The recovery from an extended tummy tuck is no longer than that from a traditional shorter scar tummy tuck.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Extended Tummy Tuck in African-American Female

Sunday, May 11th, 2014

 

Indianapolis Tummy Tuck Surgery Dr Barry EppleyBackground: Tummy tucks are one of the most common and successful body contouring procedures for women. For those women that are willing to make the commitment to a major surgery, scar and recovery, it can be a near life transforming experience that  takes what diet and exercise can do to a whole new level.

Because pregnancy and weight loss affect all women, tummy tuck surgery is done on a very diverse population across all ages and races. But because of varying degrees of skin pigment and the need for a long incision, concerns abound about the potential scar in certain ethnicities. This raises the question of whether, for example, a tummy tuck for African-American women is done differently?

African-American skin, in general, does not heal that differently from skin with less pigment. However it is prone to a higher risk of hypertrophic or keloid scarring and hyperpigmentation, what one may perceive as a too enthusiastic response to scar formation and healing due to the thicker dermis and increased number of pigment cells. Thus one has to check how healing has occurred elsewhere. The simplest test for women is to see their c-section scar, which if it has healed uneventfully, indicates that a tummy tuck scar may do as well.

Case Study: This 35 year-old African-American female wanted to get rid of her loose abdominal skin and improve her waistline. She had two pregnancies and the second one caused a lot of stretch marks, loose skin and weight gain. Through aggressive dieting and exercise, she lost 60 lbs and was finally back to her pre-pregnancy weight but there remained considerable loose skin around her waistline and a lot of stretch marks. She felt she had reached the limit of what her own efforts could improve and she now sought tummy tuck surgery.

Extended Tummy Tuck results front view Dr Barry Eppley IndianapolisUnder general anesthesia, she had an extended tummy tuck due to the amount of loose skin. It was necessary to extend the excision beyond the traditional location (anterior hip points) of the ends of the tummy tuck so that redundant skin folds (dog ears) did not occur. Liposuction was done around the waistline into the flank regions to create a near circumferential waistline reshaping.

Extended TummyTuck results oblique view Dr Barry Eppley IndianapolisHer recovery was typical for a tummy tuck and a true full recovery with a return to strenuous activities took nearly six weeks. Of note is that her extended tummy tuck scar healed beautifully with only some slight hyperpigmentation. It healed in a fine line fashion without widening or abnormal scar thickening

Extended Tummy Tuck results side view Dr Barry Eppley IndianapolisOne of the major concerns in any cosmetic face or body procedure in African-Americans is the perceived risk of potential adverse scarring. (e.g., keloid formation) This would be extremely relevant in breast reduction/lifts and tummy tucks where great scar lengths are created. Just like this tummy tuck patient, I have never seen keloid scar formation in any African-American female in which I have performed the procedure. (over 100 cases in 20 years) The final scar looks normal although may have some degree of hyperpigmentation to it. Without a prior history of true keloid formation from a surgical incision or a cut, one should have no concerns that it will spontaneously occur from an elective aesthetic operation.

However, if one has developed abnormal scarring on their breasts or abdomen from previous surgery, a shorter scar tummy tuck should be planned. Such history is extremely important if the patient has skin excess on their flank areas which is going to require a longer tummy tuck scar to work out the excess skin (dog ears) which will inevitably occur from the elliptical horizontal tissue excisions.

Case Highlights:

1) Abdominal reshaping with a tummy tuck in African-American females is not associated with an increased incidence of abnormal scarring.

2)  The African-American tummy tuck has no other ethnic considerations other than wound closure and incisional management.

3) Tummy tuck surgery can cause an abdominal reshaping effect that goes far beyond what diet and exercise can do after one has reached a good weight.

