Abdominoplasty or Tummy tuck

Overhanging bellies with excess fat and loose, sagging skin are commonly seen following pregnancy, weight fluctuations or due to genetic predisposition. However a flat abdomen conveys a physically fit appearance. Women who desire a narrower waistline and firmer abdomen  after childbirth are good candidates for abdominoplasty. Abdominoplasty removes excess skin and fat from the abdomen, may tighten the abdominal muscles as well as refashion the navel to result in a flatter, tighter abdominal profile and a youthful looking navel. 

Tummy-tuck can be performed on patients with existing medical problems such as diabetes, hypertension etc. The existing medical condition must be well under control and the primary physician managing the condition should be consulted prior to surgery. The type of anaesthesia and extent of surgery may be modified. Similarly, the experience and skill of your cosmetic surgeon is paramount to ensure a safe and optimum result.

Tummy-tuck is performed in an operation theater under suitable anaesthesia. I prefer to do it using a combination of spinal and epidural anaesthesia. This is relatively safer and provides excellent pain relief post-operatively as compared to general anaesthesia.

The first step involves liposuction in the upper abdomen and flanks. This reduces the unwanted bulges in these areas and gives a good waistline.                                                                                                     

Next, an incision is made across the lower abdomen (a little above the pubic area). The length of this incision varies as per the severity and extent of skin laxity. An incision is also made around the umbilicus (navel / belly button) to free it from the surrounding skin.

The skin apron (skin and subcutaneous fat) is separated from the abdominal wall and lifted up to the rib cage.

The abdominal muscles (if weak) are tightened to provide a stronger abdominal wall as well as to make the waist smaller. If there are any abdominal hernias present, these are repaired at this stage.

The skin is then lowered and the excess is removed. A new opening is made for the navel at the proper position. The navel is sutured to this new opening to give a better looking and more youthful navel.

The incisions are closed with absorbable sutures. Small suction drain tubes a routinely kept to prevent fluid accumulation. A sterile dressing is placed over the area and entire abdominal area is generally covered with a customized compression garment.                 

The entire surgery generally takes 2 to 4 hours.

After surgery, any pain and discomfort is controlled with medications and / or epidural analgesia.

The next morning, you will be encouraged to walk around to promote circulation. You will be instructed to bend forward at the hips slightly in order to relax the tension on the stitches.  While in bed, there may be 1-2 pillows kept under your knees to flex them and the hips so as to have the same relaxing effect on the stitches.

The drainage tubes are usually removed at 48 hours; after which you will be discharged from the hospital. A light dressing will be required for two weeks and this should be kept dry.

Some swelling and bruising is expected, but will settle in 2 to 3 weeks time. You should take it easy for 5 to 7 days and may resume most normal activities after 10 to 14 days. You may begin exercises 4 to 6 weeks after surgery. Numbness if any will gradually return to normal, but may take several months. 

The healing process is gradual, so you should expect to wait a while before fully enjoying the results of your tummy tuck. Regular gentle to moderate massage (as advised by the doctor) of the abdominal area will facilitate faster and smoother recovery. As months pass, the incision line will gradually fade.

There are many variations of tummy-tuck surgery. These as well as potential problems of this procedure will be discussed in future postings.

Yummy Mummy

YUMMY MUMMY

The gigantic task of hosting and nurturing a developing embryo is entrusted to the female of our species. The swollen belly with a proud maternal glow on the face is nothing short of a marvel of nature. This 9 month exercise with the ordeal of delivering a baby is entirely worth it when the mother holds her baby in her arms. A picture of mother and child always inspires peace, happiness and tranquility.

                          

However, spare a thought for the mother. The 9 months of being a Petri dish wreaks havoc on the body. Some of the obvious changes that are evident after pregnancy are as follows:

1. Weight gain
2. Abdomen –      Flabby, sagging skin

Stretch marks

Unsightly navel

Divarication of recti (bulging tummy)

Abdominal hernia

Scar following LSCS

3.   Breast -            Sagging breasts

                                    Shrinking of breasts

                                    Enlarged areolae

4. Varicose veins, spider nevi
5. Hairfall
6. Incontinence (urinary)

Pregnancy by itself is a high stress situation and exerts mind boggling burden on the female body. The emotional stresses involved are unimaginable. Add to this, the additional responsibility of nurturing and looking after the baby. By the time the woman is done with looking after the crying baby, her looks have gone for a toss. She looks into the mirror and can barely recognize herself.

At this stage, especially if adequate support is lacking, a woman may experience mental breakdowns (Post-partum depression etc). Sometimes, this may require counseling and medications.

In most of these cases, improving the physical appearance goes a long way to improving self-image and self-esteem as well as restoring self-confidence. This is what “Yummy Mummy” is all about.

Needless to say, a supporting and understanding husband is pivotal in the entire process. Similarly, support from family and friends, is also critical.

A balanced diet and proper regular exercises are the mainstay for improving some of the ravages of pregnancy.

However, often these changes are very severe and require outside influence to improve them. This is where a cosmetic surgeon steps in and offers a gamut of procedures to suit an individual patient and to achieve the desired goal. Some of the common “Yummy Mummy” procedures include:

Abdominoplasty (Tummy tuck)

Mastopexy (Breast lift)

Liposuction

Breast Augmentation.

My subsequent postings will try and clear the mist surrounding these procedures, simplify the procedure details and facilitate decision making.

