ABDOMINAL LIPOSUCTION, TUMMY TUCK

The degradations of the abdominal wall due to pregnancies or a weight loss lead to a cosmetic, but mostly psychological discomfort. The appearance of liposuction has considerably modified this surgery by reducing the scarring result.

Cosmetic surgery of the abdominal wall involves several techniques that can be combined. Hence the importance of a careful clinical examination in order to properly plan the surgical procedure that will achieve the best result.

Three surgical techniques make it possible to correct aesthetic disorders on the abdomen:

–Liposuction or abdominal lipoaspiration, which can be performed alone if the skin is thick, firm and elastic.

–Abdominoplasty, or “tummy tuck”. This technique, often associated with a liposuction, will be performed in the case of a distended skin with a large excess and stretch marks.

-The body lift.This surgical technique allows to raise the falling buttocks and to tighten the belly, all in one procedure. It is carried out in the case of a significant weight loss when cosmetic abdominal surgery must be associated with a cosmetic surgery of the buttocks.

The goal is to remove damaged skin and redrape the healthy skin, hence the name of “lifting” or “tummy tuck”. Most often, the procedure is preceded by a liposuction of the abdomen and possibly the hips.

• The classic abdominoplasty:

The principle is to remove a band of damaged skin (distended, with stretch marks) located between the umbilicus and the pubic superior pole (Figure 1).

Figure 1: Principle of an abdominal plastic surgery

The least damaged skin situated above the umbilicus is detached from the muscular wall and descended to the superior pole of the pubis.

The abdominal muscles are often put closer to each other (closing of the abdominal right muscles diastasis). These muscles are often spread after one or more pregnancies.

The navel is put back into proper position through a small incision in the lowered flap of the skin. There is therefore a discreet scar around the umbilicus.

The patient must be carefully informed of the cicatricial result before surgery (Figure 2).

Figure 2: Scars of a common abdominoplasty

The scar is horizontal, slightly arched following the upper pole of the pubis, and goes from one hip to the other. The width depends on the cicatricial evolution of each patient.

Doctor Jean-Charles BAYOL performs his preoperative drawing so that the final scar is hidden in the panties and cannot be seen while wearing an underwear or a swimsuit.

• Localized abdominoplasty or mini abdominoplasty:

First, it consists in an abdominal liposuction associated with a partial restoration of the skin located under the umbilicus. The umbilicus is left in place and therefore no scar is left around it as in a conventional abdominoplasty.

The cicatricial result is a little less important than with a conventional abdominoplasty.

• The body lifting or body lift:

For information on body lift, click here.

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Two medical consultations will be held with Dr Jean-Charles BAYOL either at Laclinic-Montreux, or at the Beauty Suite in Lausanne, (near Geneva by train). During the second appointment, it will be possible to discuss the modalities of the procedure and its consequences, to answer your questions if you have them, and to create the hospitalization file.

A prescription for the purchase of abdominal restraint sheath will be made. This compressive garment can be ordered directly from the manufacturer, which will require a delay of approximately 15 days.

Since tobacco consumption is a major risk factor for postoperative healing, it is strongly recommended to refrain from smoking (or at least reduce consumption) one month before and one month after surgery.

It is also preferable to stop oral contraception as it increases the risk of thromboembolism.

Finally, do not take any medicine containing aspirin or anti-inflammatories treatment one week before the procedure because they will promote bleeding and the appearance of hematoma.

The abdominoplasty is performed under general anesthesia.

The hospitalization lasts mostly 3 days (2 days in case of a mini-abdominoplasty). In case of severe fatigue, the stay can be extended. The hospitalization will be at Laclinic in Montreux.

In order to achieve the best result, each surgical procedure is unique and personalized. The different stages of the surgery are as follows:

• The Liposuction, first of the belly fat tissue, sometimes associated with one on the hips.

• The scar has a variable length depending on the importance of the skin to be removed. It is located at the upper pole of the pubis and goes on either side to the iliac fossa. It is almost completely hidden in the underwear.

• The large right abdominal muscles, if they have been distended by one or more pregnancies, will be put back in tension.

The abdominal restraint sheath is placed at the end of the surgery, after the dressing has been put in place.

The procedure lasts from 2 to 3 hours depending on the surgical act to be performed.

