Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘pubic liposuction’

Case Study: Tummy Tuck with Pubic Liposuction

Monday, January 9th, 2012

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

Indianapolis, Indiana

Case Study: Tummy Tuck Surgery and the Potential Need for Revision

Tuesday, June 15th, 2010

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.

Case Study: 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:

1) 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.

2) 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.

3P) 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

Indianapolis, Indiana

The Pubic Lift with or without a Tummy Tuck

Thursday, October 1st, 2009

Sagging and fullness of the pubic area, also known as the Mount of Venus, is a very common problem in mature woman. This condition is often observed in patients who have been suffering abrupt weight loss, pregnancies or simply because of aging. The falling down (known in plastic surgery as ptosis) of the pubic area happens due to flabbiness and looseness of the skin in the frontal pelvic area.

Even in the face of a lack of a lot of excess skin, a woman may have fat deposits in her pubic region which causes an unsightly bulge in her clothes. This deposit may have been present since birth or acquired with weight gain. It is also a common development after a tummy tuck where the scar line and  above is quite flat and the pubic fullness bulges out from below.

An isolated pubic bulge can be eliminated by liposuction, particularly when there is not a loose skin issue. When aging or weight gain has caused the pubic and vaginal regions to descend, rejuvenation can be done by excising excess skin above the pubic hair and removing excess fat in the pubic region. The pubic liposuction and pubic lift procedure are often a part of tummy tuck procedure. Even if not done as part of a tummy tuck, it can be done as a secondary procedure using the existing tummy tuck scar.

Improvement of the pubic region through lifting and/or liposuction is often referred to as genital rejuvenation or mons pubis rejuvenation. The mons pubis is the hair-bearing area of the pubis. Both women and men can have this problem, although most men acquire it through significant amounts of weight loss.

Whenever I do an abdominoplasty in my Indianapolis plastic surgery practice, an evaluation of the appearance of the pubis is done to determine whether or not the pubic area needs to be lifted. All tummy tucks will cause a certain amount of pubic lift. But the design of the tummy tuck can be done to cause a greater amount of pubic lift if needed. In all cases, the top of the pubic hairline will reach to the scar line which will also raise the level of the hairline as well. Patients often undergo laser hair removal later to create a ‘hair-free’ buffer between the scar and the pubic hair line. A few patients have also reported that the amount of pubic lift has resulted in the clitoris becomes more exposed, allowing for improved stimulation.

When a pure pubic lift is done, a caesarian type scar just above the pubic hair is used as the approach for lifting the pubis. This scar heals well as a horizontal scar just above the pubis. It is also combined with liposuction as well. Unlike a tummy tuck, this is a fairly simple procedure that does not require a drain and can be completed in less than an hour.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

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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