The Tummy Tuck remains one of the most popular Cosmetic Plastic Surgery procedures. Also called Abdominoplasty, the procedure tightens the abdominal wall and is especially useful after pregnancy or weight loss.
Tummy Tucks After Other Abdominal Surgery
The question of how preexisting abdominal surgery effects Tummy Tuck planning, execution and recovery often arrises. While most the time an Abdominoplasty can be safely performed, there are some incisions that make the procedure dangerous. Today, we will talk about how scar location may change your Tummy Tightening Procedure.
Where Is The Tummy Tuck Scar?
The above Tummy Tuck before and after pictures show where the skin is removed.
To understand how previous surgery effects Abdominoplasty, it is important to know the location of the removed skin and the circulation that supplies the remaining skin. As the Tummy Tuck Before and After Pictures above show, the lower abdominal skin is excised to remove the excess from the lower belly, to lift the skin above the pubic region (the FUPA) and to leave a scar which is low enough that it hides below the belt-line. The circulation that keeps the remaining skin alive travels in the superficial circulation of the skin that is located above and lateral (toward the sides). It’s the circulatory pattern of the remaining skin that really determines which, if any, of the surgeries performed prior to the Tummy Tuck are likely to cause problems.
Common Surgeries That Do Not Effect Abdominoplasty
In general, any surgery which leaves a scar within the excised skin is safe. This includes c-section, hernia and low appendectomy scars. Surgeries which leave small scars, such as laparoscopic surgery are safe.
Longer scars in the midline are also safe. Since the blood supply comes from each side independently, an incision that runs up and down the middle is unlikely to cause wound healing problems. Below is an extreme example.
The Fleur-de-Lis Tummy Tuck
The Fleur-de-Lis Tummy Tuck is an unusual Tummy Tuck that includes not only the usual low abdominal skin resection, but also removes skin from the middle of the abdominal wall to tighten side to side.
The Fleur-de-Lis Tummy Tuck is used in cases of extreme weight loss, when the upper abdominal skin is loose from side-to-side. In the example above, my patient had a pre-existing midline scar running from the rib cage to the pubic region. Since the scar is in the middle, it is not cutting across the blood supply and is removed with the excess skin.
The previous scar was excised with the loose upper abdominal skin as evidenced by the removal of the excess skin in her underwear, as well as the excess skin located above the underwear. Her clothes fit much better after her surgery, and her mobility is improved thanks to the loss of the excess abdominal skin. The muscle, too, was tightened to further improve the cosmetic results and to provide better muscular support for her abdominal wall.
No More FUPAs
The FUPA (fat upper pubic area) is the excess fullness located above the pubic region and below the excess belly skin. If not addressed at the time of a Tummy Tuck, this excess skin can be a continued source of annoyance and embarrassment.
The FUPA (fat upper pubic area) can be seen in the Abdominoplasty Before and After Photos above. It is the separate skin fold / bulge seen below the redundant abdominal wall skin and above the pubic region. If a standard Tummy Tuck is performed, the FUPA remains a source of annoyance and embarrassment. These pictures were originally shown on my TV show, Body Beautiful. The before picture did not require censorship, because the FUPA covered the private area.The after picture, on the other hand, had to be covered. The scar from the Tummy Tuck can be seen extending laterally from the sides of the blacked out pubic region.
Common Surgeries That Complicate Abdominoplasty
The most common surgeries that can negatively impact the healing after a Tummy Tuck include the traditional “open” cholecystectomy (gall bladder) and pancreatic or any other upper abdominal surgery performed through a “chevron” incision.
The traditional cholecystectomy scar runs diagonally across the right upper quadrant of the abdomen, parallel to the lower edge of the rib cage. This incision cuts the blood vessels supplying the skin below the scar and can lead to problems with circulation to the sin between the scar and the Abdominoplasty scar. Problems can range from slight redness, to complete skin loss. Options are available to “delay” the skin flap, a smaller operation a few weeks before the Tummy Tuck to improve the circulation to the skin, but sometimes performing the Tummy Tuck may be too risky.
