Tummy tuck

Pregnancies, genetic predisposition, gravity, previous surgeries, weight loss, or ageing can cause the abdominal wall, skin, and muscles to slacken and loosen. Sometimes there is a skin surplus, the navel has lowered, and the abdominal muscles have parted in the middle. No amount of diet and exercise can completely get rid of your sagging, hanging belly. In mild cases, liposuction may offer a solution, but a tummy tuck often is the only way to give you back a tight and flat stomach.

Recovery

Treatment

Anaesthesia

Consultation

A tummy tuck can improve the appearance of your belly in different ways:

Excess fat and skin are removed from the abdomen and flanks (sometimes in combination with liposuction)
A stretched navel is made smaller and brought up to a higher, more youthful position
Stretched abdominal muscles are tightened and, if necessary, are sutured back together
The connective tissue around the muscles is tightened
Love handles, excess skin, and disturbing bumps and pits are removed

the belly is tighter, and you regain your youthful contour

Even though a tummy tuck inevitably leaves you with a relatively large and visible permanent scar, most women are delighted with the results.

It all starts with a consultation

No two women’s bodies are the same. The cosmetic needs and expectations of patients are unique. To ensure that you are happy with the result of your treatment, Dr Pirayesh develops a customised surgical plan for each patient. During the consultation, he will take the time to get to know you, discuss your requirements and help you make an informed decision.

He will ask about your general health and medical history and examine your belly. He will determine whether and where you have excess fat around your belly: if the fat is located outside the abdominal muscles, it can be removed by a tummy tuck; if it is located on the inside of the muscles, this is not possible. Dr Pirayesh will determine the extent of excess skin and the quality of your skin and examine how firm your abdominal muscles are. The location of the excess fat, the elasticity of the skin, and the length, location, and firmness of the muscles determine which technique is preferable and how large your scar will be. He will explain where the incision will be made, the expected results, and the necessary aftercare.

Dr Pirayesh will also answer any questions, give instructions on preparing for the operation, and inform you about the cost.

The anatomy of the abdomen

The first part of the anatomy of the abdomen is the most visible: the skin. The upper layer of the skin is called the epidermis. New cells are created deep inside the epidermis and slowly pushed upwards, where they die and slough off. When we are young, our entire skin rejuvenates every two to three weeks, but as we age, this process slows considerably.

Beneath the epidermis is the dermis: next to the sebaceous glands, nerves, capillaries, and sweat glands, our skin also has collagen and elastin: they ensure that your skin can stretch and spring back into shape, but as we get older, we lose this elasticity. Therefore, our skin is thinner, and if it has stretched considerably, it will usually not return to its original shape.

Below the dermis is subcutaneous fat. Fat cells can be huge, especially if your body stores more fat. Liposuction and a tummy tuck take away large amounts of fat cells. But if you regain weight, the remaining fat cells will allow your tummy to bulge once more. Around the abdomen, there are three layers of fat:

Subcutaneous fat: a superficial layer of fatty tissue just under the skin: this is denser and more tightly connected to nerves and blood vessels.
Intramuscular fat: extra abdominal fat situated between the muscles but not in the abdominal cavity. You can hold it if you pinch the skin of your abdomen; this type of fat is often removed during a tummy tuck.
Visceral fat: fat around the organs in the abdominal cavity: this is the deepest layer of fat and protects your organs against infections. Excess fat means pressure from within the abdominal muscles, causing them to stretch.

Connective tissue is a thin membrane that covers and protects all the muscles and many organs. If the subcutaneous connective tissue stretches, the abdomen looks swollen, even if you have strong muscles. The deep connective tissue that lines the abdominal muscles and separates the muscles of the organs can stretch. With a tummy tuck, the muscles, the connective tissue, and the skin are all tightened.

Your torso has three muscle groups: the external obliques, internal obliques, and the abdominal muscles. These muscle groups are responsible for the shape of your belly and are stretched by ageing and pregnancy. With a tummy tuck, the abdominal muscles are the most important.

Shorter hospital stays

In the past, patients had to remain in the hospital for up to four days. These days, tummy tucks require just one overnight stay in the surgery clinic. Recent research underlines and confirms the safety and efficacy of a shorter stay after a tummy tuck. The gravity of the tummy tuck will determine when you can go home.

Tummy tuck overview and timeline

Duration of surgery: 2 to 4 hours
Anaesthesia: light general anaesthetic administered by a specialised anaesthetist
Length of stay: surgery clinic, you must stay at least one day and rest as much as possible
Post-surgery: swelling, tenderness, and bruising. A small drain is inserted under the skin to drain excess blood or fluid. We will provide you with a compression garment to wear day and night for a few weeks after your surgery to prevent swelling. You will receive pain medication and instructions on wound care.
Complications, very rare: fluid retention, infections, raised, livid scars
Recovery period: Generally, a tummy tuck is not painful; the first three days are the hardest but can be managed with the proper use of painkillers. You are probably not able to walk quite upright, and you need to concentrate on improving your posture. The sooner you do, the faster you will recover. You can usually return to work after two weeks. The recovery period usually takes about six weeks, during which time you may not lift or strain. After six weeks, you can move normally and are allowed to exercise. After several months, your scars will have faded and are usually barely visible in swimwear.
Result: You have a flat belly and flanks again, moving around and exercising is easier than before, and your clothes fit you better.
Scarring: the drain is painlessly removed within 2 to 4 days after surgery. Most of the sutures dissolve after some time. Dr Pirayesh has developed a program, APS Scar Care, including aloe vera-based creams, laser treatments, and (if necessary) injections to ensure that your scars heal in the best possible way.

