Tummy Tuck (Abdominoplasty) in Fort Lauderdale with Dr. John Michael Thomassen
A tummy tuck (abdominoplasty) is a surgical procedure that is designed to improve the appearance of the abdomen. Dr. John Michael Thomassen frequently performs tummy tucks for residents in and around Fort Lauderdale, Fla. During an abdominoplasty, Dr. Thomassen tightens the muscles of the abdominal wall, he also removes excess fat and unnecessary skin from the abdomen. Sometimes, during a tummy tuck, Dr. Thomassen also performs liposuction.
Reasons the Abdomen Becomes Less Tone
Various factors contribute to the loss of tone in the abdomen. These factors include the combined effects of gravity, aging, weight fluctuations, pregnancy/childbirth and a loss of skin elasticity.
What an Abdominoplasty in Fort Lauderdale Can Accomplish
When Dr. Thomassen performs a tummy tuck, he contours his patient’s body to create a firm and flat abdomen.
Custom-Designed Treatment Plans to Meet Each Patient’s Specific Needs
Each patient is unique, therefore, Dr. Thomassen takes the time to create each of his patients a treatment plan that is designed to meet his or her specific needs.
Who Should Consider a Tummy Tuck with Dr. Thomassen in Fort Lauderdale?
The majority of individuals who seek a tummy tuck in Fort Lauderdale are women who have had several pregnancies resulting in excess fat and skin on their abdomens. Women who intend to have more children should wait to have a tummy tuck because pregnancy can negatively affect the results of their abdominoplasty.
View Before & After Photos
Other individuals who choose to have a tummy tuck include:
- Men and women who have a protruding abdomen with excess fat and/or skin that is resistant to diet, and exercise.
- Healthy individuals who are within 25 pounds of their recommended body weight and who have realistic expectations as to what a tummy tuck can accomplish.
- Individuals who have lost a substantial amount of weight and have excess skin; however, an individual who plans to lose more weight should postpone a tummy tuck until his or her weight loss goal is reached.
An Initial Consultation for a Tummy Tuck at Thomassen Plastic Surgery in Fort Lauderdale
Patients should be candid during their initial consultation: All of the questions that Dr. Thomassen and his staff ask are intended to prevent complications and ensure the safety of the patient.
During an initial consultation, Dr. Thomassen will want to know about the patient’s medical history, including:
- The medications, herbal supplements and vitamins he or she takes
- Prior treatments and surgical procedures
Dr. Thomassen will ask whether the patient smokes, drinks alcohol or uses recreational drugs as well as the patient’s motivation for seeking an abdominoplasty. The use of tobacco, alcohol and recreational drugs can have a profound impact on the body’s ability to heal itself. Individuals who smoke need to quit at least a month before and avoid smoking one month after their tummy tuck procedure. Smoking and second-hand smoke cause a decrease in blood flow, which can result in infection, skin loss, poor wound healing and increased scarring.
After Dr. Thomassen reviews the patient’s medical history, he will want to examine his or her abdomen. Dr. Thomassen may choose to take pictures of the patient’s abdomen to use for reference as he creates the patient’s surgical treatment plan. In addition, these photos may be referred to during the abdominoplasty itself. For comparison purposes, Dr. Thomassen may also take photos of the patient’s abdomen several months after his or her tummy tuck procedure.
A Tummy Tuck with Liposuction
Many of Dr. Thomassen’s patients request a tummy tuck in conjunction with liposuction. The best candidates for this combination procedure are individuals who have excess fat and loose skin on their abdomens.
Preparing for an Abdominoplasty in Fort Lauderdale
Prior to a tummy tuck, Dr. Thomassen will most likely request that the patient visit his or her physician to have a thorough physical exam and routine blood work. Patients who are 40 years of age or older may need to have an electrocardiogram (EKG/ECG) prior to their tummy tuck procedure.
Certain medications need to be avoided for at least two weeks before surgery and one week after their surgical procedure. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. NSAIDs are known to cause bruising and abnormal bleeding.
The Day of the Abdominoplasty
Patients need to fast for at least eight hours before their tummy tuck with Dr. Thomassen in Fort Lauderdale.
Since an abdominoplasty is an outpatient procedure, patients need to bring a licensed driver with them on the day of their procedure. A tummy tuck can take two or three hours to complete.
1. Shaving and Marking the Abdomen
The patient’s abdomen is shaved and marked prior to surgery. These markings are used as a guide during the surgical procedure.
The majority of Dr. Thomassen’s patients receive general anesthesia: All anesthesia is administered by a licensed anesthesiologist.
3. Making the Incision
Once the patient is anesthetized, Dr. Thomassen will create an incision that extends across the lower abdomen (directly above the pubic area) from hip to hip.
