DR. BERAKA'S NEW PUBLICATION CONCERNING ABDOMINOPLASTY AND REVIEW OF OPTIONS TO IMPROVE THE ABDOMEN

FEBRUARY AND MARCH, 2008

I published a brief communication concerning extended abdominoplasty or tummy tuck for the patient who has lost a lot of weight in the February 2008 issue of Plastic And Reconstructive Surgery. This is the most respected plastic surgery journal. The aim of my published remarks is to make the extended abdominoplasty safer and more widely available to patients.

I thought this would be a good occasion to review the various options that people have to improve the appearance of their stomachs. There are basically 8 different options and I will touch on each of them briefly:

• Thermage
• Liposuction
• Liposuction followed by Thermage
• Mini-abdominoplasty
• Modified abdominoplasty
• Full abdominoplasty
• Extended abdominoplasty
• Circumferential body lift

1. Thermage: This is a noninvasive office procedure that requires no anesthesia and no down time. We have seen some quite impressive results with Thermage in patients who have some looseness of the skin of the abdomen, especially around the belly button. The procedure does not usually need to be repeated and is quite useful for patients who are not ready for surgery.

2. Liposuction: The three things which can make the stomach look bad are excess skin, excess fat and loose muscles. When the problem is excess fat in the upper and lower abdomen and when the skin is relatively tight, then major improvement can be achieved just with liposuction of the stomach which is scar free and has a very short recovery period.

3. Liposuction with Thermage: For patient who have excess abdominal fat and a mild degree of skin looseness, we avoid the scar and the longer recovery associated with the tummy tuck by first flattening the stomach with liposuction and several months later tightening the skin of the stomach with the non-invasive Thermage procedure mentioned above.

4. Mini-Abdominoplasty: This is an ideal procedure for women who already have a C-section scar and have some fullness and droopiness of the stomach that is limited to the area below the belly button. The surgery is limited to the lower abdomen and involves a short scar and a quick recovery period.

5. Modified Abdominoplasty: This is an excellent operation for patients who have only moderate skin looseness but who have weakness of the rectus muscles (also called a diastasis). The muscles can be sutured together and tightened above and below the belly button through a relatively short incision above the pubic hair and some of the excess skin is removed by slightly sliding the belly button down.

6. Full Abdominoplasty: This is the classic procedure for patients who have significant amounts of loose skin, significant amounts of fat and significant weakness of the muscles. This operation gives full correction but has a longer scar running at the level of the pubic hair, and it has a longer recovery period.

7. This was the actual subject of my recent publication, and it applies to patients who were severely overweight and then lost a massive amount of weight, either by diet and exercise or, more commonly, by gastric banding or gastric bypass surgery. This is a separate and distinct group of patients who have truly enormous amounts of loose excess skin that has to be tailored. The skin excess is both present in the vertical and in the horizontal directions and therefore there is both a vertical and a horizontal scar. These patients are so happy to be rid of the folds and layers of excess skin that they readily accept the scars and the quality of their life is dramatically improved.

8. Body Lift: This is also a fairly extensive operation which is usually reserved for the massive weight loss patient. In the front, it is equivalent to the full abdominoplasty and it corrects the weak muscles as well as removing excess skin and fat. This operation goes entirely around the hips to remove redundant skin and fat from the sides and the back as well. Obviously, this operation is associated with a long scar and significant recovery time.