The extreme is the “chevron: incision. This scar extends across the entire upper abdomen from side-to-side, just below the ribs. A traditional Tummy Tuck is usually not advisable after this surgical approach. Instead, a reverse Abdominoplasty may be recommended. The Reverse Abdominoplasty is an abdominal wall tightening procedure which is performed across the top of the abdomen, rather than the across the bottom. In most cases, the skin cannot be tightened as well as with the traditional approach, but in select cases, the improvement is still very good.
Tummy Tuck Consultations
In most cases, previous abdominal surgery is not a contraindication for Abdominoplasty; however, you should discuss your specific situation with a Board Certified Plastic Surgeon, prior to scheduling any elective surgery. If you are in the San Francisco Bay Area call (925) 943-6353 today, to schedule a private consultation tailored to your specific needs.
The Mommy Makeover combines the most common body shaping procedures, breast augmentation and tummy tuck, into one, maximum result, breast and belly shaper.
The Mommy Makeover is one of my favorite combos. The ability to reshape the damage done to a woman’s body after childbirth or weight loss, in a single operation, makes it one of the most satisfying Cosmetic Plastic Surgery procedures.
What Is A Mommy Makeover?
The Mommy Makeover is not a specific procedure, but rather the combination of breast and belly enhancement performed in a single operation. Breast Enhancement may include Breast Augmentation, Breast Lift, Breast Augmentation with a Lift or Breast Reduction. It all depends on what needs fixing. Belly Enhancement is usually a Tummy Tuck; however, for the patient who needs less, Mini Tummy Tucks or Liposuction may be the procedure of choice.
Mommy Makeover Video Presentation
Recently, I had the opportunity to discuss Mommy Makeovers with the San Francisco Bay Area television audience. Body Beautiful airs on KRON 4, the San Francisco Bay Area’s News Station. The Mommy Makeover features the best and the latest in Cosmetic Plastic Surgery. This week, the spotlight is on Mommy Makeovers.
Mommy Makeover Video
More About Mommy Makeovers
The Mommy Makeover Video segment featured above reviews many of the available options and outcomes of the procedure for several of my patients. Additional Mommy Makeover Videos are available here, on the San Francisco Plastic Surgery Blog, and on my main site’s Mommy Makeover Video Page.
Mommy Makeover Consultations
When you are considering a Mommy Makeover, be certain to consult with a Board Certified Plastic Surgeon. Call (925) 943-6353 today, to schedule a private, personalized Mommy Makeover consultation in our San Francisco Bay Area Plastic Surgery Clinic.
Learn the latest plastic surgery news on the Bay Area’s News Station’s, KRON 4’s, Body Beautiful with Dr. Mele.
Getting ready for today’s live show with Janelle Marie. Body Beautiful airs at noon (June 7, 2017) on the San Francisco Bay Area’s News Station, KRON 4. Tune in to hear the latest plastic surgery news. Today’s topics include:
Breast Augmentation Lifts (Augmentation Mastopexy)
Brazilian Butt Lifts (Fat Grafting to the Buttocks)
Thigh Lifts (Thighplasty)
The previous post has more details about the topics to be covered. If you are reading this after the show airs, segments from the show will be posted on the San Francisco Plastic Surgery Blog.
EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.
The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.
This Wednesday, June 7, 2017, I will be on the San Francisco Bay Area’s News Station, KRON 4’s Body Beautiful. The show airs live at noon. As usual, the discussion is focussed on the latest Cosmetic Plastic Surgery News for the San Francisco Bay Area.
Body Beautiful Plastic Surgery Topics
This week’s half-hour television show discusses Cosmetic Plastic Surgery of the Body. Planned topics include:
The Mommy Makeover Before and After Pictures that leads this post demonstrate the most popular combination cosmetic plastic surgery. By combining Breast Augmentation and Tummy Tucks, the two areas the often sag after pregnancy, the breasts and the belly, are both addressed. Of course, the procedures can be performed without having had children. The term Mommy Makeover was coined because of the frequent request from mommies to repair the damages of pregnancy on their breast and bellies. Another common situation in which Mommy Makeovers are performed is significant weight loss.
EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.
Breast Augmentation Mastopexy (Breast Implants with Breast Lifts)
Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.
Breast Augmentation is still one of the most frequently performed cosmetic plastic surgery procedures, but what happens if the breasts are saggy, or the nipple is very low on the breasts? Breast Augmentation in these situations may provide larger breasts, but not necessarily perky ones. As many as 40% of Breast Augmentations combine some sort of Breast Lift. The most common reasons for this are low set nipples or saggy breasts due to excess skin.
Additional procedures can also be added to correct other breast problems, Fine details of the breasts that are often targeted for improvement are: Areola Reduction, the improvement of Breast Asymmetry, Breast Implant Revision for women who had Breast Implants before pregnancy and Inverted Nipple Repair. Breast Reduction, perhaps paradoxically, can also be combined with Breast Augmentation Mastopexy when heavy lower breast tissue is distorting the shape of the breasts.
Brazilian Buttocks Lift
The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.
A newer body procedure is allowing Board Certified Plastic Surgeons to shape an area that traditionally has been difficult. The Brazilian Buttock Lift (BBL), allows us to remove fat with Liposuction and reuse it to enhance the buttock contours. Pioneered by Brazilian Plastic Surgeon, Ivo Pitanguy, the procedure allows for customized augmentation of the buttocks, and shape that is more pleasing to the eye than Buttocks Implants can provide.
Thigh Lifts in the SF Bay Area
The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.
Thigh Lifts are one of the less frequently performed cosmetic plastic surgery procedures. The numbers have risen in response to Bariatric Surgery and the massive weight loss associated with it. As weight is lost, the thigh skin that is stretched during weight gain becomes loose. As the volume of the thigh decreases, so does the support that the extra fat provides the thigh skin. As a result, the skin can hang like drapery. The Thigh Lift removes this excess skin, and helps to tighten the thigh, especially the upper, inner thigh.
Watch Body Beautiful June 7, 2017, on KRON at Noon Wednesday
If you are interested in learning more about any of the above procedures, I have provided links in this post, and I encourage you to watch me live on KRON 4, this Wednesday at noon. Segments from the show will be posted here, on the San Francisco Plastic Surgery Blog, in the coming days. So if you miss the live show, you can still catch up here or on my local San Francisco Plastic Surgery Web Sites.
Internet education can be very helpful, and it is the goal of the San Francisco Plastic Surgery Blog; however, because information on the Internet is designed to apply to the general population, it is generic in nature. Medical advice cannot be giving without the personal contact that an in-person consultation appointment provides. To get “brand name” plastic surgery information, tailored to your specific needs, call my San Francisco Bay Area Plastic Surgery Clinic today, at (925) 943-6353, and schedule an appointment to get your personal, Board Certified Plastic Surgery information.
The most common Mommy Makeover combination is the one depicted above: Breast Augmentation and a Tummy Tuck. Breast Implants restore the lost breast volume, while the Tummy Tuck flattens and tightens the abdominal wall.
Mommy Makeovers remain one of the most popular body shaping combinations for women. The combination of Breast Enhancement and Belly Embellishment is often performed after childbirth and/or weight loss, with the goal of reestablishing more shapely and youthful proportions. While Breast Augmentation with a Tummy Tuck is the most common combination, it is important to pick the procedures most appropriate to your needs. Below, I discuss the options for rejuvenation of the breasts and the belly.
Breasts often change with pregnancy and breast feeding. Variations are common, but typically breasts increase with pregnancy and then end up smaller after lactation ceases. The problems come when the postpartum breasts are too small, too saggy or remain too large (less common but, can be just as annoying).
Breast atrophy after pregnancy is very common. Breast Implants can restore lost volume and restore the proportions that enhance the breasts’ shape both in and out of clothing.
