Patient Resources

Abdominoplasty (Tummy Tuck)

  • The purpose of abdominoplasty is to remove the excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. This operation can significantly improve the appearance and contour of the abdomen. In most cases the results are long lasting, especially if you maintain a balance of proper diet and exercise.
  • Usually the surgeon will make a long incision from hip to hip, just above the pubic area. There will often be a 2nd incision around the belly button. The surgeon will lift the lower abdominal skin and fat off of the underlying muscle and complete the elevation up to the level of the rib cage. The excess skin and fat will be removed and the remaining tissues sewn together. In many cases the abdominal muscles will be tightened with sutures. Abdominal hernias and rectus muscle diastases (widening of the space between the rectus muscles) can usually be corrected at the time of abdominoplasty.
  • Abdominoplasty is not intended as a weight loss procedure. The weight of the tissue removed is usually only a small percentage of one’s overall body weight. The intended benefit of abdominoplasty is an improved body contour and a more healthy appearing abdominal shape. The best candidates for this surgery are men or women who are in good health and in relatively good physical shape, who have an excess of skin or fat hanging down along the lower abdominal area.
  • You may not be a good candidate for abdominoplasty if you are obese, as obese individuals often have other health problems that make surgery a high risk. Also, if you have had certain types of abdominal surgery in the past or if you have certain types of abdominal scars, you may not be a candidate for abdominoplasty.
  • You should postpone abdominoplasty if you intend to lose additional weight or if you intend to have future pregnancies. Pregnancy can stretch out the tightened abdominal muscles and skin and reverse the benefits of surgery.
  • Abdominoplasty surgery usually takes 2-4 hours to perform under general anesthesia. An overnight stay in the hospital is usually required for pain control. There will be pain after your surgery. Most people take narcotic pain medication for up to 2 weeks after surgery and then convert to Tylenol or Advil. Pain may persist for longer periods of time. Most people take an average of 4-6 weeks to recuperate. However, feeling well does not mean that you should resume all activities. Tissues are still healing inside and heavy lifting and strenuous activities should be avoided until your doctor allows you to resume them.
  • Drains will likely be placed at the time of your surgery in order to prevent healing complications and to help reduce swelling and bruising in the tissues after surgery. The drains will be removed in the office when the amount of fluid they produce has lessened.
  • Sutures will be used to close the abdominal tissues. Some of the sutures are of the “dissolving” type. Others may have to be removed in the office. Any visible or exposed sutures should be kept covered with antibiotic ointment (bacitracin or Polysporin) and a dressing (gauze or plain white paper towels). The dressings will be held in place with an abdominal binder.
  • Numbness of the lower abdominal skin and belly button is an expected consequence of surgery. In most cases, the skin will regain sensation after a few months, but it is possible for there to be areas that are permanently numb.
  • Scars are an expected consequence of any surgery. Any operation that involves an incision in the skin will result in a permanent scar. The abdominoplasty scar typically extends across the entire abdomen from hip to hip. There is usually also a scar around the belly button and will be small scars where the drain tubes exit the body.
  • Scars may thicken, widen, become raised, change colors, or keloid. It is not uncommon for there to be minor puckering, out-pouching, or dog-earring on the very ends of the abdominal incision. This is a result of the removal of an elliptical piece of skin from one side of the body. In most cases, these “dog ears” will flatten out and go away over time. In some cases, minor touch-up to the scars in these areas may be necessary. It is also possible for the scars to be uneven in appearance or asymmetrical in placement, position, or shape on the abdomen as a result of the operation or the body’s healing process.
  • Scar fading may take 1-2 years to complete. In fact, scars may seem to get a little redder, thicker, and firmer in the first 3-4 months before they begin to gradually fade. Suture material may take 3-4 months to dissolve under the skin as well. In unusual cases, scar redness may persist longer.
  • Daily massage of vitamin E or cocoa butter with vitamin E may help to improve healing. Other scar fading creams are available, and you may discuss using these with your doctor. Silicone gel pads have also been shown to help in scar fading and may be available with a prescription.
