What makes a loose abdomen? Usually four things conspire to give us bad abdominal contour. Too much intra-abdominal fat makes the abdomen round. No amount of surgery can make a round and filled abdomen flat and attractive. Weight reduction, by whatever means is the only reasonable way to reduce intra-abdominal fat. The second problem is abdominal wall looseness. Pregnancy is the main source of widened abdominal muscles. The body wall relaxes to accommodate a pregnancy. It usually retracts to a pre-pregnancy anatomy, but not always. Repeated pregnancy will often stretch the tissue even more. Even though many women get their shapes back following pregnancy, the inability to restore abdominal curves is often due to a stretched body wall that didn’t retract. The third issue is fat between the muscle and the skin. This layer of insulation can hide curves and look bad. The fourth factor is skin. Most skin will snap back after stress is removed, however, after pregnancy, weight reduction or as a product of aging, hanging skin can be a problem.
When someone wants an abdominoplasty. We begin by asking, “What’s the problem?” It can be any combination of abdominal wall weakness, superficial fat deposition and loose skin. If the abdominal wall is loose, we tighten it by bringing the abdominal muscles together (plication). This recontours the body wall and eliminates the central weakness called the diastases. Fatty deposits are best corrected with liposuction, and ideally, at the same time. This thins the soft tissue blanket and allows our body contouring to show through. In most cases, the abdominal liposuction should be performed with liposuction of the flanks and back. This allows a complete abdominal rehabilitation to take place. The skin is removed where and when it’s needed. The best results put the scar as low as possible and extend the scar outward in a line that can be best hidden by clothing.
The navel (belly button) is usually left attached as it normally sits on the abdominal wall, but in some cases, it’s floated or brought down with surrounding skin. This is best performed when there is a high navel or when little skin is removed. The details of the procedure are many. Does one use drains? Does one use pain pumps? How do you close the skin? All of these details matter and depend on the patient’s goals and anatomy.
Recovery is measured in weeks. Normal activities are usually easy by two weeks. Light exercise can begin at three to four weeks. Normal exercises begin at six weeks. However, all activities have to be measured against your body tolerance. If it hurts, don’t do it. Risks exist and each patient’s potential complications have to be discussed on an individual basis.
Recent advances in technology and technique have allowed more aggressive approaches to the abdominoplasty patient such as 4D abdominoplasty that sculpts the abdomen at the same time as the abdominoplasty.
The American Society of Plastic Surgeons reported that 106,000 abdominoplasties were performed in 2012. This is an important operation that serves the need for many women. The potential of this surgery is limited only by the imagination of the surgeon. With Dr. Geldner’s superior skill, 25 years of experience, and his experienced and compassionate staff, we exceed our patient’s expectations.
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“Although I came to you to improve my outer appearance, I just want you to know how much your love, passion and expertise in this field are appreciated. You are an amazingly qualified surgeon who knows how to work magic.”