If an individual is also having liposuction, the liposuction procedure is performed first. Additional incisions will need to be made. These small incisions are necessary as they are used to insert the cannula (the thin tube used to remove excess fat).
4. The Fat and Skin Are Lifted
The skin and fat are gently lifted off of the abdominal wall’s muscles.
5. Tightening of the Abdominal Muscles
If necessary, Dr. Thomassen uses sutures to tighten the abdominal muscles.
6. Excess Fat and Skin Are Removed
After tightening the muscles, Dr. Thomassen removes any excess fat and skin.
7. Dr. Thomassen Redrapes the Skin
After removing the excess skin and fat, the skin is redraped over the abdominal muscles. To hasten the healing process, Dr. Thomassen may place a drain beneath the incision. A drain is a thin, rubber tube that assists in draining fluid that accumulates beneath the incision.
8. Closing the Incisions
To minimize scarring, Dr. Thomassen carefully brings the skin together and closes it with sutures.
9. Dressing is Applied and an Abdominal Binder is Placed
A sterile dressing is applied over the incisions. Then, a compression garment is placed to help support the abdominal wall as it heals. Compression garments and abdominal binders also decrease post-operative swelling, which reduces the incidence of bruising.
10. Recovery Room
Patients will remain in the recovery room for approximately an hour following their abdominoplasty.
Patients will notice an improvement in the contour of their abdomen immediately: As swelling subsides, the contour of the abdomen will continue to improve.
Recovering from an Abdominoplasty in Fort Lauderdale
Patients will wear the compression garment or abdominal binder for approximately three weeks after their surgery.
Drainage Tube Removal
The drainage tubes that Dr. Thomassen placed will be removed at his office in Fort Lauderdale several days after the procedure.
Most patients need to spend several days in bed directly following their tummy tuck: Patients should expect to feel some discomfort and pain. Dr. Thomassen will provide patients with medications and tips for reducing their pain level.
Returning to Work
While each patient is unique, the majority of patients will require 14 days off of work to recover.
Dr. John Michael Thomassen is a plastic and reconstructive surgeon in Fort Lauderdale who frequently performs tummy tuck procedures for individuals who want to improve the way their abdomens look. If you are interested in learning more about abdominoplasty and liposuction, or any of the other procedures that Dr. Thomassen performs, please contactThomassen Plastic Surgery today.
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Fort Lauderdale Tummy Tuck Surgery (Abdominoplasty)
Desire for an abdominoplasty to improve the appearance of the abdominal wall is a common concern. Anomalies of the abdominal wall can result from many varied experiences. Weight fluctuations throughout life can lead to excess skin that will not go away with diet or exercise. Pregnancy can lead to not only excess skin but also a weakness of the abdominal wall that results in a protruding abdomen, also recalcitrant to exercise. Prior abdominal surgery can result in scars and contour irregularities that can only be corrected with surgery. Endogenous and exogenous hormones and medications can also have an effect on our body contours that may be permanent and only corrected with body contouring surgery. Finally our own genetics and age related changes can result in excess skin and fat that requires more than diet and exercise to correct.
A history of any medical conditions, particularly heart, lung, liver, or rheumatologic conditions need to be discussed in the initial evaluation. A history of smoking is a significant risk factor for wound healing. Current recommendations are that patient stop smoking for a minimum of 4-8 weeks prior and after surgery. The use of nicotine patches is not an adequate measure in the perioperative period.
The physical exam focuses on evaluation of the entire abdomen, umbilicus, mons pubis, flanks and back rolls. Any prior surgeries and the resulting scars need to be considered when planning an abdominoplasty procedure. If an incision appears to interrupt the blood supply to the abdominal wall, then a variation of the surgery needs to be performed to ensure proper wound healing. The use of liposuction with an abdominoplasty helps address fullness noted in the mons pubis, hips and flanks, and dorsal back rolls.
The skin quality needs to be assessed as part of the exam. The presence of striae indicate a loss of elasticity of the skin and may affect the way the surgery is performed. Excess skin is the main indication for an abdominoplasty procedure and the amount of excess needs to be qualified to choose the right procedure for the patient. Patients who have abundance of adipose tissue but do not require skin or muscle treatment, i.e., have a good skin tone and reasonable potential for the skin to contract after removal of substantial volume, may be better candidates for liposuction alone as opposed to an abdominoplasty procedure.
The quality of the musculofascial layer is also important to evaluate for any weaknesses. More commonly, patients exhibit a weakness of this fascia termed rectus diastasis. This leads to a bulging abdomen that can only be fixed by plicating the fascia and restoring the rectus muscles to their original position. More severe defects of the fascia consist of hernias, particularly umbilical hernias and ventral hernias. These may need to be ruled out and if present, will be corrected at the time of the abdominoplasty.