  • It is extremely important that you avoid sun exposure to your scars while they are healing. Scars will sunburn easily and sun exposure may cause scars to get redder, thicker, keloid, or even become permanently brown. You should cover your scars when you’re outside and you abdominal skin should be covered with sunscreen as it may burn more easily for 1-2 years after surgery. Tanning beds should be avoided completely.
  • Contour irregularities may also result from surgery. There may be areas that appear uneven, puckered, dimpled, or asymmetric. The thicker abdominal tissue and the thinner pelvic tissue may not line up smoothly after surgery. Usually, these irregularities go away or improve with time. However, it is possible that additional surgery may be needed to correct problems and there are some problems that may not be correctable.
  • Pubic hair growth may change as a result of surgery. Because the lower abdominal tissues are pulled together under some tension, the pubic hairline may rise to a slightly higher level than before. Also, hair growth may be sparse in the scar itself (scar alopecia).
  • Tissue loss or scabbing can occur in any surgical procedure, particularly in abdominoplasty where there is an increased level of tension or pull in the skin (as is the purpose of this surgery), or if the healing tissues do not get the blood supply they need to heal properly.
  • If there are areas that do not heal well, additional interventions or procedures may be required. It is not uncommon to have minor areas of the incisions where slowed or delayed healing may occur. These areas are usually treated with dressing changes and antibiotic ointment until they heal on their own. In a few cases, the incisions may need revision or re-suturing.
  • It is possible, although rare, to have larger areas of the abdominal skin or even the belly button develop problems with healing. In these rare cases, prolonged periods of dressing changes, antibiotics, or even additional surgeries to reconstruct lost tissues may be required. Loss of the belly button due to scabbing is an unusual, but possible, consequence of abdominoplasty.
  • Blood loss can occur in any surgical procedure, but it would be very unusual to see a substantial amount of blood loss (enough to require a transfusion). If we are concerned about blood loss, we may arrange for your own blood to be available for transfusion.
  • To decrease the risk of blood loss, you should not take aspirin, Advil, Aleve, or any type of anti-inflammatory that can cause bleeding for 2 weeks before surgery. You should also discontinue high dose vitamins (especially vitamins E, A, and C), diet pills, and ALL herbal substances 2 weeks before surgery. Some of these can cause blood pressure problems under anesthesia or can cause excessive bleeding. If you are taking any type of blood thinner (aspirin, Coumadin/Warfarin, etc), you should notify the prescribing doctor so that the appropriate steps can be taken to make your surgery as safe as possible.
  • Infection is a risk of any surgical procedure. This may come in the form of a simple infection in the skin or as a deeper infection in the subcutaneous tissues (abscess). Other types of infection may result from surgery, such as upper respiratory infections, pneumonia, or urinary tract infections. Usually, a preventative antibiotic is prescribed.
  • The results of surgery may be subject to change. Weight gain can result in a recurrence of the problem. Also, the abdominal muscles can loosen over or weaken again over time. Hernias can recur. Doing too much physical activity, especially heavy lifting, too soon after surgery before the body is completely healed can result in internal sutures breaking and the muscles loosening.
  • The desired tightening of the abdominal wall will put pressure on the abdominal contents and therefore it is not unusual to see initial pressure on the bladder, bowels, and diaphragm. Most importantly, it can slow blood pressure from the legs that can lead to blood clots. Accordingly, often the blood thinner Lovenox will be used post operatively (usually for 10 days).
  • Complications may occur with any surgery and with general anesthesia. For a more comprehensive look at the types of problems that can occur, please read the “Things you should know about Surgery” handout.
  • Smoking is known to cause problems with healing. Illegal drugs, such as cocaine and marijuana, can cause even more severe healing problems. Please read the “What you can do to help yourself” handout for more information.
  • It is in your best interest to notify your surgeon of any medications you may be taking or of any medications to which you may be allergic. You should also tell your surgeon of any health problems you may have, psychological or psychiatric conditions for which you are or have been treated, or if you smoke or use illegal substances. These facts may have major impacts on how safe it is for you to have surgery.
  • It may also be in your best interest to have a complete physical exam (including an EKG and bloodworm) by your primary care doctor to make sure that you are in the best possible health before your surgery. The surgeon may also request that you have medical or cardiac clearance before scheduling your surgery if you have a history of medical or cardiac problems.

