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Is It Safe to Have Abdominal Liposuction with Tummy Tuck?

Tummy tuck without Liposuction

2012-04-18 08-12-19.1     DSC03973.1

Before  (actual patient)                                After (actual patient)

 

Tummy Tuck with Liposuction of Hips, flanks and upper torso

   

Before (actual patient)                                         After (actual patient)

 

A full tummy tuck (abdominoplasty) improves the appearance of the abdomen following pregnancy or weight loss by addressing excessive skin, excessive fat, and abdominal wall laxity:

  1. Excessive skin: all skin from the umbilicus (belly button) to the pubic area is removed.  The remaining upper abdominal skin is advanced downward and tightened.
  1. Abdominal wall laxity: the entire abdominal wall is tightened (typically 4 to 5 inches) by permanent stitches into the fascia (fibrous tissues between the rectus abdominis muscles).
  1. Excessive fat:  all fat below the navel is removed, corresponding to the area of skin removal.

The big question: What do you do with the excessive abdominal fat above the navel?  The answer is not as obvious as it seems.  Many plastic surgeons are reluctant to perform liposuction of the upper abdomen during a tummy tuck for fear of problems with reduced blood flow to the tissues.  Specifically, they are concerned that if you elevate and advance the tissues, suctioning them at the same time may create too much trauma.

The problem: If you don’t liposuction the upper abdominal tissues, your abdomen may still protrude excessively after surgery, potentially requiring a second surgery for abdominal liposuction at a later date.

The solution: I routinely perform liposuction of the abdominal wall during tummy tucks.  The key is to be conservative with the amount of suction performed, so that the procedures can be combined safely.  Fat removal must be done conservatively to preserve blood supply to the abdominal skin and remaining fat.  Even greater care must be taken with diabetics (who must be well-controlled) and smokers (who must be off cigarettes), as both of these groups are at greater risk for blood flow compromise.

Judicious liposuction during tummy tuck can improve the cosmetic surgical results while preserving patient safety.

Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Presbyterian Hospital of Plano.  He also serves the Fairview, Lucas, and Wylie communities.

Preventing Blood Clots After Tummy Tuck and Body Lift

Tummy tucks and body lifts can be life-changing procedures.  The removal of skin and fat excess along with tightening of the abdominal wall can reverse many of the problems that occur following childbirth and/or weight loss.  But make no mistake: even though tummy tucks and body lifts are cosmetic surgeries, they are still surgery.  And every surgery has risks.

The most serious risk of any excisional body contouring procedure is blood clots.  Due to the immobility associated with any major surgery (especially one that temporarily makes it more difficult to walk), there is a risk of blood clots forming in leg veins (deep venous thrombosis).

If a clot “breaks off” and travels through the bloodstream to the lungs, it can suddenly and seriously impair oxygen exchange.  This life-threatening condition is called a pulmonary embolus.  It requires immediate treatment with blood thinners (to dissolve the clot) and oxygen.

Every plastic surgeon and plastic surgery patient should take these risks very seriously.  The question: what can we do to prevent blood clots following tummy tuck and circumferential body contouring (body lift)?  We have a protocol:

  1. DO NOT smoke for at least one month before surgery and one month after surgery.  Smoking causes constriction of blood vessels, impairing blood flow and oxygenation.  Smoking greatly increases your risk of blood clots (even if you are not undergoing surgery).
  2. DO NOT use contraceptives or hormone replacement therapy for at least one week before surgery and one week after surgery.  These substances can increase your risk of blood clots (even if you are not undergoing surgery).
  3. DO walk regularly after surgery.  Every time you want to eat or use the restroom, you must have a family member or friend help you to the kitchen or the bathroom.  Regular meals in bed are just a bad idea.  Walking helps pump blood through your leg veins, preventing clots from forming.
  4. DO use SCDs. Sequential compression devices (SCDs) are mechanical pumps that intermittently compress the leg veins, promoting circulation by simulating walking.  We place these on all patients undergoing surgery in our nationally-accredited surgical facility, the West Plano Plastic Surgery Center.  We send abdominoplasty (tummy tuck) and body lifting patients home with an SCD machine for the first few days to further reduce the risk of blood clots.  I do not know of any other surgeon or surgery center that does this routinely, and I sincerely believe that they should.
  5. DO consider anticoagulants.  Anticoagulants (blood thinners) can significantly reduce the risk of blood clots.  Unlike #s 1 to 4 above, they do increase the risk of postoperative bleeding, so they must be used with caution.  For example, I will not use an anticoagulant in a patient who bleeds excessively during surgery.  However, in most patients undergoing excisional body contouring, I begin low dose Lovenox (low molecular weight heparin) in the first 24 hours after surgery and continue its use daily for a week.

With this protocol in place over the past five years, we have not experienced a single clotting—or bleeding—episode in a tummy tuck or body lift patient.

We want you to look great after surgery.  But first and foremost, we want you to be safe!

Dr. Friedman, the former Chief of Plastic Surgery at Parkland Memorial Hospital in Dallas, serves the Frisco, Allen, McKinney, and Fairview communities.

Cosmetic and Plastic Surgery in Wylie, Texas

Board-certified plastic surgeon, Ronald M. Friedman, M.D., has provided cosmetic and reconstructive surgery for the Wylie, Texas community since 1996.  Dr. Friedman serves as the Director of the West Plano Plastic Surgery Center, located on the campus of Texas Health Presbyterian Hospital of Plano–just a 15 minute drive from Wylie.  Dr. Friedman is known for his natural results in breast augmentation, breast lift, liposuction, tummy tuck, mommy makeovers, and Botox and Restylane injections.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for FIVE consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has a unique background as a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

Cosmetic and Plastic Surgery in Fairview, Texas

Board-certified plastic surgeon, Ronald M. Friedman, M.D., has provided cosmetic and reconstructive surgery for the Fairview, Texas community since 1996.  Dr. Friedman serves as the Director of the West Plano Plastic Surgery Center, located on the campus of Texas Health Presbyterian Hospital of Plano–just a 15 minute drive from Fairview.  Dr. Friedman is known for his natural results in breast augmentation, breast lift, liposuction, tummy tuck, mommy makeovers, and Botox and Restylane injections.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for five consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has a unique background as a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

Cosmetic Surgery in Van Alstyne, Texas

Board-certified plastic surgeon, Ronald M. Friedman, M.D., has been providing cosmetic and reconstructive surgery to the Van Alstyne, Texas community since 1996.  Dr. Friedman serves as the Director of the West Plano Plastic Surgery Center, located on the campus of Texas Health Presbyterian Hospital of Plano–just a half hour drive from Van Alstyne.  Dr. Friedman is known for his natural results in breast augmentation, breast lift, liposuction, tummy tuck, mommy makeovers, and Botox and Restylane injections.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for five consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has a unique background as a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

 

© 2018 Ronald M. Friedman, M.D., P.A.

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