What Is a Tummy Tuck?
A tummy tuck (abdominoplasty) is designed to smooth and flatten the abdomen by excising excess skin and fat as well as tightening the abdominal wall. Liposuction is usually part of this procedure, as it can accentuate the waist and add definition to the abdomen. The abdominal bulge caused by pregnancy—diastasis recti—can also be repaired, pulling in the waist and providing a flatter contour of the abdomen. Additionally, San Francisco plastic surgeon Miguel Delgado, MD offers the option of a waist enhancement technique that tightens additional musculature (the external oblique fascia) around the waist. This procedure trims and sculpts the waistline and can improve the shape of the upper buttocks as a bonus.
Most women seeking a tummy tuck have gone through pregnancies and have completed their childbearing. These women have found that diet and exercise, while very beneficial, fall short of restoring the abdominal tautness and contours they enjoyed prior to their pregnancies. The surgery addresses concerns that cannot be achieved by any other means. An additional benefit is that some (but not all) stretch marks can be eliminated with the removal of the excess skin. The navel (belly button or umbilicus) is also remodeled as a consequence of the skin tightening procedure, and this is described in more detail in the procedure section below.
|Procedure||What It Does||Surgery||Recovery||Results|
Tightens abdomen muscles and removes excess fat and skin
2-3 weeks, no strenuous exercise for 6 weeks
Eliminates stubborn fat using a cooling technology
As the majority of people seeking surgery are women whose bodies have been altered by their pregnancies, the term “Mommy Makeover” has been coined. A Mommy Makeover includes a tummy tuck accompanied by a breast lift or breast augmentation, as well as liposuction of areas such as the inner and/or outer thighs, flanks, and post iliac crests. In response to the popularity of this group of procedures, we have devoted an entire page of our website to the Mommy Makeover.
Who Is a Candidate for Tummy Tuck Surgery?
A tummy tuck is appropriate for men and women who are in good health and have any combination of loose abdominal skin, excess abdominal fat, or lax abdominal musculature.
A patient may be a candidate if he or she has any of the following:
- Excess or loose, hanging abdominal skin—either from weight loss or pregnancy
- An abdomen that protrudes unnaturally and out of proportion to the rest of the body
- An abdominal muscle compartment that has been weakened by pregnancy or aging
- Excess fat that is concentrated beneath the abdominal skin
If a patient is planning to have more children, a standard tummy tuck—one that includes tightening of the abdominal muscle wall—should not be done. However, it is safe to remove excess skin that can be present following significant weight loss.
1) Mini-Tummy Tuck (Mini-Abdominoplasty)
This technique requires a short incision at the pubic hairline, and the navel (belly button or umbilicus) is not altered. Abdominal liposuction can be performed with a mini-tummy tuck. In addition, the fibrous component (aponeurosis) of the underlying abdominal musculature can be partially tightened below the umbilicus and slightly higher. This procedure is usually good for patients who have the following:
- Minimal skin laxity
- Mild to moderate abdominal fat
- Mildly to moderately stretched abdominal muscle wall and/or abdominal muscle separation
The best candidates for this procedure are those who have very toned bodies with relatively low body fat content.
It is important to make sure that a mini-tummy tuck is the best option. Once the base of the belly button is transected—which is often performed in mini abdominoplasty—a full tummy tuck can not be performed in the future without putting the belly button at risk of loss. However, Dr. Delgado now has a new technique called a neo-umbilicus, which reconstructs a new belly button three to four weeks after surgery. This method is gaining popularity because it places the belly button in the best aesthetic position for each individual’s anatomy, it is simple to do in the office under local anesthesia, and the results look natural.
2) Liposuction Alone
With firm skin and good muscle tone present, liposuction alone can sometimes yield satisfactory results. This is a good choice for women who plan to become pregnant in the future.
How Do I Prepare for Tummy Tuck Surgery?
Scheduling a personal consultation with Dr. Delgado is the first step for a patient interested in tummy tuck surgery. This appointment can take place either at Dr. Delgado’s San Francisco office at 450 Sutter St., Suite 2433 or at his Marin County office at the Sutter Community Hospital campus, 165 Rowland Way, Suite 300. During this appointment, Dr. Delgado and the patient will discuss the patient’s concerns about his or her appearance. Digital photography and computer imaging are used to demonstrate the benefits one can expect to see in the physical anatomy after an abdominoplasty, as well as where the abdominal incisions will be located.
