A Full Tummy Tuck (With or Without Circumferential Extension) Will Best Correct the Upper Belly and Bellybutton

I've lost 100 lbs. after having a Lap Band put in nearly 4 years ago.  My stomach issues are very unique looking, which is why I'm having the difficulty in determining what procedure I need.  My unwanted fat and loose skin are mainly only above the bellybutton, like they're sitting on a shelf.  I am unsure of which procedure would benefit me the most among simple liposuction, a modified Tummy Tuck, a full Tummy Tuck, or extended.  I'm open to any other suggestions as well.  I believe my skin has shrunk back as much as it can already.  Thoughts?

First and foremost, congratulations on your weight loss!  What a wonderful transformation. In addition to your improved health, your figure already looks terrific.

Second, even though you might think that your tummy has "unique" issues, nothing could be further from reality. I see at least one patient per week whose tummy looks like yours.

Third, go for a full tummy tuck.

• After 4 years, your skin is not going to shrink on its own any farther--no matter how much exercise you do.
• Liposuction will not be helpful to treat the upper tummy (called the epigastrium) and bellybutton. Since liposuction is a fat removal technique (without any significant skin tightening), liposuction is the wrong answer.  You are already skinny!  The problem is too much skin without good tone, not excess fat.
• Mini tummy tucks are nonsense operations. I have never found the right patient for a mini tummy tuck--even after 8 years of practice!  A mini tummy tuck is for that very rare patient whose problem area is limited to her lower middle abdomen, just above her pubis.  Obviously, this is not where you are concerned.
• A standard tummy tuck will work.  To minimize "dog ear" formation on the bilateral hips, weight-loss patients generally get their best results when the tummy tuck is extended all the way around circumferentially.  Whether you choose to keep the surgery just in the front or all the way around will be your decision.  Both are good choices, but the circumferential technique generally produces better contours.
• Do not do a fleur-di-lis abdominoplasty.  The vertical portion of the scar is ugly, and the operation is now recognized as obsolete.  If any doctor offers you this surgery, run away!  He is out of date!!

Fourth, make sure that your lap band port is exchanged from a high-profile to a low-profile.  Now that you are thin, the low-profile port will be less visible.  You don't need that extra prominence to find the port anyway; you've got no subcutaneous fat.  (Congratulations again!)

Fifth, make sure that your surgeon is certified by the American Board of Plastic Surgery.  And, better yet, research whether he specializes in weight-loss patients.  I do a lot of post-bariatric contouring, and let me tell you that weight-loss patients are very different from "regular" plastic surgery patients.  Your surgeon needs the expertise only garnered from years of experience with your peer group.

Good luck!

Comments

[San Diego Plastic Surgery]

Wow, losing 100 pounds and ending up looking that good is really an accomplishment. Best wishes to the writer of that question on whatever procedure she decides to go with. Your answer really covered all the bases.

Regarding the fleur-di-Lis abdominoplasty, in a 2003 study published by the National Library of Medicine, a complication rate of 62% was reported out of 68 consecutive operations. Coupled with your note that this procedure causes ugly scarring, I can see why it has fallen out of favor.

Daisy McCarty

[Michael Pickart]

Thanks for the informed comments!

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com

[plastic surgeon houston]

Well, I can't add an informative comment since I have already learned so much from your post and from the previous comment. Thank you for the information you have shared. It helped that there were photos.

[New York liposuctions]

Depending on the extent of the tummy tuck, an overnight stay in a hospital is not very common. In most cases, the patient may return home the same day. These issues are usually discussed and decided by the surgeon and patient during the initial consultation.

[Michael Pickart]

Agreed! Most tummy tuck patients can be discharged home directly after surgery. Only a rare few elect to remain overnight in a hospital setting.

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com

[Ardmore, Pennsylvania Plastic Surgeon]

I think the importance of a good, experienced doctor can't be stressed enough. Regardless of what procedure you choose, the results of going to a bad doctor are going to come out bad.

[Michael Pickart]

I agree. Tummy tucks are usually straightforward, but only in the right hands. Patients should make sure that their surgeon is Certified by the American Board of Plastic Surgery, and that he is compassionate, dedicated, and accomplished.

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com

[Plastic Surgery Dr]

Very informative response to a common problem among people who have major weight loss. What I find so perplexing is why the skin of over weight patients has not problem stretching but can never shrink. A full tummy tuck is the best way to remove excess skin and restore a persons confidence.