Pre: 38 year old after 3 Pregnancies with extenive stretch marks and a hernia in the left umbilicus.
Post: Repair of hernia, resecting of stretch mark skin and correct muscle.
Pre: 43 year old diabetic with back pain and umbilical hernia.
Post: Abdominal and hernia repair.
Pre:This 40-year-old woman is post 3 deliveries. She has back pain and a small umbilical hernia.
Treatment: Abdominoplasty, repair hernia and lateral wall repair. Resolution of back pain. She noted better exercise tolerance and more strength during yoga.
Pre: 43 year old with pannus and skinof inferior muscle.Poor muscle tone.
Post: 1 week after surgery repair muscle and remove excess skin and fat.
PROBLEM
Hanging skin, excess fat, stretch marks, umbilical hernias, lower back pain, poor contour in general
ANALYSIS
Important aspects to consider:
Height
Current weight
Presence of any hernias or bulges
Incisions and scars on the abdomen
Number of pregnancies
Smoking history
Weight gains and losses
Weight during pregnancy
History of diabetes
Whether more children are desired
Type of bathing suit
Width of your pelvis
Distance from the pubic area to the ribs
Amount of fat on the abdominal sides
Muscle tone
History of back pain
The physical exam looks at the above factors. Measurements are made of the planes to be corrected - skin, subcutaneous fat, fascia, muscle, bony dimensions, spine curvature and overall appearance. Previous incisions are particulary noted, especially C-section scars and the tissue superior to them.
After the analysis, a total plan is developed. This is usually different from cosmetic clinics due to the general surgical training and our anesthesia capability which allows total sculpting. The plan is to shape the abdomen when looked at from various angles - Critical for models in photo shoots and for overall appearance in non models.
The goal is to have - in the frontal view: the abdomen curve in then out at the hips, taut skin, a low incision as few stretch marks as possible and for some women, a visible rectus muscle; in the lateral views: flat or with a slight inferior bulge if pregnancy has occurred.
SURGICAL CORRECTION
LIPOSUCTION
If your skin tone is good, you didn't have significant weight gains during a pregnancy, the muscle is good, and there aren't scars, then a liposuction to sculpt the fat works well. Some skin tightening does occur during the recovery period as the underlying scar will contract the skin. This is usually performed under light or moderate sedation. The recovery time is 1-2 days. The lateral abdominal wall, hips and frontal abdomen can be corrected.
Mini abdomen with/without liposuction
If you have had a Caeserean section, abdominal surgery, and have a near normal skin above the umbilicus, have inferior muscle laxity, have hanging skin, are in compromised health, then a mini abdomenoplasty works very well. The procedure involves removing the scar, tightening the skin, and liposuctioning the frontal and lateral fat. Additional options include repairing hernias and some muscle tightening. This is almost always done under moderate, not general sedation (you breathe on your own but are unaware of the procedure - a very safe situation). The recovery depends upon extent of procedure but is usually 2-3 days.
Complete Abdominoplasty
If you have excess skin, a very stretched muscle, excessive fat, lower back pain, poor skin in the upper half, poor condition in the skin, fat and muscle planes, then the best option is a complete abdominoplasty. This is designed to correct all 3 layers including muscle, fat and skin. Frequently, scar removal and hernia repairs are also performed. The procedure is done as an outpatient under sedation in the clinic. The surgery lasts 1 and 1/2 hours. The recovery is from 3-10 days depending upon the extent of procedure.
Post pregnancy rejuvenation - "the mommy makeover" of the abdomen and the breast.
Pregnancy significantly changes the external and internal anatomy of a woman's body. These changes not only involve the visible anatomy, i.e., stretching the abdominal skin, stretching the umbilicus, stretching the pubic area, stretching the breast skin, changing the breast size and changing the position of the breast on the chest-but also microstructure underneath, ie stretched dermis of the skin, stretched fibrous ligaments, stretched nerves, and scarring under the abdomen and the breast. These changes are from hormonal and the physical changes from the added weight of pregnancy.
Plastic surgery post partum rejuvenation addresses the external and internal changes that have occurred by repairing the abdomen.
Because each pregnancy is different, each restorative approach is different.
FREQUENTLY ASKED QUESTIONS
What if i get pregnant later? Several patients have had abdominal and breast surgery and become pregnant again. They have had normal pregnancies. Because I don't cut the ducts, they could breast feed as well. The abdomen and breast returned to the near tightening situation and did not require further correction.
Is the anesthesia safe? I have small children. Yes. Because I have nearly 25 years' experience in using only sedation anesthesia - not general - and using only highly trained board-certified anesthesiologists, the procedures have been 100% safe. You can literally walk out of the operating room afterwards should you want to.
Can I speed up the recovery? Yes. By avoiding any medicines that cause bleeding, you can minimize the bleeding risk. I frequently use non-painful drains to remove any fluid accumulation. I also fashion a custom plaster mold of your abdomen and apply it after the surgery. This greatly reduces bleeding, recovery time and tenderness. Many patients like to wear it after it is no longer required. Recovery is 3 - 13 days.
Can I lift my children afterwards? Yes. Liposuction and minis do not affect any muscles,and complete abdominoplasty has strong internal sutures. Ideally , avoiding heavy lifting for 2 days reduces discomfort but will not alter the results.
Do I have to have my sutures removed and when can I travel? Suture removal is not neccesary as I close the incisions in 4 layers - the last being with the newest long-lasting but dissolvable suture.
What about my husband? I have polled multiple husbands pre and post op these combination procedures. Many were only somewhat supportive before surgery but converted to being enthusiastic after surgery. Indeed, 15% of husbands or boyfriends have done or inquired about a procedure for themselves afterwards.
Are there functional changes? Yes. Most women feel less lower back pain after the abdominal correction.(Recent studies with CT scans shows improved back alignment after abdominal surgery.)
What are the finances? Insurance coverage is frequently available for many types of abdominal corrections . Cost ranges from $6,000.00 - $12,000.00.Financing is readily available for those that require it.