It is best to wait at least three months after lactation ceases before having any breast procedure. This allows the breasts to settle down to a consistent shape, providing more predictable and safer surgery. Depending on your experience and goals, options for Breast Enhancement include:
Bellies, too, get stretched out during pregnancy. Subsequent pregnancies tend to increase injury, especially if close together. Working out and abdominal exercises help, especially if you are in good shape before pregnancy and maintain a healthy weight during pregnancy. Even under the best circumstances, a big healthy baby can trump a flat healthy belly. The options for tummy rejuvenation include:
After pregnancy or weight loss, the abdominal muscles, skin and fat can all be compromised. Fortunately, a Tummy Tuck repairs all three areas. An experienced Board Certified Plastic Surgeon is the best choice for your Mommy Makeover.
Liposuction can also be used in combination with either of the Tummy Tucks, and the fat removed with Liposuction can be repurposed to enhance other curves, like the buttocks when combined with a Brazilian Butt Lift. If you are wondering which procedure is best for you, an in-person consultation is the best way to find out. I have a page on my main website that explains some of the decision points when trying to decide: Liposuction or Tummy Tuck?
Mommy Makeover Consultations
To explore all your body rebuilding options, call (925) 943-6353, and schedule a personal consultation appointment in our San Francisco Bay Area plastic surgery clinic. A Board Certified Plastic Surgeon is your best guide for explaining what Cosmetic Plastic Surgery can offer. Since we offer a wide variety of procedures, we can offer you the best choices for your Mommy Makeover.
The 2016 ASPS National Plastic Surgery Statistic were released this week.
This week the American Society of Plastic Surgeons (ASPS) published the United States’ national Plastic Surgery Statistics for 2016. It is always interesting to me to see how the national statistics correlate with my own Cosmetic Plastic Surgery practice here in the San Francisco Bay Area. Last year, the correlation was pretty close.
Top Ten Cosmetic Plastic Surgery Procedures
As a group, surgical procedures grew 4% from 2015 to 2016. The top five Cosmetic Plastic Surgery procedures are almost the same. Facelifts edged out Tummy Tucks for the fifth spot, but the popularity of the two procedures remains very close. Here are the top five procedures as reported by the ASPS:
The fastest growing procedure last year was the Brazilian Butt Lift (BBL). The BBL is not really a buttocks lifts, but more a buttocks enlargement. During the procedure, fat grafting is used to enlarge the buttocks and selectively enhance its shape. The results can be quite dramatic and the resultant shape is usually much nicer than that obtained from buttocks implants.
The Brazilian Buttocks Lifts is again the fastest growing cosmetic plastic surgery procedure. Significant improvement in the size and shape of the buttocks is possible by removing disproportionate fat from other areas, the lower back in this example, and selectively inserting the excess fat into the buttocks.
The number of Brazilian Butt Lifts increased 26%, from 14,705 to 18,489 in 2016. The procedure was also the fastest growing procedure of 2015 when it grew 28%, from 11,505 to 14,705. In fact, for the US population, the number of BBL’s has doubled from 2013 to 2016, and shows no signs of slowing in 2017.
Minimally Invasive Plastic Surgery Procedures
Minimally invasive plastic surgery procedures grew 3% in 2016. The top five procedures remain:
Botulinum Toxin Type A (Botox®, Dysport®, Xeomin®)
If you live near the San Francisco Bay Area and are considering Cosmetic Plastic Surgery, be certain to seek out an experienced and Board Certified Plastic Surgeon in your area. To schedule a private consultation, tailored to your specific needs, call (925) 943-6353, today.
Smoking leads to more complications after surgery.
There is ample evidence proving that smoking tobacco cigarettes increases the risk of complications after plastic surgery. Most plastic surgeons recommend that smoking be stopped four weeks before and four weeks after cosmetic surgery to reduce complications and improve healing. If you are a smoker, this may seem excessive, but even four weeks is a compromise. For example, it takes eight weeks for the immunosuppression that accompanies smoking to substantially resolve.
Since patients and doctors alike want the best results with the lowest risk of complications, stopping smoking before plastic surgery is aligned with the patients’ ultimate goal of being better, faster. In fact, even if you are not considering plastic surgery, not smoking significantly improves your health and decreases the outward signs of aging.
