Abdominal Contouring Mobile
All layers of the abdominal wall (skin, fat, fascia, and muscle) are affected by changes occurring with age, pregnancy, and weight change. Excess fat with elastic skin can be treated with abdominal liposuction. Patients with excess fat, loose skin, and weak abdominal muscles, commonly seen after pregnancy, are ideal candidates for an abdominoplasty.
An abdominoplasty is a cosmetic operation not covered by insurance aimed at re-contouring the abdominal wall, but muscle tightening also may improve low back discomfort and strength. The operation can be safely performed in an operating room facility with general anesthesia, deep sedation, or epidural block. Incisions are designed to place scars under a preferred underwear or bathing suit pattern. After elevating the abdominal wall and redraping, excess skin and fat are removed and the abdominal muscles are tightened if necessary to improve the waist line. Often the vertical abdominal muscles are separated, a “diastasis rectus,” and the hourglass narrowing above the hips are lost, both of which can be improved with internal sutures. The existing navel (umbilicus) is preserved and transposed. The procedure takes approximately 2 to 3 hours.
Overnight observation, drainage tubes, maintaining a flexed position, and a compression binder are routine. Pain can be controlled initially with prescription medication, but tapers rapidly several days after the procedure. There will be a general soreness of the muscles and the back for several weeks. Laying and standing straight can be resumed at 7 – 10 days as tolerated. Most individuals return to work 3 weeks later depending on requirements. Strenuous activity and lifting (20 + pounds) can slowly escalate between 6 weeks and 12 weeks. The downsides are the scar and common surgical risks: fluid collections, bleeding, infection, and healing difficulties.
A mini-abdominoplasty may be indicated if the excess skin, fat, and muscle weakness is mild and limited to the lower abdomen. This smaller operative procedure can be done with a smaller scar, lighter anesthesia, as an outpatient without observation, and with much less pain and recovery. If the upper rectus also has a diastasis, an endoscopic or limited plication can be performed.
About limited abdominoplasty
Dr. Park also modifies the above techniques in a hybrid procedure that he calls a limited abdominoplasty that can improve the entire abdomen but without as much recovery or discomfort by floating the umbilicus, moving it down, and liposuction.
In individuals with massive abdominal obesity, a hanging flap of skin and fat (a pannus), or significant abdominal wall scarring, a panniculectomy (removal of the excess fat and skin) without raising the rest of the abdominal wall is safer than an abdominoplasty. A lower transverse and midline vertical abdominal dermal lipectomy may be indicated in certain patients. Postoperatively, observation for at least 1 night is required due to the comorbidities and increased risk in this patient population. Drains and sutures are usually removed in 2 -3 weeks. It usually takes 2 to 3 weeks to get back to work and moderate activity and 6 weeks to get back to more strenuous activity.
Patients with upper abdominal scarring, atypical upper abdominal excess, or the need for certain combined breast procedures may be best served by taking tissue from the upper abdomen in a reverse abdominoplasty. The scar is left below the breast but still may be visible or distorted.
A circumferential body lift, or belt lipectomy, is indicated in patients with excess skin and fat of the abdomen, flanks, and back with laxity and descent of the buttock and hips, often seen after massive weight loss. The cumulative effect is an abdominoplasty, lateral thigh lift, back dermal lipectomy, and buttock lift, and as expected, a belt lipectomy is a major surgery with additive risks, operative time, and recovery. Therefore, a preoperative determination of safety, risks, and goals is necessary. Risks can be minimized with early postoperative ambulation, multiple suction drains, and close followup. This procedure can drastically reduce the girth, but typically cannot recreate an hourglass figure. Even limited activities can be difficult for the first few weeks and activities must be limited for several months. Results are usually quite pleasing, but the focus is more on function and safety rather than maximum cosmesis.
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Due to COVID-19, MPRSD and the Med Spa will be closed indefinitely beginning March 30th, 2020. Both Dr. Park and Dr. Rebowe will only be seeing post-operative patients, patients with pressing issues, and will continue working hospital consults and ER coverage. However, during this time we will not be seeing new elective patients. Staff will reach out to cancel appointments and notify patients, and will be reaching out to reschedule when we are back in the office.
We always do our best to stay available to our patients. If the normal communication systems break down during this crisis, Dr. Park should be reachable at email@example.com and Dr. Rebowe at firstname.lastname@example.org. Immediate availability cannot be assumed during these unpredictable times so do not email with urgent issues. Urgent issues need direct communication with a provider either through the office or if necessary, your nearest emergency room.
Email email@example.com to setup a virtual consultation with Dr. Park or Dr. Rebowe