As Jim, the incredibly well-trained instructor for my figure-drawing class, explained one day, everyone has a little convexity to the lower part of their abdomen. Armed with a piece of chalk at the chalkboard, he deftly illustrated that a little curve to the belly is how the human body comes naturally; with a straight, or even concave, line below the belly button, the drawn figure looks odd.This is how the human form is meant to look, he insisted, pointing with his stub of chalk to the curvy line he had drawn, which in his magical hands looked perfectly like a belly. This just isn't right, no matter what they tell you, Jim said of the flat abdomen he drew beside it.
There's no arguing with Jim, especially when he's pretty much spot on (an old plastic surgery mantra: there are no straight lines on the human body), but that doesn't mean that we can't aspire to be sleeker versions of ourselves.
Last Friday, we investigated the most common reasons why bellies go bad, why women get poochy after pregnancy, and why some of us just didn't win in the genetic skin lotto.
Today, let's delve into the world of abdominoplasty, or tummy tuck, the plastic surgeon's answer to the problem of "the flat belly".
The simplest scenario would be this, the patient of every plastic surgeon's dreams: a thin, healthy, young(ish) woman who had finished bearing her children and upon exam had no muscle separation (that pesky diastasis I mentioned last week), only a little extra skin on the lower part of her belly. Our straightforward case would be represented by the left side of the drawing below, where there is just the slightest "pooch" of extra skin and fat below the belly button:
This simple scenario would be addressed by a relatively simple procedure, the so-called "mini-tummy tuck". Since there is no weakness of the abdominal muscle/wall, the excess skin can be trimmed, leaving the patient with a small scar low on the belly (represented by the pink line on the right side of the drawing). This type of incision would be similar to a c-section scar, easily concealed by underwear or a bikini bottom.
Since the surgery time is relatively short (about one to one and a half hours) and no muscle work is done, patients can go home after a mini-abdominoplasty and enjoy a relatively quick recovery (around a week).
However, most of us aren't that lucky (that is, we're not exactly thin, young, and have remarkably intact abdominal walls), so the "flat belly solution" is more complicated. What this entails is a full-out abdominoplasty.
We know we have a muscle issue (that six-pack just isn't doing it anymore), where the abdominal muscles have become lax and separated, as I've illustrated (below, left):
As plastic surgeons, a huge part of our training and practice mission is to restore anatomy and function. So a major component of the abdominoplasty is the muscle plication (above, middle), where the abdominal muscles are realigned and tightened, resulting in a "corset"-like effect. The extra skin (often from above the belly button to just above the pubic bone) is removed.
The result (above, right): a waist that's slightly cinched in, a flatter, tighter belly, a slight lift of the pubic mound (yes, gravity affects everything), and scars hidden in the shadows of the umbilicus and low across the belly, from hip to hip (again, represented by the pink lines). The circumferential belly button scar usually fades pretty imperceptibly, and anyone wearing a reasonable set of underpants won't be showing off the lower abdominal scar. A small (but wonderful) bonus for moms who undergo tummy tucks is the removal of those impossible stretch marks where the skin is excised.
The full abdominoplasty takes a little longer (two to two and a half hours) and is also performed under general anesthesia. If patients are healthy and have reliable help around, they can go home after the operation; if not, they spend at least one night in a medical recovery center or hospital. Recuperation after this surgery is a bit longer as well (the muscle tightening is pretty painful - imagine doing ten thousand crunches, but worse), anywhere from two to six weeks.
One step beyond the tummy tuck I describe above is the circumferential abdominoplasty. Now this is a procedure most commonly done for patients with massive weight loss. After losing so much weight, not only is the skin of their bellies stretched out and hanging, but it continues like this all the way around the hips, flanks, and back. The circumferential abdominoplasty (also, belt lipectomy) addresses this by continuing the skin excision all the way around as well; the end result is an improved contour, in exchange for a scar that rings the waist like a belt.
Tummy tucks are often done in conjunction with liposuction, to smooth out the contours of the upper abdomen and flanks; but lipo is a whole topic on its own, which we will tackle on another Friday.
