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Hi everyone I’m Dr. Danielle Andry and I’m a Plastic Surgeon here at The Oaks Plastic Surgery in Houston, Texas.  So today we’re going to be talking about 5 things you need to know about a Tummy Tuck.  There’s a ton of things you should know about Tummy Tucks but here are 5 things to get you started!

So the first thing that you need to know is that whenever you’re getting a Tummy Tuck there are safe areas of liposuction and unsafe areas of liposuction.  This is something that we run into problems with a lot whenever we’re having patients that are going to providers that are not necessarily trained to do these procedures or in other countries that come back with problems.  So let me show you why they get these problems.  So there’s certain areas like the sides that have been found safe for liposuction.  So those are called the flank areas.  We tend to liposuction these with almost all of our Tummy Tucks.  We can also liposuction the back area, that’s another safe area.  The areas you cannot really  liposuction are between these oblique muscles. The middle part of the abdomen, and I’ll show you why.  So, whenever you have a Tummy Tuck like this, your blood supply is cut off completely from the bottom and so that blood supply to the skin then has to come from another area.  If you’re liposuctioning the sides, that can block the blood supply from the side area. So you have to have blood supply that comes from the top right here and also from the other sides that come in right here.  Now, if you do liposuction in this area, you have a potential of damaging all the blood supply that’s now coming to the skin and that can cause wounds down at the bottom right here.  What we tend to see with patients who have had unsafe liposuction is wound healing problems or breakdowns or even dead skin and fat in this area that’s central right here at the bottom because that is the area that’s most prone to this whenever you block the blood supply.  

So number 2 is what we call the internal corset or muscle plication.  So what we do in your abdominoplasty procedure is that you have 2 groups of muscles called your ab muscles or your rectus abdominal muscles and then on the sides of those you have your oblique muscles.  So with pregnancy or with weight gain, you can have separating of those rectus abdominis muscles or you abdominal muscles (your abs), and that creates something called diastasis recti which is the separation of those muscles.  I’ll show you a video here, it is a little bit graphic so be aware of that if you’re sensitive to it of us bringing those rectus abdominis muscles back together with this internal corset.  So you have your abdominal muscles here on either side, and that separation and what we do, we use a permanent suture to suture from top to bottom, bringing all of that together and whenever we do that, it cinches in your waist on either side to give you that internal corset and it also helps with some of that lower poochy area, kind of bringing that in.  

So the third thing that we’re going to talk about is progressive tension sutures.  You probably have no idea what this means, so, progressive tension is a way that we can distribute tension along the areas of the flap or you know, your abdominal skin that’s lifted up and sutures are stitches.  What we do is, whenever we lift up your abdominal skin, you have a large area right here that is prone to getting fluid collections and its a big area of skin that is brought down.  So what some of the modern day techniques are is that we take sutures (or stitches) from the top layer of your abdominal skin called your scarpa’s fascia and we bring that down to the underlying fascia that holds in your organs and bring that down.  Now that does 3 things. The first thing that it does is it closes off the dead space we created by lifting up that abdominal skin and allowing us to kind of plicate those muscles and pull all that skin down.  By bringing that skin down and closing up that dead space, it removes that space where fluid can build up.  This decreases your risk of getting seromas which are fluid collections in your abdomen after surgery and also helps you get those drains out faster if you need drains during your surgery. The second thing that it does is help with contouring. Whenever we pull that skin up and pull it down with those sutures, it helps create that ab look of having that cinched in area right over the middle part of your abs and then that cinched in area over the side part of your abs, so it really helps with your abdominal contour.  I’ll show you a picture of one of my post ops that you can really see that in.  The third thing that it does, is it helps bring that skin down further so that we can remove more skin overall which everyone wants.  

So the fourth thing we’re going to be talking about is the type of scar.  Everybody wants to know what scar they’re going to have from a Tummy Tuck.  The first thing you should know is that we keep our scars low.  We mark almost as low as we can go with getting as much skin from the top so that we don’t get a “T” incision here in order to bring all that skin down.  We stick it well in your bikini line but what kind of bikini do you wear?  We have people who wear the more traditional bikinis that go straight across, but we do have some of our patients who wear the more brazilian style bikinis that come up top.  What we can do is we can tailor your Tummy Tuck to what type of bikini you wear.  I have my patients bring a bikini to the pre-operative area and we actually mark in that bikini line.  

The fifth and final thing that you should know about a Tummy Tuck is one of my favorite things that I like to tell my patients about a Tummy Tuck.  There is a new medication called Exparel, well, I guess it’s not so new anymore but we’ve been using it for the past several years and it has completely changed the game as far as how our patients recover after Tummy Tuck.  What Exparel is, is an injectable pain medication very similar to the kind of injectable medication that you can get at the dentist that numbs your gums for tooth surgery.  What it does is it gives you that numbing medication and it lasts for 3 days in most patients.  That really gets people over that hurdle of the first 3 days that tend to be the most painful after a Tummy Tuck.  We inject it along the fascial area, along your scar line and around your drains so that it’s very comfortable for the first 3 days.  This makes it so that most of our patients hardly take any narcotic pain medication after surgery and our patients who get Exparel just absolutely love it and have such an easy recovery.  So there it is, those were my 5 things that I want you to know about my Tummy Tucks but of course there’s so many more things that you should know about Tummy Tuck if you’re planning to undergo one.  What you should do if you’re interesting in undergoing a Tummy Tuck is come see me in my office, we can talk about wether you’re a good candidate, things that you should know about before surgery, what your surgery entails, what are the risks involved, what alternatives could be involved and what you can expect after surgery and in recovery.  So if you’re interested in a Tummy Tuck, come and see me, I’ll be happy to talk to you about it so that we can get you your best result.

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