Tummy tuck procedures, by New York City plastic surgeon Dr. Wallach, can vary. Some procedures remove a small amount of excess skin and fat from the lower abdomen while others remove an entire ellipse of skin and fat below the umbilicus, (“belly button”) as well as tighten the muscles (diastasis recti) in the midline to narrow the waist. For massive weight loss patients or for those with severe skin laxity, more extensive skin excision along the hips and buttocks may be required. The goal is to provide the best contour result with the least amount of scarring. Liposuction can be combined with these techniques to improve the contour further. Some New York City patients request liposuction alone to treat their abdominal contour problems, but if the patient has significant skin laxity and/or weakness of the abdominal musculature, then liposuction alone will not be sufficient. For more information regarding Abdominoplasty, visit our blog.
“I believe true confidence comes from a feeling of self-assuredness from one’s inner self. However, I also believe that it is heavily impacted by a lack of confidence with one’s outside appearance as well. Plastic surgery can help improve confidence in this way.”
This is for a patient that has very little to no skin laxity or subcutaneous fat, and has mainly midline muscular laxity.
Endoscopic equipment is used to gain access through two or three small incisions. This allows visualization with a small camera of the area between the muscle fascia and the overlying subcutaneous tissue so that the midline muscular laxity can be treated. Liposuction can be performed in conjunction with this procedure.
Two to three very small limited incisions are used. Liposuction of the entire abdomen can be performed at the same time.
This procedure is limited to very few patients. It can not treat skin laxity.
Mini-Abdominoplasty (mini-tummy tuck)
This is for a patient that has redundant skin and some subcutaneous fat in the area between the umbilicus and the pubic region. The midline muscular laxity is mainly confined to the lower abdomen.
A small ellipse of skin and fat is removed from the lower abdomen. The final incision is not much larger than that of a cesarean section. The umbilicus is not usually detached from the surrounding tissues. The musculature from the umbilicus down to the pubic region can be easily tightened. Liposuction can be performed on the entire abdomen and hips.
A short incision is used. Liposuction of the entire abdomen can be performed in conjunction with this procedure.
The musculature from the upper midline to the umbilicus can be difficult to treat from this exposure. Lax skin around the umbilicus or the upper abdomen is difficult to treat.
Modified Full Abdominoplasty
This is indicated for patients in Manhattan that require a full abdominoplasty but have abdominal incisions from other surgical procedures that may impact the viability of the tissues elevated (i.e. an open gallbladder surgical incision). The patient has a lot of skin laxity and may have a significant amount of abdominal subcutaneous fat. There is midline muscular laxity. There are one or more previous surgical incisions on the abdomen that would impact performing a full abdominoplasty safely.
An ellipse of skin and subcutaneous fat is removed from the lower abdomen. Undermining of the upper abdominal tissues is performed in a limited fashion to maximize the blood supply to the tissues that may have diminished circulation due to the previous surgical incisions. Treatment of the muscular laxity is performed. Liposuction can be done selectively. The umbilicus is detached from surrounding loose skin attachments and is re-inserted after the upper abdominal skin is re-draped and sutured to the lower abdominal incision.
The incision may be shorter than a full abdominoplasty. Lax skin can be treated better than a mini-abdominoplasty or endoscopic abdominoplasty. Lax midline muscles can be tightened easily. Laxity around the umbilicus can be treated.
A longer incision than used for a mini-abdominoplasty or endoscopic abdominoplasty is performed. There may be residual skin redundancy because of limited undermining. Liposuction has to be performed selectively to avoid compromising the blood supply to the skin and subcutaneous tissue.
Full Abdominoplasty (“full tummy tuck”)
This is indicated for a patient that has a lot of skin redundancy of both the lower and upper abdomen. The patient also has midline muscular weakness and may or may not have significant subcutaneous abdominal fat.
An ellipse of skin and subcutaneous fat is removed from the lower abdomen. The upper abdominal skin and subcutaneous fat is elevated more extensively than during a modified full abdominoplasty. The midline muscular weakness is tightened. The umbilicus is reinserted into the upper abdominal skin flap after the flap has been re-draped and sutured to the lower abdominal incision. Liposuction can be selectively performed.
Lax skin from above and below the umbilicus can be treated successfully with this technique. Thus, better than the endoscopic abdominoplasty, the mini-abdominoplasty, and the modified full abdominoplasty can achieve. The lax muscles can be tightened easily. Laxity around the umbilicus can be treated.
It requires a long incision along the lower pubic region. Liposuction needs to be performed selectively to maintain the blood supply to the abdominal flap and subcutaneous tissue.
Circumferential Abdominoplasty (Lower Body Lift)
This is a procedure often reserved for patients who have undergone bariatric surgery that have had massive weight loss, and thus have significant skin excess. (see Post-Bariatric surgery treatment)
Most of the abdominoplasty procedures described take between two and three hours to perform with a recuperation time of one to two weeks. The circumferential abdominoplasty (lower body lift) can take four to six hours to perform. Dr. Wallach has presented at national meetings and published journal articles on abdominal contour procedures.
Tummy Tuck Recovery
Before your procedure, Dr. Wallach will discuss your recovery and aftercare instructions with you at length to make you are comfortable. Depending on how invasive of a technique is used for your tummy tuck, you may be released the same day or asked to stay overnight for observation. However, before leaving, a member of Dr. Wallach’s team will review with you how to care for any drains that have been placed, symptoms you may notice during recovery and signs for complications to watch for. Most patients will need at least a week of rest; however, some light movement or getting up to gently walk is encouraged for circulation. Circulation is important during the healing process in order to avoid blood clots from forming. Your specific recovery time frame and instructions will be reviewed with you by Dr. Wallach prior to surgery and again afterwards before being released.
