During an abdominoplasty, an incision is made near the pubic hair line. If the required attention is not given during the incision, pubic hair may move upward during the healing period, thus creating an antistematic appearance. Dr. Makhlouf prevents this problem from occurring when a lower incision is made inside the pubic hair foreseeing excessive displacement. This makes the results are superior and aesthetic.
During a pregnancy and after a significant weight loss, the muscles of the abdomen are stretched to allow support of the extra weight to which the body is subjected. When stretching these muscles, it is difficult to appreciate the waist. When stretching these muscles, it is difficult to appreciate the waist, in order to tighten these muscles and make the waist visible; Dr. Makhlouf uses a unique technique. He uses a three layer technique to close the incision which provides a better reinforcement and longer duration.
While some surgeons use a circular incision around the navel, it is possible that the circular scar is unpleasant and may reveal signs of plastic surgery. Dr. Makhlouf has developed and refined an incision from intermittent lines to ‘distract’ the scar tissue, thus allowing a natural navel with minimal scarring. To see the amazing results of Dr. Makhlouf’s surgeries, visit our photo gallery and let the photos speak for themselves.
Consultation with Dr. Makhlouf is an invaluable experience for patients considering any type of procedure. It is there where you can meet in a comfortable environment and have the opportunity to talk openly with him, about how he would like to change your body and his role in surgery. He will be able to express all his questions and concerns and will realize the exceptional attention that he always gives his patients. The consultation is the first step in this event of great transformation that abdominoplasty can offer.
A tummy tuck is a surgical procedure that aims to improve the appearance of the waist, tighten the abdominal muscles and remove excess fat, skin and stretch marks below the navel. In an extended abdominoplasty, a liposuction of the middle and lateral part of the abdomen in addition to the abdominoplasty is used to sculpt and detail the body that the patient wishes. A tummy tuck can also be combined with procedures in other parts of the body, such as liposuction of the sides of the abdomen, thighs, and / or breast surgery. If the procedure is limited to the area below the navel it is called mini abdominoplasty. A tummy tuck can also be combined with procedures in other parts of the body, such as liposuction of the sides of the abdomen, thighs, and / or breast surgery. Visit our Mommy Makeover section for more information on combination surgery
Dr. Makhlouf believes that the pre-operative appointment is one of the most important parts of getting excellent results. The procedure is explained in even more detail along with risks and complications, medical history is again reviewed, instructions for pre and post operative care are given as well as the prescriptions.
On the morning of surgery, Dr. Makhlouf carefully marks the patient. Patients are then given an intravenous antibiotic and SCD boots are placed. These massage the legs and help avoid the formation of blood clots. The procedure can range from 1.5 – 4 hours. Patients are able to return to their homes the same day of the surgery after they have demonstrated that they can walk, talk, retain fluids and urinate.
An aesthetic umbilicus should be devoid of visible scars, should rest in a peri-umbilical depression, and have a small hood on top through which some women place a piece of jewelry. I have worked on the design of the incision for some time and presented the work six years ago. I believe that the ultimate goal of a tummy tuck is to allow a women to wear a two piece bathing suit. The umbilicus is the center of the abdomen and deserves the extra care I give it.
The aesthetic and youthful umbilicus:
1. Is small.
2. Has a vertical orientation.
3. Has a superior hood that allows for placement of jewelry, if desired.
4. Rests in a peri-umbilical depression to provide proper contour to the abdomen.
5. Is devoid of protrusion (and hernias).
6. Allows for proper hygiene.
Most of the time, the surgeon is not able to do a proper abdominoplasty (tummy tuck) without an incision around the umbilicus, so that as the skin is pulled down, the umbilicus is allowed to remain in its anatomic position and is not pulled towards the pubic line. Most pictures showing abdominoplasty (tummy tuck) procedures show a circular scar. The problem with a circular scar is that it tends to contract and frequently remains visible. Over the years, we have relied on sound plastic surgery principles to avoid this problem. We do not do a circular scar.
One of the aspects of the procedure that most interests patients is the position of the scar. Dr. Makhlouf asks patients about the type of undergarments they are interested in wearing after the surgery. This allows him to plan placement of the scar so that it is as hidden as possible.
Many published results show a scar far too high on the abdominal wall. In placing the scar high, not only does it restrict the clothing that can be worn, but the pubic hairline is pulled upward in an un-esthetic way. By placing the lower incision within the hairline and removing some of the hair bearing skin, should any tension be present during skin closure, and hairline elevation to occur, the upper part of the pubic hair will return it to its normal position and not any higher. The final scar will be hidden by the underwear or bathing suit.
During the procedure, the muscle laxity is addressed and the abdominal wall tightened. Dr. Makhlouf uses special sutures that will repair the weakness of the supporting structure of the muscles (both in the horizontal and the vertical direction). Two layers of these independently placed sutures (30 or more) will ensure that even if cough or pull was to occur in the post-operative period, there are enough sutures supporting the repair to maintain the result achieved during surgery. A last layer of continuous suture ensures an even tension of the repair and covers the knots of the two previous rows of sutures. It is important to use suture technique that tightens the abdominal in both directions because when the stretching occurs it did so both in the vertical and horizontal direction.
After the incision is made in the pubic area, the skin is separated from the muscles underneath. The dissection will proceed upward towards the chest, past the umbilicus all the way to the lower sternum.
After the muscle laxity is corrected, the skin that was separated from the muscles is pulled down and the excess removed. The lower skin incision is at the level of the pubic hairline, the upper incision is at the level of the umbilicus. Every effort is made to remove all the skin from just above the belly button down to the hairline.
As the upper skin flap is brought down to close the abdomen, the belly button is temporarily covered. Once skin tension is set, the location of the umbilicus on the skin flap is marked and the belly button (still attached on its stalk like a flower) is brought out to the surface.
At the end of the tummy tuck procedure, bandages are placed and are reinforced with an abdominal garment.
There are two drains and the patient records the output twice a day. These drains are frequently removed by the 4th to 6th post operative day. The patient can take a shower after the drains are removed painting the incisions with an iodine based antiseptic. When the skin tapes are removed, silicone strips are to be used to help in providing the best scar possible. The scars tend to be at their worse at six weeks after surgery and go on to flatten and soften up in the ensuing months. On occasion, as the hair grows through the scar a little irritation is experienced.
Dr. Makhlouf recommends patients use some support for 6 weeks after surgery. Early on, the support keeps the skin against the abdominal wall muscles and helps in reattaching the skin to the muscles and minimizes seroma formation. Later on the patients become more mobile the role of the “binder” is supports the muscles and help with the swelling. I place a garment at the end of the surgical procedure. At two weeks, I recommend the patient use a girdle of their choice. The garment needs to be tight and secured from above and below so as not to roll. An ace wrap is not good, it will roll and create bands of tightness that may result in creases in the skin and deter from a good surgical result.
Patients are able to return to exercise and sexual activity three weeks after surgery. Exercises for the abdoment such as sit-ups and crunches are allowed at six weeks. Again, Dr. Makhlouf recommends patients use their compression garments.
Dr. Makhlouf sees patients frequently after surgery. At 3 to 5 days post op, one week, one month, 3 months, 6 months, and one year. One of the biggest concerns after abdominoplasty is clots in the legs and pulmonary emboli. You should be aware of the symptoms and be able to get medical care expeditiously. The chances of having one decreases as the post op days go by. This is why it is recommended that all patients stay within reach of our office for the first few days.
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