Finally, Dr. Delgado will do a physical examination to assess the quality of the abdominal skin, the location of any existing scars, the degree of excess fat, and the tone of the underlying musculature.
Each patient will receive a preoperative instruction booklet detailing preparations that should be made leading up to surgery. This includes a list of suggested supplements, vitamins, and homeopathic medicines to begin taking to help diminish bruising and assist with healing after surgery. Additionally, the booklet provides directions as to which medications to discontinue or avoid prior to the procedure, such as ibuprofen, Advil, aspirin, and more—all of which can heighten the potential for excessive bleeding and/or other issues following a tummy tuck. If a patient smokes, he or she will also need to discontinue this entirely at least four weeks prior to surgery, as smoking significantly impedes normal healing and can compromise final results.
Another important aspect of preparation is arranging for help during the early stages of recovery. Initially, caregivers will be required to aid patients in getting in and out of bed and to and from the bathroom. They will also need to prepare food and assist with medications. It is critical to have responsible friends and/or family members briefed on how to help postoperatively to ensure a smooth recovery.
Dr. Delgado will order blood tests that need to be done prior to surgery so that he and the anesthesiologist will know that the blood count and blood chemistry are within normal limits, indicating that the surgery and anesthesia should be safe for the patient. These blood tests include, but may not be limited to, a CBC (Complete Blood Count) and an Electrolyte Panel. A patient’s medical history may require that additional tests be ordered. If a patient is 50 years old, or has any personal history of heart disease, an EKG will be required, as well.
The patient is given prescriptions that need to be filled before the surgery date. These prescriptions include an antibiotic (usually Keflex) and Reglan, a medication that prepares the digestive tract for anesthesia. The patient also receives prescriptions for pain medication (Vicodin or similar) and a muscle relaxant (Robaxin). The patient will be advised to have an over-the-counter stool softener on hand.
Dr. Delgado has found that having a colonic cleansing before surgery greatly adds to postoperative comfort. In addition, with an empty colon, the abdominal fascia can be better tightened. Postoperative constipation can be an issue due to the pain medication. The colonic cleansing helps with this as well.
What Does the Tummy Tuck Procedure Involve?
Dr. Delgado performs tummy tuck procedures at his private surgery suite—Marin Cosmetic Surgery Center—which is situated on the campus of Sutter Marin County Community Hospital in Novato, CA. The proximity of the surgical suite to the hospital allows for optimal safety while also maximizing patient privacy.
Before anesthesia is administered and surgery begins, Dr. Delgado will use a special pen to illustrate a detailed procedural map on the abdominal area while the patient stands upright. Doing so enables him to make any appropriate adjustments based on gravitational changes that occur when the body is lying horizontally during surgery. Once this is complete, a board-certified anesthesiologist will dispense the anesthesia.
To start the surgical aspect of treatment, a horizontal incision is strategically placed below or at the pubic hairline towards the hipbone. Today’s fashion has evolved to low-rise pants and dipping swimsuit lines, but Dr. Delgado can customize the placement of the incision to accommodate a patient’s lifestyle and clothing preferences. Through this incision, the fibrous component of the abdominal muscle wall (the aponeurosis) can be tightened by lacing it centrally to achieve a flatter abdomen, much like lacing up a shoe will pull in and flatten the tongue of the shoe. This repairs the diastasis recti, the bulge, that occurs from pregnancy. The procedure is essentially the application of a surgically installed corset. If waist enhancement is desired, Dr. Delgado will also tighten the external oblique musculature, as this procedure will pull in the waist and accentuate that contour. Then, superficially, the skin is pulled downward, and after the excess skin is excised, the skin is sutured into position. The belly button maintains its vascularity but is excised around the perimeter, much like an apple core. It is then pulled through the skin to the new location. The umbilical position is unchanged in relation to the abdomen itself. Skin with stretch marks may be completely or partially excised depending on the location of the stretch mark scarring. Liposuction is used to improve the abdominal and waist contour. The abdomen is closed with two drains in place.