If you would like more information about Dr. Wallach and his success with New York City Tummy Tuck (Abdominoplasty) procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 257-3263 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details.
Frequently Asked Questions
How big of an incision will I need?
This is individualized based upon the extent of the work needed. Sometimes a “mini- tummy tuck” can be performed. LIPOSUCTION is performed and residual loose skin from the lower abdomen is removed through a small incision in the pubic region (4-6 inches long). If the lower muscles of the abdomen need to be tightened, then it can be performed as well through this small incision. Patients with more laxity of the tissues and greater weakness of the muscles require a longer incision to accomplish the surgery.
Can I have other procedures at the same time?
Yes, in fact it is often easier to do other operations at the same time. Harvesting fat for FAT INJECTION TO THE FACE can be obtained from the discarded tissue during the ABDOMINOPLASTY. Sometimes, BREAST AUGMENTATION can be performed through the abdominoplasty incision to avoid incisions on or near the breast. Liposuction of the outer thighs and flanks can be performed through this area as well.
What is a mini-abdominoplasty?
A mini-abdominoplasty is a procedure that treats abdominal contour issues mainly of the lower abdomen. This is best suited for a patient who does not necessarily need muscle plication above the umbilicus and has a slight protuberance below the umbilicus along with some loose skin of the lower abdomen. Because of the limited undermining of soft tissue, liposuction can be combined with the procedure. Sometimes surgeons will “float” or detach the umbilical stalk to move it lower to remove more skin. The incision is often shorter than what one would have with a full tummy tuck. This is often best for thinner patients. A disadvantage of this procedure is that it does not adequately treat the upper abdomen and skin laxity above the or around the umbilicus.
Can I have liposuction instead of a tummy tuck?
The best candidate for liposuction is someone who is not heavy but has isolated areas of fat that they want to remove to improve the contour. Usually younger patients have better quality skin than older patients. That being said, those patients that do better with abdominal liposuction are those with good skin quality and who are not very heavy. Just like a balloon, if it is stretched out too much, due to air or in this case fat, the tissues may not rebound well. Like a balloon’s skin that shrinks after being maximally extended, the abdominal skin may become loose as well after liposuction or decreasing the volume. In most cases, if a patient has had multiple pregnancies or large fluctuations of weight and has loose skin, and/or has a diastasis with weak abdominal muscles, then more than likely a full tummy tuck would be best. There are some patients that are in between the two extremes and sometimes these individuals may be happy with liposuction.
I have had three children and I am not going to have anymore. What is the best procedure for me to improve the appearance of my abdomen?
In all likelihood, for someone who is unhappy with the appearance of their abdomen after having children they will more than likely do best with having a full abdominoplasty. The loose skin and fat is removed from the region usually between the umbilicus to the pubic region leaving the remaining incision along the lower abdominal region usually in the bikini of bathing suit line. The muscle weakness is corrected by suturing the midline internally. The laxity in the upper abdomen is usually improved as well from the redraping of the abdominal flap. Liposuction of the flanks can be performed at the same time as well when indicated.
I have loose skin around my umbilicus, how can you correct this?
If one has isolated loose skin around the umbilicus, it can be difficult to treat this area in an isolated fashion. I have seen a few isolated excisions of skin around the umbilicus that has caused a very spread out scar around the umbilicus. Sometimes treating the skin can be performed with a mini-tummy tuck, but often it is best treated with a full abdominoplasty.
Should I lose weight before a tummy tuck?
It is always best to get down to your ideal weight prior to having a surgical procedure. The results of a full abdominoplasty is often better and the surgical risks are reduced as well. That being said, if you are close to your ideal weight that is reasonable as well.
What is a reverse abdominoplasty?
A reverse abdominoplasty is exactly what it sounds like. Instead of elevating the tissue from an incision in the lower abdomen by the pubic hairline, the incision is made under the breast creases and the excess skin is brought out through this region. This is a procedure that is performed in patients that have isolated laxity in the upper abdomen. This may occur after a mini-tummy tuck or even after a full tummy tuck. If the patient has had a previous breast procedure leaving an incision under the breast folds then using these same incisions may be possible.
I lost more than a 100 lbs and everything is loose; what procedure should I have done?
When a patient has had massive weight loss (more than 100 lbs) through either diet and exercise or surgery, often times their skin is very loose. In some patients a full abdominoplasty is an option. But if the laxity of the tissues is more severe, an extended abdominoplasty, or even a full body lift procedure may be more prudent to give a better result. An in-office evaluation is always best to perform a proper exam and review a patient’s goals.
What does “floating” an umbilicus mean?
“Floating” an umbilicus refers to the concept of detaching the umbilical stalk from its underlying abdominal wall attachments but keeping it attached to the surrounding skin to preserve its blood supply. This is most commonly performed during a mini-abdominoplasty when there is some loose skin superior to the umbilicus and the surgeon wants to treat this by pulling it down a bit.
Can you perform aggressive liposuction of the abdomen along with a full tummy tuck?
Aggressive liposuction can be performed in some cases when performing a full abdominoplasty. This is most commonly done when full undermining of the abdominal flap is not performed. The undermining of the abdominal flap stops by the lateral row of perforator arteries that feed the overlying abdominal flap. It is undermined just enough to allow for muscle plication in the midline. The abdominal flap is usually separated a bit more around the vessels using a liposuction cannula as well.
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Steven Wallach MD
Dr. Wallach is a board-certified plastic surgeon in New York City who specializes in performing cosmetic procedures of the face, breast and body. As one of the cutting edge experts in the field, Dr. Wallach consults on a regular basis with people in the beauty, media, and publishing worlds.