Abdominoplasty is a surgical procedure that helps to flatten and shape the abdomen and waist by bringing the abdominal muscles to a midline, more anatomically sound, strong position and by simultaneously removing excess skin and fat. Sometimes after pregnancy or significant weight loss, abdominal muscles assume a more separated, weaker position and the overlying skin becomes lax or redundant. Abdominoplasty can be helpful in this regard.
This operation may be performed on an outpatient basis or during a brief hospital stay. The procedure entails a low abdominal incision that spans the hips. Because sagging skin will be pulled down over the abdomen before it is removed, it may be necessary to release the navel from its surrounding skin and bring it out through a new skin opening. In some instances, when skin laxity and muscle weakness are limited to the area below the navel, a modified or mini-abdominoplasty may be indicated. This procedure usually requires a shorter incision and no incision around the navel.
Regardless of the specific procedure utilized, it is not adequate to merely address the abdominal wall musculature and skin laxity. There are several considerations which distinguish a superior result from a mediocre result. These considerations essentially represent attention to detail and consist of:
Location of the incision
- The incision should be positioned so that the resultant line of closure is concealed beneath all garments inclusive of swimwear and lingerie.
Design of the incision
- The incision should be designed so that the resultant line of closure has a pleasing, aesthetic flow, most often curvilinear, with symmetry from side to side.
The use of quilting sutures
- One of the most frequent untoward sequelae of this procedure is fluid accumulation in the potential space created between the layer of skin and underlying musculature. Quilting sutures, described by a South American plastic surgeon, are dissolvable sutures which essentially obliterate this potential space and are quite effective in preventing this accumulation.
Quality and uniformity of the resultant line of closure
- The resultant line of closure should be finely linear and without irregularity.
Attention to the aesthetics of the umbilicus
- The final appearance of the umbilicus should not be flat nor amorphous but rather taught with a hood above and a relative valley below.
Upon completion of the procedure, a silicone-backed foam padding is utilized to minimize both swelling and bruising. This is used in conjunction with an elastic compression garment. The well known abdominal binder is inadequate if not problematic as it tends to shift and fold upon itself acting like a tourniquet.
After substantial weight loss or simply from the effects of aging, skin on the upper arms can become inelastic, loose and flabby. Arm lifts, also known as brachioplasty, remove that excess skin and fat. Patients who have significant amounts of fat may want to consider combining the procedure with liposuction though it is skin excess that ultimately determines someone’s eligibility for this procedure. Here, two techniques are available. In the traditional method, the resultant line of closure is designed to lie along the inner aspect of the upper arm so as to be relatively inconspicuous. This method has the ability to provide for a substantial lift. The second, more recently described procedure, provides for more limited correction in proximity to the axilla, or armpit, only and a resultant line of closure that lies at the junction of the upper extremity and axilla.