The use of drains is a controversial issue—the vast majority of plastic surgeons use drains, but there is a growing movement for no-drain techniques. One of the possible complications with a tummy tuck is a seroma, or fluid buildup, underneath the skin. This can be a significant problem. The patient will have to return to the office multiple times to have the fluid drained by needle aspiration. If the issue still persists after multiple aspirations, a drain may be required. It could even become a chronic issue with scarring and possibly infection. For these reasons, Dr. Delgado uses drains after abdominoplasty, helping to avoid the sermoma issue almost completely. He will, however, continue to evaluate the technique of no drains.
In the past, we used the On-Q™ pain pump system for long-term (three to four days) pain control. Dr. Delgado has changed to a much better long-term pain injection called EXPAREL. The advantage of EXPAREL is that it is an injection that is placed directly into the tissue where it is most needed. No indwelling catheters are necessary, and no pouch needs to be carried, like the On-Q pump system. In addition, the pain control is much better.
Another great advancement in abdominoplasty is the use of Quill™ sutures. Dr. Delgado abandoned the use of the Insorb™ internal staple closure to the Quill barbed suture technique. The Quill suture is a suture that has one-way barbs on them. This is much like a fishhook that goes in and is difficult to pull out. The advantage is that the sutures are locked into place as they are applied, and no knots are required. This allows for an even tension closure with beautiful incisions. The Quill is also used for the muscle repair-closure as well. Dr. Delgado is very impressed with this new advancement for closure.
After the skin closure is complete, large cotton pads—with Vaseline™ (petroleum jelly) and 2.5% hydrocortisone cream applied to the skin side—are placed over the abdomen and secured with an abdominal compression garment containing a Velcro closure.
General anesthesia provided by a board-certified anesthesiologist is used for abdominoplasty surgery at Marin Cosmetic Surgery Center. An LMA (or laryngeal mask airway) is a state-of-the-art technique that allows the patient to breathe unassisted during the procedure. Short-acting anesthesia medications are given to maintain an adequate, but light, level of general anesthesia. This allows the patient to awaken very quickly at the end of the procedure. However, with a tummy tuck procedure, it is required that a short period of paralysis is performed, so that the abdominal muscles can be adequately tightened. This, again, is a short-acting paralysis, which quickly wears off before the procedure is concluded. Unless the muscles are in a relaxed state, this cannot be adequately accomplished. The anesthesiologist manages the patient’s breathing during this short phase. For most of the procedure, however, the patient breathes on their own.
To help maximize the effectiveness and safety of anesthesia, the anesthesiologist calls the patient the night before surgery to do a final medical history review, reiterate any last-minute preoperative directions, and address any anesthesia-related questions or concerns.
Dr. Delgado and staff are phenomenal! Dr. Delgado walked me through the process and helped put me at ease. I feel so fortunate for the comfort and warmth they provide me at each follow up visit.
What Is Recovery from a Tummy Tuck Like?
Initial postoperative hours are spent in the recovery room with a Registered Nurse trained in post-anesthesia recovery. During this time, Dr. Delgado and the anesthesiologist will check on the patient’s status periodically. When fully alert and comfortable, he or she may go home with a responsible adult.
If it is the only surgical procedure a patient is having, he or she may go home the same day. The EXPAREL intra-operative pain shots greatly helps with postoperative discomfort, as it dissolves into the surgical site for three to four days following surgery.
A patient must have adequate help at home for the day of surgery, as he or she should not get out of bed unaccompanied for the first 24 hours. Due to lingering effects of general anesthesia, a patient can become dizzy and fall unexpectedly during this time period. Also, due to discomfort of the surgery itself, it is best that a patient has someone to prepare food and keep liquids easily accessible. It is good to have someone to remind the patient to take antibiotic and pain medications (and/or other medications) on time, as he or she may still be a little foggy from residual anesthesia or the pain medication itself. The Jackson-Pratt drains will need to be emptied twice a day or more, and it is helpful to be able to delegate this to a caretaker.
Very often, especially if other procedures are performed, a 23-hour overnight stay at the Marin Cosmetic surgery center is required. This is a welcome option for many patients as it assures optimal management of pain and (although rare) nausea, provides licensed medical nurse supervision during the most critical postoperative and post-anesthesia time period, and relieves the patient (and the family) of the chore of emptying the Jackson-Pratt drains while he or she is most active.