The innervation of the abdominal wall is provided by lateral branches of intercostal nerves. These branches remain intact after the procedure so numbness in the anterior abdominal wall after surgery will improve and sensation should return to normal. Other nerves in the abdominal wall like the lateral femoral cutaneous nerve and the ilioinguinal and iliohypogastric nerves are susceptible to injury during closure so particular attention needs to be directed at these.
The presence of intraperitoneal fat or fat inside the abdominal cavity deep to the fascia cannot be treated with an abdominoplasty procedure. This fat is only reducible through diet and exercise. If fullness due to intraperitoneal fat is excessive, this may preclude undergoing a successful abdominoplasty.
Once the decision to pursue an abdominoplasty is made, blood work is obtained and possibly a medical clearance from your primary care doctor is obtained to ensure you are at optimal health for the surgery. In some patients the use of anticoagulants is recommended due to their having a high risk of blood clots develop in the lower extremities after the surgery.
Day of Surgery
The day of surgery, markings are made on the patient’s body with the patient’s choice of swimwear or underwear. Incisions are placed immediately above the pubic region with a horizontal lateral extension, so that it would be hidden beneath current attire.
The surgery is typically performed under general anesthesia with a board certified anesthesiologist. When you wake up from the procedure, you will have an abdominal binder with dressings and should be comfortable. You may be admitted overnight or go home after the surgery. The pain medicine prescribed to you by Dr. Thomassen will keep you comfortable during the early postoperative period.
This procedure is indicated when there is minimal extra fat and skin in the lower abdomen only, and only fascial weakness in the lower abdomen below the umbilicus. It removes an elliptical area of skin in the lower abdomen that may be affected by prior scars or striae and does not address the upper abdomen. The incision line is not as long as a standard abdominoplasty incision. Liposuction is added to improve the overall result.
The umbilicus is not relocated with this procedure. The fascia below the umbilicus is plicated so any bulging in the lower abdomen is corrected. In some cases the umbilicus can be “floated” by cutting the stalk and reattaching it lower on the abdominal wall. Indications for this are limited.
This procedure is not indicated for most patients since most patients would benefit for more skin removal and plication of the entire length of the abdominal wall fascia.
First described by Pitanguy and Callia in 1967, this is the procedure most commonly performed in patients desiring improvement of their abdomen and torso. It involves a low anterior curvilinear incision extending from one anterior superior iliac spine (ASIS) to the other, umbilical translocation and full fascial plication. The umbilical stalk is kept attached and the umbilicus is brought out through a new incision in the abdominal wall skin. Sometimes, plication of the external oblique aponeurosis is added for improved contouring of the waist.
Liposuction has been proven safe to undergo along with this extensive dissection and is typically added to improve the overall contour of the result. It can reduce the thickness of the upper abdominal area. Liposuction and wedge reduction (both vertical and horizontal) are the most common techniques used to treat the mons pubis and excess volume in this area.
Sometimes an abdominoplasty can be combined with a hysterectomy or other gynecological procedures for patients interested in avoiding two recovery periods. Studies have proven the safety of these procedures.
Fleur de Lis Abdominoplasty
In this variation, the horizontal elliptical excision of lower abdominal wall skin is performed as well as a vertical elliptical excision in the midline. This results in a vertical scar that extends from the xyphoid to the pubis, and then a second horizontal scar extending from each hip. This procedure is indicated in patients who have lost significant weight and have excessive skin in the midline. It aids in contouring the waist for a more feminine outline; however the additional vertical scar needs to be considered carefully.
Because conventional abdominoplasty procedures involve significant undermining, there is increased potential for complications, such as skin necrosis, infection, wound dehiscence, seroma, and hematoma. In addition, plastic surgery procedures are associated with a high incidence of adverse effects when performed in patients who smoke. These complications are related to the release of nicotine and carbon monoxide during smoking, which decrease blood flow and oxygen delivery and induces thrombogenesis. One recent study of 132 patients who underwent abdominoplasty reported a complication rate of 48% in smokers.
Patients should be advised to discontinue smoking four to eight weeks before the surgical procedure and for an additional four weeks after surgery. Serum levels of nicotine have been shown to return to normal when patients abstain from smoking for eight weeks. In addition, studies of patients who underwent flap reconstruction showed that complications were decreased significantly when smoking was discontinued a minimum of four weeks before surgery.
Some patients are at high risk for developing a clot in the lower extremity deep vein system during or after the surgery. The use of graded compression stockings worn preoperatively and 7 days postoperatively, intermittent pneumatic compression devices placed before surgery and until discharge, strict intraoperative and perioperative warming, and ambulation within the first hour of the operation are important to reduce this risk. High-risk patients are treated with an anticoagulant after surgery to help reduce this risk.
Seroma is a fluid collection that can occur under the skin flap. Postoperative seroma in abdominoplasty is the most common complication in this type of surgical procedure and is avoided with the use of drains, quilting sutures, and compression garments.