Cosmetic surgery does not always yield the results a patient expects, for a number of reasons. Improper outcome expectations, a practitioner whose skills are not well-paired to the specific patient’s anatomy or difficulties with the healing process can all result in procedures which don’t come out the way the patient had hoped. An example of this is the subject of this week’s Ask Dr. Pane segment. The patient is from Miami, and writes: “I had [my] tummy done [and I’m] unhappy with the results. Need to know if I need lipo or revision tummy tuck to make it flatter. I’m 4 weeks [postop and] I don’t think it will go down flat cause I was told it’s swollen.”
In this case, the patient did not provide “before” pictures, only “after” photos. Because of this, it is much more difficult to evaluate the case, primarily because the patient is reporting so soon after the procedure. However, Dr. Pane was able to get a sense of where the patient is now, if not necessarily where she has been.
After evaluating the pictures, Dr. Pane’s initial reaction is that the patient is actually recovering quite well. The skin and underlying tissue are somewhat swollen and irritated, which is only to be expected less than one month postop after a major surgical procedure, but overall the results are well within what Dr. Pane would consider to be acceptable parameters given the timeframe.
With that said, there is some thickness of the abdominal area. Whether this thickness is a result of traumatized and inflamed tissues or simply because a volume of subcutaneous fat was left in place is an open question without seeing the patient in person and being able to evaluate the area by both sight and touch. Always remember that pictures are a distant second best to a complete in-person clinical evaluation of the areas under consideration!
In most cases, surgeons are reluctant to perform a full session of liposuction in conjunction with a tummy tuck. While they may remove some fat from the flanks and thigh areas, they generally will not do a great deal of lipo on the front of the abdomen. This is to avoid the patient being under general anesthesia for a needlessly extended period, as well as to facilitate healing and prevent unnecessary tissue insult during the procedure. Also, as a matter of Florida law, surgeons are typically prohibited from keeping patients under anesthesia for more than eight hours during elective procedures unless very specific criteria are met. Since most cosmetic procedures are performed on an outpatient ambulatory basis, surgeons typically prioritize the main procedure over secondary considerations.
In this patient’s situation, Dr. Pane says the best course of action is to be patient and allow the area to heal fully. The scar profile looks excellent and the area where the tuck was performed is presenting normally, obviating any immediate cause for alarm. Usually, it takes between 3-6 months for primary healing to resolve to a point where the area can be properly evaluated and the final outcome appropriately defined. At four weeks, it is simply too soon to say anything definitive, but Dr. Pane wants this patient to feel at ease and understand that based on current appearances, he expects a complete and satisfactory recovery. If the patient feels it appropriate after primary healing has resolved, a full session of liposuction is not out of the question later, so long as no complications reveal themselves in the course of healing. For now, however, Dr. Pane feels this patient should expect good results from the primary procedure, but that she should continue to evaluate her condition in conjunction with a qualified surgeon and make a final determination at the appropriate time.
If you have a question concerning any aspect of cosmetic surgery, the clinical and support staff of Atlantic Coast Aesthetics are always pleased to discuss any concerns or interests you may have. Simply follow us on Facebook, Instagram and/or Twitter; email us through our website at http://acplasticsurg.com/contact; or call us at (561) 422-4116. Your question may even be the focus of an upcoming Ask Dr. Pane segment, where our founder and Chief Medical Officer, Dr. Thomas A. Pane, will answer your question live in a Google Hangout! This allows us to address your concerns and also inform other patients who share your interests. Remember, at ACA we believe the only bad question is the one you don’t ask!