Abdominoplasty

Tummy Tuck, or Abdominoplasty, is a surgical procedure most often performed after multiple pregnancies which reduces excess skin/fat and repairs the abdominal muscles known as rectus diastasis.

Tummy Tucks is the primary surgery performed in any Mommy Makeover procedure.  Historically, the tummy tuck was a means of removing extra skin and repositioning the belly button, or umbilicus.  Little attention was paid to the appearance of the belly button, and it was widely accepted that scars from a tummy tuck would be unattractive with little or no alternatives.  Today, the appearance of the belly button is very important, and the abdominoplasty scar is of great concern to Dr. Schlesinger and his staff.  It is our feeling that surgery does not end at surgery.  It ends when the patient has the best conceivable result.

The name of our new surgery center is “Mommy Makeover Institute of Hawaii”.  It was our intention that this name would convey to everyone our desire to perform the best conceivable surgery for each element of the Mommy Makeover.  The Tummy Tuck has become our centerpiece surgery.

Each element of the Tummy Tuck has been studied extensively by Dr. Schlesinger over his long career in cosmetic surgery.

Belly Button Surgery is known as Umbilicoplasty.  Your belly button is the remnant of your umbilical cord which is how your mother fed you while you were inside of her.  Nutrients flowed from the placenta to your liver, and therefore the belly button has one artery and two veins that go to its base.  In a tummy tuck, the skin of the abdomen is moved downward.  The belly button is anchored to the muscle wall and brought out through a new opening created by your plastic surgeon.  The skin from the abdominal wall to the button button has no fat, so the first thing the surgeon must do is defat any skin at the opening to your new belly button.  Dr. Schlesinger has created his own unique belly button surgery.  Here, the dimensions are 15 mm long by 8 mm wide, with no sutures placed at the junction of the abdomen to your belly button.  All sutures are placed either below the skin or hidden inside the belly button which minimizes scarring.  The belly button has become an object of art in today’s world, and Dr. Schlesinger treats it as such.
Rectus Diastasis. The separation of the abdominal muscles occurs during pregnancy to allow the uterus to come forward.  This is known as “Show”.  Should the abdomen not separate, the uterus would grow straight up during pregnancy and hit the diaphragm, suffocating the mother.  The repair of the rectus muscles has to be performed in a very specific way.

The surgeon must use permanent sutures to ensure that the repair lasts long enough for the scar tissue to take over from the repair.  If one uses a dissolvable suture, it may dissolve too soon and separation may occur.
A very specific sewing is necessary.  Dr. Schlesinger uses a series of figure 8 sutures with very strong permanent thread, then over sews that with what is known as a running locking suture.  The combination of these two suture techniques has worked well for Dr. Schlesinger in hundreds of abdominoplasties.

The Adbominoplasty Closure.  The closure needs to be as low as possible, usually removing 1 to 1-1/2 inches of pubic hair along with abdominal skin.  This ensures that the central scar is low on the abdomen with no hair bearing tissue above the bikini or panty line.  The wings of the incision go slightly upwards so the resultant scar stays on the abdominal skin and not out on thigh skin.  During surgery, the patient is first on a flat table which is subsequently bent to 30 degrees to allow a very tight closure.  This ensures that the abdominal skin will not only be tight when one stands up, but also when sitting in a chair.  To keep the scar as thin as possible, suturing is done deep near the muscle, and progressively up from the muscle to the skin to get the best possible scar.  Dr. Schlesinger does a 5-layer closure. Drains are placed to decrease the possibility of hematoma and fluid buildup.  Drains are always removed at the third post-operative day.  The patient wears a girdle for two weeks which also decreases the chance of fluid buildup on the abdomen.

Muffin Tops.  The love handles, muffin tops, or hips are the area of fat that folds from the back around towards the abdomen, and is in fact, the largest collection of fat on any woman.  We at the Mommy Makeover Institute of Hawaii feel that an abdominoplasty is rarely complete unless one also has suctioned out the fat in this area.  To that end, a small midline incision is made and liposuction is performed on both hips.  At the time of a tummy tuck, aggressive lipo of this area will decrease the length of a tummy tuck incision.  The lipo incision is closed below the skin surface with a dissolvable suture, so there are no stitches to remove and, very often, minimal to no scarring.

Side Benefits.  There are many side benefits to a tummy tuck:
Repair of the rectus diastasis takes tension from the back leading to a significant decrease in low back pain.

When abdominal skin is pulled down, there is a resultant upward movement of the pubic area including the vulva.  This often corrects a condition known as stress incontinence (women who have had one or more pregnancies often when they laugh, they pee, when they cough, they pee).
This upward movement of the vulva often moves the clitoris into a more favorable location for friction.

As you can see, the Tummy Tuck is not a simple operation and should be performed by only very experienced Board Certified plastic surgeons.  At the Mommy Makeover Institute of Hawaii, we take the Tummy Tuck Hawaii operation as a very serious part of our responsibility to our patients. To set up a consultation or to find out more about our tummy tuck Honolulu or tummy tuck Kona procedures, call us today at 1-808-597-8835.

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