A Board Certified Plastic Surgeon in Scottsdale
Posts tagged tummy tuck Arizona
Plastic Surgery after Major Weight Loss: The Modified Vertical Abdominoplasty.
22 years ago
Plastic surgery after major weight loss.
Scottsdale – After major weight loss many people experience notable skin excess in almost all the areas of the body. For many, the anterior abdominal wall becomes a priority. For most, a comprehensive circumferential body contouring procedure, such as, a body lift offers the best overall improvement. However, many patients believe the bodylift is too aggressive or they do not want an incision that goes all the way around their body for other reasons. Those patients may present themselves requesting a traditional tummy tuck. Unfortunately, the standard tummy tuck does not address all the excess skin that is usually present after major weight loss.
A Modified Vertical Abdominoplasty, on the other hand, has been shown to compensate for most of the excess skin and can help patients achieve a better result. Other options might include an extended tummy tuck (will be covered in a forthcoming issue of the blog). While for others the only option may still be the bodylift. An exam by a plastic surgeon will be necessary to see which procedure might ultimately be better for you.
The modified vertical abdominoplasty has been around for a long time. It was, however, seldom used until the popularity of weight loss surgery exploded a few years back. An article published in Plastic and Reconstructive Surgery, presents a significant experience using this technique out of Harvard Medical School. The authors present a 2 year experience, in 64 consecutive patients and noted the outcome and complications. The average patient in the series was 44 years old, had lost 59 kilograms, and had surgery done 22 months after bariatric surgery. Some of the patients had hernia repair performed at the same time as modified vertical abdominoplasty. Seven other patients had brachioplasty (arm tuck) or breast surgery.
The procedure involves creating a horizontal abdominoplasty excision combined with vertical triangular excision of the tissues above the belly button. It is an ideal design for patients that already have an open bariatric surgery scar. The design of the skin excision compensates better than the traditional tummy tuck for the amount of excess skin seen in major weight loss patients. Final closure of the incision leaves an upside-down T design on the abdomen.
The results of the study demonstrate that the procedure can be carried out efficiently, with an average time of 2.5 hours by itself and 3.6 hours with hernia repair. The weight of the tissue removed, on average, was 3.8 kilograms. The most common complication was wound breakdown at the T junction, experienced in 17 patients, seroma formation (trapped fluid) in 3 patients, hernia recurrence, and minor wound separation.
Importantly, the authors only identify one potential risk factor for wound healing complications at the T junction- and that was a Body Mass Index (BMI) of 35 and above. In fact, they no longer offer the procedure to patients with a BMI greater than 35, instead they encourage those patients to loose weight until they can have surgery. Abdominal scars, diabetes and smoking were not independent risk factors for wound healing complications.
Patients should realize that Modified Vertical Abdominoplasty is an option after weight loss surgery that “partially compensates” for all the excess skin. Bodylift is still considered the best operation. However, the MV Abdominoplasty may be associated with less risk than body lift. Wound healing complications at the T junction are common as this article shows, but most wounds healed efficiently with treatment. The authors of the article stated that all wounds healed by an average of 4 months. This is not unusual since bariatric patients suffer from profound malnutrition and it takes a long time for most wounds to heal completely (model used in illustration).
Know your Options: Plastic Surgery after Pregnancy.
02 years ago
by Dr. Aldo
in In the news
Options after pregnancy.
Scottsdale- Body contour changes after pregnancy are well known. In the abdomen, most women develop excess skin, stretch marks, and loose abdominal muscles. Others may develop a variety of breast deformities, such as asymmetry of the breasts, saggy breasts, and atrophy or softness of the breasts. Yet others, may never loose that “baby” fat. The recommended Phoenix plastic surgery procedures will vary from patient to patient. However, the breast and tummy combination with or without liposuction is known as the mommy makeover. On the blog, I plan to review important articles related to post-pregnancy plastic surgery options currently available to patients.
Some of the topics included include:
One stage augmentation and breast lift.
Safely combining tummy tuck and breast surgery.
Abdominoplasty combined with additional Arizona plastic surgery.
10 years of outpatient abdominoplasty: safe and effective.
Seroma risk for combined liposuction with abdominoplasty.
Extreme cosmetic surgery.
Decision making in abdominoplasty.
Revision augmentation/mastopexy.
and many more…..
(model used in illustration).
Composite Body Contouring: Safety is demonstrated in new study.