In order to reduce the importance of bruises and postoperative swelling, you will be systematically taken care of by the department of physiotherapy, for a postoperative care. The check-out will happen on the same day, in the case of an outpatient hospitalization, or the next day, if you stay in hospital overnight. Gentle massages of the operated areas and LED care (lien vers LED) will ensure the lymphatic drainage and will promote the healing process. Several weeks after the procedure, an LPG treatment can be undertaken on the areas where the fat tissue has been collected.

Scar treatments should be performed for 15 days.

An anticoagulant treatment with low molecular weight heparin is systematically prescribed for a period of one week.

The abdominal restraint sheath should be worn day and night for 6 weeks.

A professional leave of 15 to 20 days must be planned.

The scar will have to be protected from the sun for one to two years with sun block.

The practice of sport can be resumed after 6 weeks.

The final result can be assessed after 6 months to a year. On the other hand, it may take a year and a half or even two years for the healing process to be complete. Regarding the scar, one must keep in mind that, if it generally fades over time, it will not completely disappear. It is important to remember that if the plastic surgeon performs the sutures, it is the patient’s body that heals.

In addition to the aesthetic benefit of the procedure, the improvement is also functional since the patient feels comfort especially while dressing. The psychological effects of the procedure also allow a better balance of the patient’s future weight.

In most cases, a properly performed abdominal dermolipectomy represents a real improvement for the patient, with the achievement of a satisfactory result, in accordance with what was expected.

Resulting imperfections can sometimes be observed and do not constitute complications:

– The scar can be located too high, asymmetrical, enlarged, hypertrophic or even keloid.

– The umbilicus may not appear as natural as before surgery.

– A cutaneous and fat excess may persist at each end of the scar (lateral ear).

– In the case of an excessive tension due to traction at the level of the scar, there may be an ascension of the pubic hair.

These result imperfections can be retouched under local anesthesia but not before a year after the first surgery.

An abdominoplasty must always be performed in a clinic approved for cosmetic surgery such as Laclinic Montreux.

With regard to the surgical procedure, by choosing a qualified, competent and serious trained cosmetic surgeon, you minimize these risks, but do not completely eliminate them.

The abdominoplasty is certainly the heaviest plastic surgical procedures. An abdominal dermolipectomy remains a true surgical act and carries certain operating risks even if they are rare.

These complications should be known:

– Thromboembolic events (phlebitis and pulmonary embolism): These complications are very rare but serious. The treatment is above all preventive: wearing compressive clothing, early lifting and mobilization and anticoagulant treatment by heparin of low molecular weight may be prescribed for 7 to 10 days. It is recommended not to take short-haul flights for 6 weeks, and long-haul flights for 12 weeks after the surgery.

– Hematoma: rare, it occurs in the first hours following the procedure (24-48 hours) and will require an additional surgery for evacuation, haemostasis and cleaning.

– Infection: rare, infection may require an antibiotic treatment or even surgical drainage in some cases.

– Lymphatic flow: It is not uncommon. When it occurs, sometimes repeated punctures will dry it out. Prolonged compression by the abdominal restraining sheath prevents this complication.

– Skin necrosis: it can occur in case of a major tobacco poisoning or in case of health problems such as diabetes or significant obesity. Most often this necrosis is limited but it can delay the healing process for several weeks. The resulting scar may be wide. This localized unattractive scar can be retouched under local anesthesia.

– Change in the sensitivity of the abdominal wall: a decrease in sensitivity can be felt especially in the sub-umbilical region. Sensitivity reappears with a variable delay of 3 to 10 months.

– Cicatricial anomaly: hypertrophic or keloid scar. This scar formation is rare, favored in black and Asian patients. These scars may require treatment with local corticosteroids.

– Subjectivity: Because the procedure is motivated by aesthetic reasons, the result can only be subjectively assessed. It is therefore important to recognize that the obtained result may not correspond exactly to the expected results.

Cosmetic surgery of the abdominal wall involves liposuction and abdominoplasty, or abdominal dermolipectomy (tummy tuck). This procedure can be extended or limited, in the case of a mini abdominoplasty. When it is associated with a lifting of the buttocks, this intervention is called a body lift.

The cosmetic abdominal surgery has a beneficial aesthetic result but also important functional and psychological effects on the patient.

Doctor Jean-Charles BAYOL always performs these procedures in a surgical clinic, in order to minimize The postoperative risks of this intervention.