Smoking And General Surgery
Smoking doubles the risks associated with general surgery (operations like hernia repair, appendectomy and gall bladder removal). The glass-half-full way to look at this is that if you smoke, you can cut the risks of surgery in half by stopping smoking four to eight weeks before surgery.
General Surgery Vs. Plastic Surgery
General surgery procedures and plastic surgery procedures are different. Many general surgery procedures are emergencies, so there is little chance to stop smoking before surgery. Additionally, most general surgery operations are performed on internal organs, rather than the skin. Since general surgeons are not usually rearranging the skin, the circulation to the skin is less likely to be disturbed with general surgery procedures. The mastectomy is the most obvious exception to this rule.
Smoking And Plastic Surgery
Smoking increases the complications of plastic surgery by 600%. Plastic Surgery is Skin Surgery, so most procedures involve rearranging skin, tightening skin, stretching skin or removing excess skin. The sentinel procedures for smoking studies in plastic surgery have been Face Lifts, Breast Reductions and Tummy Tucks.
How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for the health benefits to be seen.
Face Lifts, Breast Reductions and Tummy Tucks
Face Lifts, Breast Reductions and Tummy Tucks require the formation of skin flaps. Skin flaps are sections of skin that are moved based solely on the blood supply within the skin. These vessels are extremely sensitive to smoking. When smoking, the blood vessels in the skin contract, reducing the blood flow, and the ability of the incision to heal. For these procedures, the risk of wound healing problems is not doubled like in general surgery procedure. It is increased by factor of six. Wound healing problems and skin loss are six times more likely for smokers than for non-smokers.
Is Marijuana Safer Than Tobacco?
The banner on the left was meant to convince voters that marijuana should be legalized. The banner on the right is a joke. Any questions?
No. In many ways, smoking a weed is smoking a weed. Both lead to increased coughing, and for most facial plastic surgery and body work, this causes real problems like bleeding and torn sutures. It is believed that the high from marijuana is directly related to the damage done to the alveoli. Just like smoking, this leads to an increased heart rate to compensate for the decreased oxygen delivery and lower than normal oxygen concentrations in the blood. Since normal oxygen delivery is better for wound healing, smoking makes healing worse. Marijuana may decrease nausea, and so does tobacco, but there are better and safer meds for the nausea associated with anesthesia. Marijuana also has psychological effects not present with tobacco, which can further interfere with the medications given around the time of surgery.
Is Vaping Safer Than Tobacco?
An actual Lucky Strike advertisement, trying to make is seem like doctors recommend them. Granted, less information about the long term effects of smoking was known then. The message of the ad is that their cigarettes are less irritating than other cigarettes; however, they still make you cough, and coughing leads to additional surgical complications. Less terrible seems to be a redundant theme in smoking advertising, begging the question that it is still terrible.
The long-term effects of inhaling nicotine vapor are unclear. It may be less likely to cause cancer and heart disease, but research is still early. Early in smoking’s history, it was touted as the new health craze. It is good to know the history, so that we don’t repeat it.
While there seem to be fewer noxious chemicals with e-cigarettes, questions remain about exactly what all the substances in e-cigarettes are, and what they do. The American Society of Plastic Surgery has recommended to all its members that e-cigarettes be treated the same as cigarettes until they have been proven safe. Definitive research on the effects of vaporized nicotine on the survival of skin and soft tissue flaps is not currently available. Nicotine is vasoactive, and inhaling nicotine vapor may have similar effects on skin circulation as inhaling the nicotine in cigarettes. When it comes to your appearance and your health, why take unnecessary risks?
What Do Most Plastic Surgeons Recommend?
It may seem like I am being hard on smokers, but these are not theoretical risks. I have seen Tummy Tucks go from perfect to purple after half a cigarette. I have replanted fingers successfully, only to have a patient go home, weeks later, smoke and have his finger turn black and fall off. Smoking caused the blood vessels in the skin to contract to the point of not working. These are preventable injuries, and there is no better medicine than prevention.