Types of Liposuction

Variations in Liposuction

Dry, Wet, Super-wet and Tumescent liposuction – These terms mainly determine the amount of fluid that is injected into the liposuction area before suctioning (the volume of injected fluid increasing with each terminology). Ideally “tumescent” includes use of local anaesthetic in the infiltration fluid.

Syringe liposuction – This includes use of 60ml syringes to suck out fat. This is the most gentle liposuction technique and fat collected in syringes can be used for injecting into fat deficient areas like hollow cheeks, buttocks or breasts. This technique of fat redistribution is called liposculpturing.

Power assisted liposuction (PAL) or vibroliposuction cannula was designed to vibrate at the tip. This reduces physical strain to the surgeon and the vibrating cannula breaks down the fat in tougher areas with a lot more ease.

Ultrasound assisted liposuction (UAL) – Here ultrasound waves were used to break fat cells which are then sucked out. However, UAL went out of vogue because of increased complication rates like skin burn and altered sensation of liposuctioned part.

VASER liposuction – Vaser (acronym for Vibration Amplification of Sound Energy at Resonance) again uses ultrasound energy to break fat cells but at a different frequency so that it causes lesser damage to surrounding tissues.

LASER liposuction – Laser (acronym for Light Amplification by Stimulated Emission of Radiation) uses laser energy to break fat cells. The broken fat cells may be left behind (for the body to clear them) or sucked out.

Vaser and Laser liposuction reduce the surgeon’s effort to some extent but at the same time increase the duration of surgery. Some claim lesser blood loss, lesser pain post-operatively and faster recovery which are not always true.

Infact, Vaser and Laser liposuction are “infants” in the field of body contouring. At best the safety profile and long term results are yet to be studied and documented. Certain amount of skin tightening and shrinkage occurs in all forms of liposuction. The contour results and safety profile of SAL (Suction assisted liposuction) are long established. The end result depends not on how fancy the technique sounds but on the surgeon behind the machine. As ever it the skill and the experience of the surgeon that determines the safety and outcome of liposuction surgery.  

Liposuction - Facts and Myths

LIPOSUCTION – FACTS AND MYTHS

Liposuction, also called lipoplasty or suction-assisted lipectomy (SAL) or liposculpturing, removes deposits of excess fat from specific areas of your body or face.

For millions of people who are striving to improve their appearance and bodies, liposuction can be a dream come true as it can remove fat that exercise cannot reach. 

For example, it can slim your hips and thighs, flatten your abdomen, shape your arms or calves or eliminate a double chin.

Liposuction is well-suited for men and women with either relatively normal weight with isolated pockets of fat or overweight individuals. It is particularly effective for areas that do not respond to diet and exercise.

Liposuction can be performed at any age, but older patients with inelastic skin may also require skin tightening procedure for optimum results.

Liposuction can be performed on patients with existing medical problems such as diabetes, hypertension etc. The existing medical condition must be well under control and the primary physician managing the condition should be consulted prior to surgery. The type of anaesthesia and extent of surgery may be modified. Similarly, the experience and skill of your cosmetic surgeon is paramount to ensure a safe and optimum result.

Liposuction can be performed to contour thighs, hips & buttocks, abdomen & waist, chest area (especially male breasts or gynaecomastia), back, upper arms, calves & ankles and cheeks & neck. Often many different areas can be treated during a single operation.

Liposuction is performed in an operation theater under suitable anaesthesia. Prior to performing liposuction, fluid is instilled into the area/s to be suctioned to facilitate removal of fat (“super-wet” or “tumescent” technique). Fat is removed by inserting small hollow tube (cannula), through one or more tiny incisions near the specified area. Incisions are usually 1 to 1.5cm in length and are placed as inconspicuously as possible, often within skin creases or contour lines.

After fat removal, the incisions are generally closed. The liposuctioned area is then covered with a customized pressure garment to assist and accelerate the healing process and achieve the desired contour.

It is important to realize that the amount of time it takes for recovery varies from patient to patient and on the extent of surgery. The day after surgery, you must move around to promote blood circulation. You can resume normal non-strenuous activities in 2 to 3 days. Your dressings will be removed after 5 to 7 days so that your cosmetic surgeon can examine the treated areas. You will have some swelling and bruising, which subside by 10 to 14 days. Typically, stitches are removed by 10 days after surgery.

The pressure garment must be worn for at least 4 to 6 weeks.

You may be able to resume most of your normal work within 5 to 7 days after surgery and begin some form of exercise after 2 to 3 weeks.

The healing process is gradual, so you should expect to wait a while before fully enjoying the results of liposuction. Regular gentle to moderate massage (as advised by doctor) of the liposuctioned area will facilitate faster and smoother recovery.

Liposuction is ideally a body contouring procedure (“inches” loss) and weight loss is merely a by-product of the procedure. The weight loss is apparent after the fluid retention and swelling settles and varies from patient to patient.

Occasionally, a touchup may be desired to further improve an area that has been liposuctioned.

The results of liposuction will be permanent as long as you maintain your post-operative weight. Regular exercise and balanced diet will also go a long way to maintaining your results of liposuction. 

Cosmetic Surgery

Most people would agree that inner beauty is more important than outer beauty. But increasingly in today's world, one experiences that outer beauty is just as important - as it has a direct impact on how one feels about oneself.
The real story behind today's cosmetic surgery is not about self-indulgent folks but about ordinary people with problems. Not simply, with the way they look or with their appearances but with the way it makes them feel.
Cosmetic surgery is now about procedures that not only make you look better but feel better as well. They lead to increased self-esteem and self-confidence. Cosmetic surgery is about making a change - a BIG change on the inside.