Abdominoplasty (Tummy Tuck)
Abdominoplasty is one of the more commonly performed plastic surgical procedures as there are really no conservative alternatives to address severe skin and muscle laxity of the trunk. Many patients seek treatment of residual skin and muscle laxity due to pregnancy. It is also commonly performed in individuals who have experienced a significant decrease in waist size whether if be from loss of fat, muscle or both. The goal of the procedure is to remove excess skin of the mid and lower abdomen as well as bring together or "tighten" the muscles. This is accomplished by making an incision in the lower abdomen below the bikini or underwear line, elevating and removing the skin and fat above the muscle. This usually allows all skin, including stretch marks, below the belly button to be removed. The muscles of the abdomen are then moved together and sutured in place at the midline which improves the profile of the trunk. The remaining skin is then draped over the lower profile abdomen. The incisions are closed and the belly button is brought through the new site. The procedure can result in a dramatic improvement of the trunk where excess skin including prior surgical scars, rolls and stretch marks below the belly button are permanently removed. Liposuction of the flanks is usually performed concurrently to give a "silhouette" appearance. The procedure can also dramatically improve the side profile as the muscle plication can significantly decrease abdominal girth. Patients who undergo abdominoplasty will often request or require liposuction of the flanks, back, or hip to make these areas appear more proportioned to their "new waist." The procedure may be contraindicated in patients who are significantly obese or who carry the majority of the fat below the abdominal muscles. Checking for a significant change in side profile while holding your breathe is often a good parameter to determine this. Patients who can't see a significant difference in side profile while holding their breath should consider further weight loss prior to surgery. Other relative contraindications include planned pregnancies within 2 years of the procedure, smoking, insulin dependent diabetes, active weight fluctuations, recent liposuction and certain prior surgical procedures. The procedure does require temporary placement of drains which are removed ten days after surgery. Pain is rated 8 out of 10 and patients will require 2 to 3 weeks for recovery. The risks of the procedure include irregular appearance of the bellybutton, infection, and possibility of fluid collection requiring removal in the office.
Mini-Abdominoplasty (Mini-Tummy Tuck)
Mini-Abdominoplasty may be indicated in patients who require excision of redundant skin just above the pubic area. Many such patients are physically fit but have a problem area of excess skin in the lower abdomen. Many also desire this procedure to correct unsightly scars as a result of a prior c-section. These patients have good muscle tone and may require limited tightening of muscle below the belly button or no muscle tightening at all. It involves a scar which is 1/4 to 1/3 the length of standard abdominoplasty scar. The procedure is rated a 3 out of 10 on the pain scale and most patients are able to return to work in 5 days.
Augmentation of the calves may be performed with the use of solid silicone implants. The implants are usually carved to custom fit the desired area at the time of surgery. They are inserted through incisions at the back of the knee. Most patients who request calf implants fall into one of three categories. Patients with significant congenital deformity such as poor calf muscle development or asymmetry due to club foot and competitive bodybuilders are the first two. The third group is patients who live in warm weather climates or model clothing revealing their legs and have disproportional medial or "inner" calf in relation to the upper leg. This may result in an "knobby" knee appearance which is noticeable in shorts and bikinis. Therefore calf implants are used to address asymmetry, increase size, or make the legs appear more proportionate and the knee less noticeable. The procedure takes about 30-45 minutes under a general anesthetic. Pain is rated as 4 out of 10. Bed rest in the postoperative period for 2 days and use of compression of leg wraps or compression stockings for 3 weeks is required. Risks of the procedure include infection, implant displacement or mal-position, and thickened scar around implant requiring revision.
Augmentation of the buttock is performed to improve the contour of the lower body and make the lower body appear more proportionate or "balanced". Dr. Coleman feel that for most patients, this is best accomplished the old fashioned way with weight maintenance and the Stairmaster. If there is ample "surrounding" tissue, liposuction can be performed at the lower back and the area of the fold where the buttocks meets the posterior thigh. This improves the contour and gives the impression of gluteal augmentation. Patients who don't have much "surrounding tissue" or with low body fat, may require a true augmentation. Treatment options include placement of fat from another area or placement of a solid silicone implant. Dr. Coleman prefers placement of an implant however patient selection is critical as there is the risk of infection, implant misplacement, scar contracture or asymmetry requiring removal.
Male Pectoral Augmentation
Male Pectoral augmentation may be performed with placement of an solid silicone implant. Patient selection is key as many aspiration body builders will do just as well with liposuction of the chest wall to improve definition in conjunction with an appropriate conditioning regimen. These implants produce the most dramatic results in patients with chest wall deformity or poor muscular development. Patients who meet criteria for augmentation with implants receive a general anesthetic while solid silicone implants are placed in through the armpit. Like all implants, pectoral implants carry the risk of infection, formation of thickened or contracture, malposition or asymmetry.
Liposuction involves the aspiration of fat to improve contour or symmetry. It may be performed on most areas of the body including the neck, back, arms, legs, buttock, flanks, hips or thighs. Ideal candidates for liposuction are patients who have isolated problem areas resistant to exercise. This is usually the inner or outer thighs, hips, lower back or banana roll below the buttocks in women. Men generally desire liposuction on the chest, abdomen and flanks.
Liposuction is very effective in removing fat in localized areas but does require contracture of the overlying skin in order to mold properly. Therefore, liposuction is not effective in areas with overlying stretch marks or loose skin.
Liposuction is also not effective in the morbidly obese as it will create contour deformities due to the surrounding tissue. Liposuction is not a means of weight loss. The risk of liposuction include contour deformities, skin laxity and need for revisional procedures.
Brachioplasty is the term used to describe contouring of the arms. This is usually performed by skin excision is patients who have experienced significant weight loss. Some patients with good skin tone may be treated with liposuction alone. The procedure is successful at significantly improving the appearance of the arms however involves lengthy scars when excision is necessary.