Tummy tuck surgery in five steps

On the day of your surgery, Dr Pirayesh will make markings on the surgical site on your abdomen. In addition, he will take photos for your medical record.

Step 1. Anaesthesia

A specialist anaesthesiologist will inject a light general anaesthetic into a vein through a cannula (a thin, plastic tube) in your arm or hand. The anaesthesiologist and his team will monitor you closely throughout the operation, ensuring you are comfortable and safe. The anaesthesiologist will discuss the anaesthesia with you before your surgery and answer any questions.

Step 2. Different techniques

There are several techniques with tummy tucks, depending on the amount of sagging skin that needs to be removed and whether you need a new navel. Dr Pirayesh has previously discussed the best option with you:

Partial or Mini Tummy Tuck: if you have a small amount of fat and excess skin and only in the area below your belly button, you will need a less invasive procedure. This treatment is usually performed on an outpatient basis. In this procedure, the fat is removed under your navel, and the muscles are tightened from the navel to the pubic bone. Your belly button will not change position. The scar from a Caesarean is often re-used and made slightly longer for this purpose. This procedure is known as the Mommy Makeover.
Full Tummy Tuck: during this operation, Dr Pirayesh makes a second incision, detaches the navel from the surrounding tissue, and tightens the muscles below the chest to the pubic bone. If possible, existing stretch marks are removed simultaneously with the excess skin. Then the skin flap is sutured after a small incision is made where the new navel will be. The scar usually runs from hip to hip. This procedure is often performed in conjunction with liposuction to get the best results.
Extended Tummy Tuck: this operation is generally carried out on obese patients with a lot of excess fat and overhanging skin. This can extend onto the back. To obtain a beautiful shape, the scar will run further than the hip, in the direction of the back. Dr Pirayesh will tighten your muscles and create a new navel.
Body Lift: this surgery is usually performed by patients who have lost a considerable amount of weight, e.g. after gastric bypass surgery. To recreate a beautiful shape, an incision must be made circling the entire waist. This ensures that Dr Pirayesh can lift the outside of the thighs and the buttocks, giving them a better shape. The muscles are tightened, and a new navel is created. Dr Pirayesh is assisted by a colleague plastic surgeon so that this major operation does not take too long.

Step 3. The incision

The length of the incision depends on the type of tummy tuck being performed on you, the anatomy of your muscles, and your skin type. For instance, the incision for a partial or mini tummy tuck is much shorter than for an extended tummy tuck. There is no need for an additional incision to reposition your belly button.

Step 4. Suturing and bandaging

A drain is placed to drain the fluid that collects in your body after the tummy tuck. The skin flap is then closed and your abdominoplasty is completed. Possibly, liposuction is performed at the same time as the tummy tuck to improve the end result. Dr Pirayesh uses sutures and/or surgical tape to close the skin and protect the wounds.

Step 5. Recovery and aftercare

You will almost immediately see a massive change in your body, even though it remains hidden under special compression garments for a while. Dr Pirayesh gives you specific, written instructions on aftercare for the weeks after surgery and what medication to use for optimal healing and minimal risk of infection. When you come to the clinic for follow-up appointments, you will meet with him to discuss details with him and ask questions.

Overall, a tummy tuck is not painful: the first three days are the hardest but manageable with the proper use of painkillers, although you will tire quickly.
You are probably not able to walk quite upright, and you need to concentrate on improving your posture. The sooner you do, the faster you will recover.
Because your abdominal muscles are tightened, you will experience a difference in breathing and must practice a deeper breathing technique.
After 3 to 4 days, your drain will be removed.
After one week, Dr Pirayesh will examine your wounds and remove the stitches.
It is advisable to undergo regular lymphatic drainage treatments to distribute and dissipate fluid build-up.
Depending on the severity of your surgery, you can return to work after ten days to two weeks, provided that you do not have to perform any strenuous exercise.
After about one month, your pants will fit you like a glove, and you will feel reborn.
The total recovery period usually takes six weeks, during which you may not lift or strain.
Avoid the solarium or sauna, and don’t drink alcohol or take blood thinners like aspirin (paracetamol is allowed).
You may resume your normal activities six weeks after surgery.
After two months, you will feel happy in your body again, and shopping will become a pleasurable experience.

Step 6. Wound healing and scarring

Dr Pirayesh is very savvy when it comes to promoting rapid healing. He has developed a customised regimen, APS Scar Care, including creams based on aloe vera, laser treatments, and (if necessary) injections to ensure that your scars heal in the best possible way.

This regimen has ensured that many of Dr Pirayesh’s patients have hardly noticeable scars. However, it is impossible to pre-determine if patients will have problems with their scars healing.