Dr. Delgado personally checks on overnight patients the following morning before discharging them to go home with a friend or family member.
If the patient lives some distance from Marin Cosmetic Surgery Center and is not staying overnight at the surgery center, it is often recommended that he or she spends the first night after surgery in a local hotel, such as Best Western Marin County Oaks Inn at 215 Alameda del Prado or Courtyard by Marriott at 1400 Hamilton Parkway. If a patient does not have a friend or family member to stay with them, Marin Cosmetic Surgery Center has specially trained post-surgery caretakers who can stay with the patient, assisting with medications, drains, positioning, and safe ambulation.
The early postoperative recovery is focused on preventing blood clots the day of surgery and throughout the recovery period. These are some of the important steps in prevention:
- Pneumatic sleeve leggings are used around the calves before, during, and after surgery, until the patient is again walking. This medical device is sent, on loan, home with the patient.
- When in bed, the patient’s knees should be bent, or flexed, by having pillows under the knee joints. This provides unobstructed venous blood flow.
- The patient’s temperature is controlled, especially during surgery.
- The patient is discharged home with T.E.D.™ (Thrombo Embolic Deterrent) stockings (anti-embolism compression stockings).
- The patient is advised to ambulate every hour at home while awake.
- Lovenox (enoxaparin sodium) injection is a blood thinner used to prevent blood clots called deep vein thrombosis (DVT), which can lead to blood clots in the lungs. This is not always used, depending on the patient’s past medical history, as these drugs are not without complications for all individuals.
The patient will not be able to stand up straight immediately after surgery, as it will be more comfortable to stand and walk slightly bent over. This is because the skin is stretched and sewn snugly to give the smoothest and flattest result possible. The skin eases and stretches out within a week or so to where the patient will be able to stand and walk normally.
Dr. Delgado encourages early ambulation to reduce swelling and promote blood circulation. The patient should avoid any strenuous activity, lifting, or bending. The pain is described as moderate and is successfully controlled with pain medications and the EXPAREL pain injection. This usually improves significantly within three to seven days.
The drains will be removed at seven to ten days. This can be done at Dr. Delgado’s San Francisco office or at his Marin County office. The drains are used to remove any fluid that accumulates underneath the skin. Prior to drain removal, and for 24 hours following drain removal, bathing is restricted to sponge baths only, keeping the dressings entirely dry. The patient may shower 24 hours after drain removal. By this time, the drain site incisions will have sealed and the patient is again “waterproof” and considered safe from bacteria entering at these sites.
Bruising and swelling begin to dissipate at seven to ten days for most patients, and sutures are removed in approximately ten days. Sutures can be removed at either the San Francisco or the Marin County office.
There is a two-step compression garment system. The first abdominal compression garment is worn for approximately four to six weeks. After the drains are pulled, a secondary garment is placed, which is much more comfortable and easy to camouflage under clothing. A patient should be able to go back to work 10-14 days after surgery, although jobs demanding higher levels of physical activity may require a longer recovery period. It is strongly advised that a patient wait until six weeks after surgery to ensure adequate healing has taken place before he or she resumes any formal exercise. Scar management begins about six weeks after surgery.
It generally takes at least six months to see the final results. By this time, most of the tightness and numbness will have resolved, and the incisions will typically begin to fade.
Are There Potential Tummy Tuck Risks & Complications?
Like any surgical procedure, tummy tucks carry the risks of bleeding, infection, and blood clots, as well as potential anesthesia-related issues. However, the combination of Dr. Delgado and his team of licensed and credentialed professionals at Marin Cosmetic Surgery Center, help to significantly minimize these risks.
Abdominoplasty surgery produces a long incision. These incisions usually heal excellently, but occasionally will form scars that respond well to scar management or other medical treatments, such as steroid injections. If fluid accumulates underneath the skin after the drains are pulled, it can be successfully aspirated in the office.
What Results Can I Expect from Tummy Tuck Surgery?
The results achieved through abdominoplasty are dramatic and long lasting. Most patients find that a flatter and firmer abdomen boosts their esteem and makes them feel more confident in clothing. Unless a significant amount of weight is gained or lost, a patient can expect to retain his or her new shape for many years.