32 years ago
Scottsdale – Composite body contouring is relatively new on the plastic surgery scene. The composite body contouring procedure includes a tummy tuck along with a certain amount of lipo, based on the patient’s desires and needs and fat grafting to deficient areas. In many cases, the liposuction can be circumferential and can include lipo of the upper and lower back, love handles and extremities. A modified technique is used to perform the tummy tuck which can reduce the risks of wound healing complications. Restoration of body contour with fat transfer can be used to give better shape to the buttocks or thighs. I have been performing composite body contouring since 2005 and have been impressed with the outcomes.
It is very important to provide the greatest amount of safety for our patients when performing such cases and the key with this set of procedures is to perform them only in a surgical facility that can admit patients for recovery and observation for at least 24 hours after surgery. I use a specialty surgery hospital that is specifically designed to meet the needs of cosmetic plastic surgery patients.
In many ways, “the composite” is a variation of the “mommy makeover” concept of combining multiple procedures to reverse the changes associated with pregnancy. Previously published studies demonstrate that the combination of cosmetic breast surgery and Arizona tummy tuck is safe when performed in an appropriate environment. That combination of surgery is the classic “mommy makeover” duo I have used since 2003. On the other hand, the “composite” mostly excludes breast surgery, but targets different areas that can affect women either post-pregnancy or with weight gain or loss, including the tummy, back, thighs and buttocks. I report here on a recently published study that documents the safety and efficacy of composite body contouring.
The article was published in the July issue of Aesthetic Plastic Surgery. The study included 64 consecutive female patients who underwent tummy tuck and circumferential liposuction with fat grafting to the buttocks (45), thighs only (6), and buttocks and thighs (13). The surgeons report a 90% satisfaction rate with the surgery, with 63% of patients judging the results as excellent or very good after a follow-up time of 3.2 years. Approximately 10% of patients were dissatisfied with their results.
The group reported that, on average, they removed 2478 milliliters (range 1500 to 4600 ml) of fat with lipo. The average injected volume into the buttocks was 346 ml (range 165 to 625 ml) and into the lower limbs, it was 195 ml (range 75 to 270 ml). The revision rate was 14% for the entire group, but a good number of these were related to the abdominal scar, which can often times be revised under local anesthesia. The major immediate complications after surgery included infection (3%) and bleeding with hematoma formation (2%).
I find that the complication and revision rate is acceptable for this extensive set of procedures. Patients should realize that there is no perfection in plastic surgery. Even these world-renowned experts had a dissatisfaction rate of 10% in their patient population. The more procedures you have, the more likely a revision will be required. Revision in this study included the need for additional liposuction, fat grafting and scar revision. Two patients requested silicone buttock augmentation.
The authors should be congratulated in keeping the number of immediate post surgery complications at a low level. Patients should realize that a bleeding complication usually requires immediate re-operation to evacuate the trapped blood collection, probable blood transfusion and a possible hospital admission. Infection may also require admission for the administration of intravenous antibiotics. This review goes to show that no surgeon or technique is free from complications and patients should be thoroughly prepared for the known potential complications before undergoing composite body contouring. This article is an important contribution to the advancement of Phoenix plastic surgery techniques.
The case above demonstrates the typical results with composite body contouring. In this case the patient had a tummy tuck and liposuction, including her back performed elsewhere 5 years before consulting with me at the AB Guerra Plastic Surgery Center. The patient is shown before and 6 months after composite body contouring procedure with revision tummy tuck, circumferential liposuction, and buttock fat grafting. The benefits of the surgery are a flatter and tighter tummy, a smoother back with a significant reduction of the rolls, and firm round buttocks. For more before and after photographs please see our main website at www.myfaceandbody.com
Shorter scars while combining Liposuction with Tummy Tuck.
12 years ago
Scottsdale – I have combined abdominoplasty and liposuction since I began my own clinical practice in 2002. I have found the combination of these techniques to be safe and effective in producing better results when compared to the tummy tuck without liposuction.
There are several advantages of the combined techniques, including, a reduction in the fat volume in the love handles and upper tummy. This translates into a smaller waistline and a tighter, flatter tummy. I have noticed that many patients benefit by having shorter scars when the tissue over the hips is removed with lipo as supposed to extending the incision farther.
A study published in the Annals of Plastic Surgery, has confirmed that a shorter scar can be seen after tummy tuck when using liposuction in the love handles with a tummy tuck. The study measurements were made with a 3-dimensional laser surface scanner which more objectively measures the outcome of the surgery and the scar length. The study also demonstrated that liposuction did not increase the number of complications with the tummy tuck procedure. Other studies have confirmed this finding.
Patients should be offered the opportunity to have liposuction when pursuing a tummy tuck. I always discuss the pros and cons and the potential complications that come along with adding this additional procedure. However, most healthy individuals can the have the procedure without increasing the risks of complications as previous studies have confirmed.