Dr. Barry Eppley

Indianapolis, Indiana

The Extended Tummy Tuck for Optimal Abdominal Reshaping

Friday, September 4th, 2009

Tummy tucks (abdominoplasty) traditionally are a horizontally-oriented operation. This means that excess skin and fat is removed with an elliptical incision that is oriented from one side of the waistline to the other. This results in a fairly low horizontal scar that is some distance below a newly created belly button. (if it is a full tummy tuck)

This conventional tummy tuck is effective for the vast majority of people as their abdominal skin excess is largely located in that direction. However, some patients have abdominal skin issues that have greater dimensional excesses than just in one direction. In my Indianapolis plastic surgery practice, I can determine this before surgery by looking at the sides of the waistline and seeing how much tissue bulges to the side. One can also see how much skin can be pinched in a vertical direction above the belly button.

When there appears to be considerable vertical excess as well, consideration can be given to an extended or combined vertical-horizontal tummy tuck. This is also known as a fleur-de-lis type tummy tuck. By removing both horizontal and vertical tissue, the sides of the waistline are brought in as well as the frontal overhang removed. This creates a better abdominal result but there is a trade-off…a vertical closure as well as the horizontal one creating an anchor or inverted T scar.

In the past, there were many more patients who presented with a history of prior abdominal surgery in which a midline scar was present. But the use of laparoscopic techniques is making such patients fewer and fewer. Therefore, the consideration of adding a vertical abdominal scar when one isn’t already present can be a difficult decision. If a vertical scar is present, however, the choice of an extended tummy tuck is straightforward.

While this type of tummy tuck always produces a better abdominal result, it does bring some increased risks of wound complications. The intersection of the vertical and horizontal closures at the inverted T creates a zone of tension. Combined with upper skin flaps that may have a blood supply to the skin edges which is compromised, it is not uncommon that these incisions can develop an opening at this intersection several weeks after surgery. This wound problem can be magnified based on where the new belly button is brought through on the vertical closure. Most of the time, this is only a few inches above the horizontal closure. These wound problems are self-limiting although it can take four to six weeks to close if the opening is significant.

Dr. Barry Eppley
Indianapolis, Indiana

 

The Extended Tummy Tuck – A Three-Dimensional Approach

Thursday, July 9th, 2009

The traditional tummy tuck (abdominoplasty) is primarily what I call a frontal approach where skin and fat is removed from the lower abdomen. The skin cutout is done horizontally in the shape of a football. Often times, liposuction is also performed on the sides around the waistline to get more of a 270 degree result. When the skin excess is not large, this is a perfectly fine approach and will immensely satisfy the vast majority of people who seek abdominal contouring.

When the amount of abdominal skin increases, however, the dimensions of the skin problem change. Redundant skin and fat is present not only in the horizontal direction but in the vertical dimension as well. Such abdominal problems exist in the larger abdominal pannus patient (skin overhang onto the thighs) and in the extreme weight loss patient. (greater than 100 lbs.)

If this additional dimension is not taken into consideration during the planning, patients may be disappointed with the result at the sides of the waistline. They may wonder why the side of the  waistline does look as flat or as contoured as the front. Herein enters the concept of the extended tummy tuck, also known as the anchor tummy tuck or the fleur-de-lis tummy tuck.

The extended tummy tuck adds a upper vertical cutout of skin along with the lower horizontally oriented skin removal. By so doing, the skin closure pulls in on the sides of the waistline as well as pulling down in the front. This effectively helps narrow the waistline as well and helps reduce the amount of redundant skin in that area. By adding this ‘third’ dimension to the tummy tuck, the length of the operation is increased but it does not result in any significant increase in the risk of postoperative problems.

The extended tummy tuck does result in an additional scar that runs vertically from below the sternum down to the pubis. This creates the anchor scar result. Whether this extra scar is worth the trade-off for the improvement in the waistline is a personal choice. That choice is an easy one if an existing midline abdominal scar is already present. If no such midline scar exists, then one has to decide which ‘negative’ they can live with the best….loose skin on the sides or a vertical scar.

In my Indianapolis plastic surgery practice, I have noted that most patients with a lot of excess abdominal skin opt for the most skin removal and the best abdominal contour result. My general approach to the consideration of incisional scarring in non-hidden areas is…if you have to think about whether the scar is worth it…don’t do it. If the answer is an immediate yes and one could care less about the scar (compared to the existing problem), then the scar is not very likely to be a regrettable concern after surgery.

 

Dr. Barry Eppley

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Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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