Most plastic surgeons recommend stopping smoking four weeks before and after any procedure that involves skin flaps. The most common cosmetic skin flap procedures are Face Lifts, Breast Reductions and Tummy Tucks. The risks of wound healing problems is six times higher in smokers when compared to non-smokers having these types of procedures.
When the incision used is only an access point, i.e. no skin flaps, like Breast Augmentation, your risks are only doubled from smoking. Only doubled. Think about that.
While most plastic surgeons will operate on smokers for non-skin-flap type cosmetic procedures, it is still better to stop at least four weeks before surgery. And if you can stop for four weeks, there is no reason to restart. Only 15% of Californians currently smoke cigarettes. This is an all-time low, but with the recent passage of Proposition 64, we will have to see if the decline in smoking will continue.
The Tummy Tuck is the Plastic Surgery workhorse for repairing the abdominal contour after childbirth or weight loss. Abdominoplasty is consistently one of the most frequently performed cosmetic plastic surgery procedures, because it can provide the best, safest and most predictable results possible.
Abdominoplasty on Body Beautiful
I had the opportunity to speak about Tummy Tuck surgery on the San Francisco Bay Area’s News Station, KRON 4’s, Body Beautiful. The following Abdominoplasty Video contains multiple sets of Tummy Tuck Before and After Pictures. Each exemplifies the possibilities available with Abdominoplasty.
Tummy Tuck Video (Abdominoplasty)
Abdominoplasty Consultation Appointments
When considering your Tummy Tuck, be certain to ask how the procedure is performed, what can be improved and what will remain the same. I prefer to keep my Abdominoplasty patients overnight. This allows for a supervised and more comfortable recovery, and assistance with mobility. I find once the initial pain is well controlled, and you are confident in your ability to move about, the recovery goes much smoother.
Be certain to consult a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.
Every Mommy Makeover includes enhancement of both the belly and the breasts. The most common combination is Breast Augmentation with a Tummy Tuck (Abdominoplasty). However, other options include:
Breast Implants with Breast Lift
Mini Tummy Tucks
Other Body Enhancements
Brazilian Butt Lift
Lower Body Lift
The combination best for you depends on what you need, tempered by safety and predictability.
Mommy Makeover Video Presentation
The television segment included below is all about Mommy Makeovers and includes many of the most popular variations. The Mommy Makeover Video includes Mommy Makeover Before and After Pictures that illustrate what the procedure has to offer.
The following video segment is from my latest appearance on the San Francisco Bay Area’s New Station, KRON 4. The show gives me the opportunity to talk about the latest Cosmetic Plastic Surgery News.
Mommy Makeover Video
Make Your Mommy Makeover Consultation Appointment
When considering a Mommy Makeover, be certain to find a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.
Dr. Joseph Mele appears on the Bay Area’s News Channel, KRON 4’s Body Beautiful this week discussing Breast Augmentation, Breast Lifts, Tummy Tucks, Liposuction and Mommy Makeovers.
Body Beautiful Live Wednesday at noon on KRON 4
San Francisco Bay Area’s News Station, KRON 4, will be airing the latest installment of Body Beautiful this week. The show will be broadcast live, at noon, this Wednesday (Dec 7, 2016) on channel 4, and will include the latest in Cosmetic Plastic Surgery with the emphasis on Body Sculpting.
Liposuction – Sculpting the body by removing disproportionate fat
Abdominoplasty – Using a Tummy Tuck to tighten the abdominal wall and remove excess skin and fat
Mommy Makeover – Combining Breast Enhancement with Abdominal Enhancement to reverse the damage done by pregnancy
So Many Topics; So Little Time
I try to keep the show fast-paced, accurate and informative, but I did not learn about these topics in a half-hour television show. More information is available online by clicking on the links above, but nothing can substitute for an in-person consultation tailored to your specific needs. If you are serious about learning what Cosmetic Plastic Surgery can offer you call my Walnut Creek Plastic Surgery Clinic at (925) 943-6353.