Please feel free to contact our office if you have further questions about having surgery. We will do everything we can to make you feel comfortable with your decision.

Blepharoplasty

  • The purpose of blepharoplasty is to remove excess tissue around the eye – both redundant skin and bulging, herniated fat – as well as to restore eyelid position relative to the surrounding bone structure (improve droop). This may require tightening the eyelid structure (lid shortening or resuspension to the bony canthus) or redefinition of the upper eyelid crease. Related procedures can also be performed at the same time to tighten or raise the eyebrow (brow lift or suspension), tighten or raise the cheek (mid-facelift). Note that the position of the brow or cheek structures are not directly affected by the blepharoplasty itself. It should also be noted that though surgical blepharoplasty removes excess skin and fat, it cannot improve the actual quality (color, texture, or consistency) of the remaining skin. Good skin care can be used to improve the quality of skin both before and after surgery and is encouraged for patients considering blepharoplasty.
  • Pre-existing differences in the appearance of the eyelids (it is uncommon for the two sides to perfectly match) and some asymmetry is always expected in the shape and size of eyes, both before and after surgery. This can be addressed with surgery, but it should not be expected that it can be completely corrected. This is especially true if the bone structure around the eyes is different or if the eyeball shape or position is different between the two eyes.
  • One goal with upper eyelid surgery is to recreate sufficient skin show to permit the application of eye makeup. In cases of heavy or drooping eyebrows, this goal may not be achieved (especially laterally), unless the brows are also elevated through a brow lift procedure.
  • Heavy eyelids that rest upon the upper eyelashes or literally hang down over the eyelid opening can interfere with vision. In such cases, an improvement in vision, as it relates to the physical blockage of peripheral vision by the excess skin, can reasonably be expected. However, blurred or fuzzy vision would not be expected to change.
  • Pre-existing tearing problems can be made worse with any eyelid surgery. Dry eyes or overly moist eyes may be a contraindication to eyelid surgery.
  • Any patient with glaucoma, cataracts, retinal problems, or any history of vision surgery should first be seen by his/her eye doctor (ophthalmologist) before undergoing blepharoplasty. Any patient who experiences severe eye pain, loss of eyeball movement, or vision loss should seek immediate medical care.
  • Visual changes can occur with any eyelid surgery. Temporary blurred vision from swelling is almost always seen by the third day, but usually improves by the sixth or seventh day after surgery, and can be greatly reduced by using ice and keeping the head elevated above the heart. Permanent visual impairment would be very unlikely, but there are rare cases of blindness reported in association with eyelid surgery (even cosmetic blepharoplasty).
  • Sutures around the eyelids are unpleasant because they tend to feel tight and “prickly.” Those sensations improve once the sutures are removed, usually 6 or 7 days after surgery.
  • Bruising and swelling can be very noticeable and is usually the most severe from the third to sixth day after surgery. This can be minimized by applying ice to the eyes continuously for the first 24 hours and by keeping your head elevated. It is also very important to prevent injury to the operative site and to minimize any activities or that could cause an elevation in blood pressure, including head down positions (like bending over to pick something up), lifting, and being overly active. Arnica Montana can be used, starting the day after surgery, to minimize bruising. Dark glasses can be worn right away, but makeup cannot be used to camouflage bruising and swelling until after the sutures are removed and the incisions are completely healed. Even after this time, rubbing the operated tissues should be avoided for at least 3 weeks. It will be about 6 weeks until the tissues can withstand the usual traumas of life. It will take up to 3 months until the majority of swelling and bruising is unnoticeable. The longest lasting area of swelling tends to be over the cheekbones, which can still be seen at 3 months in some cases. Bruising does tend to travel slowly in the skin in the direction of the heart and, because of this, it is not unusual to see a slight yellow color over the jawline or even on the upper neck. This can be concealed with cosmetics.
  • Dryness, redness, and burning sensations to the eyelids and eyes can sometimes be seen in the first 3-5 days after surgery, but are usually self-limiting. Rarely, these can persist and may need treatment with steroid eyedrops or ointment. If not treated, it can lead to the thickening of the eyelid tissues.
  • In rare cases, scars can be thick or tight, or excess tissues, especially on the outside portion of the upper eyelid, can remain after surgery. In these cases, additional surgery may be needed, which would usually take place in the office, under local anesthesia, about 6 months after the initial surgery. Also in rare cases, some pull of the lower eyelid away from the eye itself can develop. That situation usually resolves with time (and maybe with massage, as directed by the doctor), but could require additional surgery to shorten or tighten the lower eyelid.
  • Small white cysts can sometimes develop along the eyelid scars. They may need to be drained or removed, which is a simple office procedure that usually does not require anesthetic.
  • The removed tissues (both skin and fat) will not come back and, in most cases, the remaining tissue does not redevelop the original excesses. The surrounding tissues, however, especially those of the brow and cheek bones, will continue to age. Therefore, the effects of blepharoplasty surgery can be overshadowed with time.
  • Discoloration of the lower eyelids (“purple bags”) is usually related to congestion in the nose. Therefore eyelid surgery will not correct that problem unless the underlying nasal problem (usually allergic rhinitis) is also corrected.
  • In rare cases, especially in patients with very thin skin, the bruising from surgery can lead to permanent skin discoloration (“old age spots”). In such cases, skin bleaches may be needed.
  • Surgical removal of excess skin is not always needed. In some cases, aggressive skin care, such as topical growth factors, vitamin C or chemical peels, can be helpful. Laser treatment can be used to tighten the skin as well.

Please feel free to ask any other questions that you may have after your consultation with the doctor. We will be glad to help you in anyway we can to make you feel comfortable with your decision to have surgery.