How Significant Will My Scars Be Following a Tummy Tuck?
All surgical procedures leave incisional scars. Dr. Delgado understands that you want these scars located in the most inconspicuous areas so that regular clothing will conceal them. The tummy tuck scar is located low on the abdomen, just below the pubic hairline on most patients. The scar traverses from hipbone to hipbone, with the exact length depending on how much extra skin is to be removed. The scars can be easily hidden with clothing and should significantly blend into your skin tone over the subsequent year. Women tend to wear a large variety of clothing styles, and they can opt to have a lower or higher incision.
Incisions heal at different rates and quality, and much depends on the skin type, as well. Generally speaking, scarring on lighter skin tends to fade more quickly because there is very little pigment, whereas darker skin takes longer for the color of scarring to normalize. Even though incisions heal the same, the pigment in dark skin causes a “hyperinflammatory pigmentation”—the pigment-producing cells, melanocytes, go into a hyper-productive state, which causes a deeper pigment. This pigment takes longer to blend than lighter skin that has little to no pigment.
Dr. Delgado has a revolutionary scar management system that has been very effective called Embrace. The older system was the use of silicone sheeting, which is effective but very cumbersome to utilize, so compliance was an issue. Embrace is a one-time use device that, when placed, simultaneously relieves tension while applying beneficial pressure directly on the incision. It stays on for about a week, after which it is replaced by another for about six weeks. For those who desire to do so, exercising (including swimming) is allowed with Embrace.
What Is the Cost of Tummy Tuck Surgery?
The typical cost of tummy tuck surgery is about $14,400, which includes Dr. Delgado’s professional fee, EXPAREL for pain control, the Marin Cosmetic Surgery Center fee, the anesthesiologist’s fee, the compression garments, and all follow-up care. The total expense may be more if other procedures are added, such as waist enhancement and additional liposuction. At the time of your consultation, you will be given a detailed estimate of all your surgery fees.
An example of abdominoplasty cost breakdown is as follows:
- Surgeon’s Fee – $7,100
- Surgery Center with General Anesthesia – $3,500
- EXPAREL, Quill™ Sutures, Embrace, Vitamedica, Garments – $1,850
The complete package is approximately $14,400, including all follow-up care and touch-up revisions for the first year.
Is a Non-Surgical Tummy Tuck Possible?
Non-surgical tummy tucks are a marketing ploy; if someone requires abdominoplasty, there is no replacement procedure.
A tummy tuck candidate has clear anatomical issues from pregnancy and/or significant weight loss—there is muscle laxity, skin redundancy, excess fat, and varying degrees of stretch marks. Below are a few techniques in the industry to treat these concerns:
- Radiofrequency Energy – Thermage® or Accent™
- Intense Pulsed Light – VelaShape®
- Ultrasound – Ultherapy®
Non-Invasive Fat Reduction
- Cryolipolysis (Freezing) – CoolSculpting®
- Injection Lipolysis – KYBELLA®
- Radiofrequency Lipolysis – Vanquish
- Laser Lipolysis – SculpSure
While these procedures can be good and successful with excellent patient satisfaction for very specific situations, not one is a non-invasive tummy tuck! Non-surgical treatment modalities such as these may be used to complement the outcome of tummy tuck surgery, but not as a substitute.
Additional Tummy Tuck FAQs
How is a tummy tuck performed?
During an abdominoplasty, Dr. Delgado makes a horizontal incision along the lower abdomen, staying inside the underwear coverage area line. The underlying musculature is tightened like a corset. Excess skin is pulled down and inward (enhancing the waist), meticulously trimmed, and the incision line is sewn closed. The belly button does not change from its original location in the abdomen, but it is pulled through a tiny incision made in the newly tightened abdominal skin. Tiny sutures reaffix it to the skin surface, resulting in a flat reset as an “innie” style belly button. Dr. Delgado spends nearly 30 minutes on the belly button alone. This is a sign of a good tummy tuck—and the only thing seen in public.
What can I expect during my initial consultation?
