The Question
Regrettably, patients are not always satisfied with the results they achieve with cosmetic surgery. This may be due to a number of factors: unrealistic expectations, improper explanation of what the surgery may reasonably achieve, inappropriate diagnosis or other issues, which may lead the patient to expect a recovery track other than the one they actually receive. Regardless of the original reason, they are concerned, and sometimes their concerns are not unjustified. One example is the subject of this week’s Ask Dr. Pane segment. The viewer, from Palm Beach, asks, “Was my tummy tuck done correctly? You did not do the original surgery, but I’m reaching out to you because it just doesn’t look quite right.”
The Case
The patient provided before and after pictures of the surgical site. From the pictures, the patient appears to be in his early thirties, with no evidence of significant weight loss or skin laxity in the “before” images. The “after” images clearly show an abdominoplasty scar, and Dr. Pane feels the procedure itself was done correctly. Whether it was done appropriately is another matter, as Dr. Pane discusses below.
The Answer
An abdominoplasty, or tummy tuck, is a procedure which is commonly used to excise loose skin from the abdominal area after an extended period of weight gain and loss. It is typical after bariatric surgery or as part of a Mommy Makeover but may also be used anytime there is atypical skin laxity in the abdominal region.
In this case, Dr. Pane says there is no evidence based on the photographs to suggest the patient had lost weight beforehand, or that any liposuction was done in conjunction with the tummy tuck. The patient’s records may reveal something different, so he is reluctant to state with certainty that this did or did not occur. However, he feels this is the most likely explanation for the patient’s dissatisfaction with the results of the tummy tuck he received.
Dr. Pane says he would have offered the patient one of two choices, and let the patient decide which would be most beneficial to him. The first option would be a full course of liposuction, focusing on the back and sides. The reason he is not focused on the front as much is because the front of the abdomen is a relatively delicate area in terms of fat harvesting and removal, and if it is not done with a great deal of care and precision, it could leave the abdomen looking lumpy, uneven or simply odd. This doesn’t mean it cannot be done, but it must be done with a great deal more exactitude than the flanks and back require.
The second option would be to do a combination tummy tuck with liposuction. This in some ways might be the more desirable option. However, because of Florida state law and the difficulty associated with liposuction in the front of the abdomen, the surgeon would be limited to removing a single liter of subcutaneous adipose tissue during the procedure. The problem here, of course, is that if enough fat is not removed from the correct areas, the patient may end up needing a second course of liposuction to correct the lumpy and uneven appearance. If it is done improperly, the patient may even require a revision to the initial tummy tuck.
Revision procedures always carry a higher risk of complications than the initial procedure. Tissue insult, likelihood of infection, risk of adverse reaction to anesthesia and other factors make a revision more difficult. However, if the procedure is done properly by a skilled, qualified surgeon and the patient is diligent about following all prescribed aftercare protocols, the added risk is very minimal. The key here is to ensure the patient and surgeon have a strong working relationship and are comfortable with one another, so each can trust the other to fulfill their ends of the bargain and obtain the best possible result.
If you have a question about anything regarding cosmetic surgery, the staff of Atlantic Coast Aesthetics are always pleased to discuss your needs and interests. Simply email us through our Contact page; call us at (561) 422-4116; or follow us on LinkedIn, Instagram, Twitter and Facebook. Your question may even be selected as the focus of a forthcoming Ask Dr. Pane segment, allowing us to help others while giving you the honest answers you need to make an informed decision. Remember, at ACA we believe the only bad question is the one you don’t ask!