Abdominoplasty in Manhattan

Tummy tuck procedures can vary. Some procedures remove a small amount of excess skin and fat from the lower abdomen while others remove an entire ellipse of skin and fat below the umbilicus ("belly button") as well as tighten the muscles (diastasis recti) in the midline to narrow the waist. For massive weight loss patients or for those with severe skin laxity, more extensive skin excision along the hips and buttocks may be required. The goal is to provide the best contour result with the least amount of scarring. Liposuction can be combined with these techniques to improve the contour further. Some patients request liposuction alone to treat their abdominal contour problems, but if the patient has significant skin laxity and/or weakness of the abdominal musculature, then liposuction alone will not be sufficient.

Techniques:

Endoscopic abdominoplasty - Indications - This is for a patient that has very little to no skin laxity or subcutaneous fat and has mainly midline muscular laxity. Procedure - Endoscopic equipment is used to gain access through two or three small incisions. This allows visualization with a small camera of the area between the muscle fascia and the overlying subcutaneous tissue so that the midline muscular laxity can be treated. Liposuction can be performed in conjunction with this procedure. Advantages - Two to three very small limited incisions are used. Liposuction of the entire abdomen can be performed at the same time. Disadvantages - This procedure is limited to very few patients. It can not treat skin laxity.
Mini-abdominoplasty (mini-tummy tuck) - Indications - This is for a patient that has redundant skin and some subcutaneous fat in the area between the umbilicus and the pubic region. The midline muscular laxity is mainly confined to the lower abdomen. Procedure - A small ellipse of skin and fat is removed from the lower abdomen. The final incision is not much larger than that of a cesarean section. The umbilicus is not usually detached from the surrounding tissues. The musculature from the umbilicus down to the pubic region can be easily tightened. Liposuction can be performed on the entire abdomen and hips. Advantages- A short incision is used. Liposuction of the entire abdomen can be performed in conjunction with this procedure. Disadvantages - The musculature from the upper midline to the umbilicus can be difficult to treat from this exposure. Lax skin around the umbilicus or the upper abdomen is difficult to treat.
Modified full abdominoplasty - Indications - This is indicated for patients that require a full abdominoplasty but have abdominal incisions from other surgical procedures that may impact the viability of the tissues elevated (i.e. an open gallbladder surgical incision). The patient has a lot of skin laxity and may have a significant amount of abdominal subcutaneous fat. There is midline muscular laxity. There are one or more previous surgical incisions on the abdomen that would impact performing a full abdominoplasty safely. Procedure- An ellipse of skin and subcutaneous fat is removed from the lower abdomen. Undermining of the upper abdominal tissues is performed in a limited fashion to maximize the blood supply to the tissues that may have diminished circulation due to the previous surgical incisions. Treatment of the muscular laxity is performed. Liposuction can be done selectively. The umbilicus is detached from surrounding loose skin attachments and is re-inserted after the upper abdominal skin is re-draped and sutured to the lower abdominal incision. Advantages - The incision may be shorter than a full abdominoplasty. Lax skin can be treated better than a mini-abdominoplasty or endoscopic abdominoplasty. Lax midline muscles can be tightened easily. Laxity around the umbilicus can be treated. Disadvantages - A longer incision than used for a mini-abdominoplasty or endoscopic abdominoplasty is performed. There may be residual skin redundancy because of limited undermining. Liposuction has to be performed selectively to avoid compromising the blood supply to the skin and subcutaneous tissue.
Full abdominoplasty ("full tummy tuck") - Indications- This is indicated for a patient that has a lot of skin redundancy of both the lower and upper abdomen. The patient also has midline muscular weakness and may or may not have significant subcutaneous abdominal fat. Procedure - An ellipse of skin and subcutaneous fat is removed from the lower abdomen. The upper abdominal skin and subcutaneous fat is elevated more extensively than during a modified full abdominoplasty. The midline muscular weakness is tightened. The umbilicus is reinserted into the upper abdominal skin flap after the flap has been re-draped and sutured to the lower abdominal incision. Liposuction can be selectively performed. Advantages - Lax skin from above and below the umbilicus can be treated successfully with this technique. Thus, better than the endoscopic abdominoplasty, the mini-abdominoplasty, and the modified full abdominoplasty can achieve. The lax muscles can be tightened easily. Laxity around the umbilicus can be treated. Disadvantages - It requires a long incision along the lower pubic region. Liposuction needs to be performed selectively to maintain the blood supply to the abdominal flap and subcutaneous tissue.
Circumferential abdominoplasty (lower body lift) - Indications - This is a procedure often reserved for patients who have undergone bariatric surgery that have had massive weight loss and thus have significant skin excess. (see Post-Bariatric surgery treatment)

Most of the abdominoplasty procedures described take between 2-3 hours to perform with a recuperation time of 1-2 weeks. The circumferential abdominoplasty (lower body lift) can take 4-6 hours to perform. Dr. Wallach has presented at national meetings and published journal articles on abdominal contour procedures.

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