Dr. Delgado sees patients for consultations in both his offices. In your initial consultation, he will inquire about your concerns and goals, both short-term and long-term. Dr. Delgado, in addition, will confirm that you are certain you will not become pregnant in the future. This is because the procedure is intended only for patients who have completed childbearing or have no intentions or ability to become pregnant in the future. Dr. Delgado will perform a physical examination to assess the degree of your skin laxity, determine any slackness in the belly button and your abdominal wall, and evaluate the appearance of the belly button. In addition, he will examine for any type of hernias, such as the most common umbilical hernia that is a result of pregnancy. He will show you an outline of where the incision will likely be located and approximately how long it would be. Dr. Delgado will give you the opportunity to review before-and-after photographs of patients that he has performed surgery on so that you have an impression of his artistic work and talent. You will be provided a link to his media library which will show many videos of documentaries and before-and-after photos of his work. An exact price quote for your procedure will be prepared and given to you the day of your consultation for review.
How long does the procedure take?
It takes approximately four and a half hours. Oftentimes, liposuction is done at the same time, which takes an additional hour or so. It also depends on if there is a waist-enhancement procedure performed, which takes more time as well. The length of time also depends if there are additional procedures, such as breast surgery; much like a Mommy Makeover. Dr. Delgado will be able to give you a fairly accurate time for your surgical procedure at the time of your consultation.
Will I be able to return home the same day?
Most patients are able to return home the day of surgery. Significant advances have been made regarding early postoperative recovery with the administration of long-acting EXPAREL directly into the surgical site, which provides pain relief for three to four days following surgery. This greatly reduces the amount of discomfort during the early postoperative period. However, if other procedures are added, an overnight stay may be required for safety and pain management.
When can I return to work?
You will likely be able to return to work and most other activities within two to three weeks following your procedure. However, intense exercise and other strenuous activities should be avoided for at least six weeks to avoid unnecessary swelling and excessive stress on freshly healed structures. Driving generally can be resumed within 10 to 14 days.
How Significant Are My Scars Following My Procedure?
All surgical procedures leave incisional scars. Dr. Delgado understands that you want these scars located in the most inconspicuous areas so that regular clothing will conceal them. The tummy tuck scar is located low on the abdomen, just above the pubic hairline on most patients. The scar traverses from hipbone to hipbone, with the exact length depending on how much extra skin is to be removed. The scars can be easily hidden with clothing and should significantly blend into your skin tone over the subsequent year. Women tend to wear a large variety of clothing styles, and they can opt to have a lower or higher incision.
What is seroma after tummy tuck surgery?
A seroma is a collection of fluid that accumulates under the surface of the skin. Seromas can develop after the tummy tuck surgery, between the skin/subcutaneous tissue and the abdominal wall. The fluid that builds up is called serum, which has a yellow-clear color. This results from friction of the two layers—the skin/subcutaneous tissue and the abdominal wall—not yet healing together. If a drain is placed, the space would close because the drain decompresses the space by continually draining the fluid and allowing the two layers to heal together by scar tissue. Dr. Delgado utilizes drains to help minimize the risk of seroma after abdominoplasty.
How can I reduce swelling after a tummy tuck?
This is a very common question patients ask, along with “Is there still swelling?” and “When will the swelling be gone?” The resolution of swelling is a process that takes time. Dr. Delgado generally advises patients to wear compression garments for six weeks, which helps reduce swelling (in addition to reducing the rate of seroma). During this time, exercise should be avoided. There may be a rebound of swelling at some point during the six weeks, but this will gradually resolve. Other ways to help diminish swelling include lowering salt intake (salt attracts water) and sleeping in an elevated position.
Will I be able to have children after an abdominoplasty?
We recommend that the childbearing years be completed. The internal tightening of the muscles could adversely affect a future pregnancy and, therefore, pregnancy is highly discouraged following a tummy tuck. We do not recommend it.
How can I tell if I am a good candidate?
Many women, after childbearing years, would like to reclaim their pre-pregnancy bodies. The results of pregnancy can cause irreversible stretching, increased laxity of the skin, increased muscle laxity around the mid-torso region, and unwelcome increased fat deposits. A patient may best benefit from a Mommy Makeover, which, in addition to an abdominoplasty, includes breast augmentation and/or breast lift and liposuction. This has become a very popular surgery combination. Other patients who are good candidates are those who lose a large amount of weight, resulting in excess skin, which can be removed with a tummy tuck procedure.