While we are happy to offer noninvasive alternatives to liposuction (CoolSculpting is an excellent option) we have been consistently disappointed by noninvasive techniques for tightening the skin. Therefore, abdominoplasty is currently the only effective option for improving the appearance of significantly loose skin in the abdominal area. Procedures that use the word “tuck” are exactly that. Meaning, in order to “tuck” the skin, the excess skin must be removed. As a result of “tucking” the skin, abdominoplasties have a scar in the lower abdomen, which can generally be placed within the area that would be covered by a bathing suit or underwear.
Depending on skin elasticity, removing fat alone may not adequately improve the overall appearance of the abdomen. Younger individuals typically have excellent elasticity, and the skin can be expected to “bounce back” following liposuction or CoolSculpting, which lends to an excellent overall result. However, factors such as history of pregnancies, significant fluctuations in weight, age, history of smoking, and genetics can all contribute to diminished skin elasticity.
Unfortunately, non-invasive skin tightening techniques – including Ultherapy and Thermage – are on the whole extremely poor in achieving meaningful tightening of lower abdominal skin. Dr. Rapaport does not recommend these procedures. His NYC tummy tuck may well be the procedure of choice for patients with poor skin elasticity.
An abdominoplasty has two components: One is the skin and fat that occurs beneath the skin and above the muscles of the abdominal wall. We refer to this fat as "pinchable fat," as opposed to the fat that occurs beneath the abdominal muscles. That fat, also referred to as visceral fat, lies within the abdomen and is therefore not “pinchable.” The other component of some tummy tucks is the muscle, whose front portion you can feel with your fingertips when you pinch the skin and fat of your abdomen.
As part of normal anatomy, there is a fine line (linea alba) between the two vertical rectus muscles in the front of the abdomen. These are the muscles that create a six-pack when well developed. As one of the natural changes that occur during pregnancy or major weight gain, the abdominal wall stretches. In some women, the linea alba between the two muscles stretches and does not return to normal. This is called a diastasis recti.
To repair diastasis recti during an abdominoplasty, the muscle edges are sutured together, thereby tucking in the loose abdominal wall. Sutures can also be placed at other portions of the abdominal wall to create further tightening and shaping of the muscle.
While tightening the abdominal muscles during an abdominoplasty can provide substantial improvement for some of our patients, this can lead to some abdominal soreness during recovery. When a patient has abdominal muscle weakness, or abdominal wall laxity, they may be a candidate for abdominal muscle tightening during the abdominoplasty procedure.
In many patients, there is no real problem with the abdominal wall. For patients whose primary complaint is their loose skin and fat, there is no need to perform any suturing of the muscles. Typically, these patients will not complain of abdominal pain following their surgery; however, they may experience some lower back pain during the six-day recovery period when it is required to walk bent over. An abdominoplasty that removes loose skin but does not tighten the underlying abdominal muscles is called a skin-only abdominoplasty.
The scar from a full abdominoplasty must, by necessity, be a long scar in order to remove the large area of skin. Top New York City tummy tuck surgeon Dr. Rapaport frequently likens this scar to a hem on clothing; the hem has to cover the length of the area to be reduced. In fact, Dr. Rapaport has seen some extremely unfavorable results when other, less experienced surgeons have tried to achieve the results of a full tummy tuck with a short scar.
The amount of pulling in and crimping of the tissues, and/or excess of skin on the sides (dog ears), can be very disturbing. It is important to differentiate between a long scar and a wide scar. In the vast majority of cases, Dr. Rapaport’s abdominoplasty scars are narrow and fine because of the techniques employed in closure and the fact that tension in the closure is kept to an absolute minimum.
A tummy tuck surgery is a significant surgery. Because of the skin removal, it is crucial that the area of closure be kept under minimal tension for the first several days after the operation. This is why all abdominoplasty patients are instructed to walk bent over whenever they are upright for the first 5-7 days.
All of Dr. Rapaport’s full abdominoplasty patients are required to stay overnight in Manhattan, New York under the supervision of a nurse, both for patient safety as well as comfort. The nurse ensures that the patient is resting in the proper position (back elevated 30-40 degrees, legs bent with pillows under the knees). The nurse monitors blood pressure, as well as discomfort and can medicate accordingly, as needed. The nurse also monitors drainage (drains are almost always used) and instructs the patient on drain care for the days following their abdominoplasty in New York City.
Prior to the nurse’s departure on the morning after surgery, photographs of the abdomen will be taken and sent to Dr. Rapaport to confirm good healing. Typically, between days 5 and 7 following surgery, drainage is low enough that the patient can come into the office and have her or his drains removed. At this point, the patient can stand upright again.
The minimum downtime after abdominoplasty surgery is about 10 days. If surgery is performed on a Friday, one can generally expect drains to be removed the following Thursday or so, and one may return to very non-active work 10 days after surgery. However, it must be emphasized that even at 10 days after an abdominoplasty, activity must be kept at a minimum in order to ensure proper healing and to avoid complications.
A patient coming from another city or country should plan to arrive in New York at least 1 full day (preferably 2) prior to surgery and to stay in New York for a minimum of 14 days following surgery.
A complete tummy tuck surgery normally takes approximately 2.5-3 hours to perform. A mini tummy tuck, on average, takes between 1 and 2 hours to perform.
General anesthesia is typically utilized for abdominoplasty surgery. Epidural anesthesia may be employed in selected cases.
Risks related to smoking in tummy tuck surgery
When one smokes cigarettes, there is a very significant disturbance of the blood flow within the skin. This abnormal blood flow can lead to major complications in surgeries where the skin is significantly manipulated, such as an abdominoplasty. These complications can include necrosis of the skin, which essentially means that the skin does not survive, and the patient subsequently would experience an open wound and poor scarring to follow.
It is for this reason that Dr. Rapaport will not perform an abdominoplasty on people who are actively smoking. We require that our abdominoplasty patients stop all smoking for a minimum of six weeks in order to help reduce the risk of major complications.