Thursday, September 4, 2008

Muscle Tightening

What is muscle tightening?

There is a fair amount of confusion about the process of "muscle tightening" during the tummy tuck procedure। The key to understanding this process is understanding the anatomy of the abdominal wall। The basic idea is that the muscles of the abdominal wall are all covered or enclosed in a thick tissue cover called fascia. This fascia, in part, maintains the general position of the abdominal muscles to one another, especially the "six-pack" muscles in the midline.
With age, pregnancy, and weight fluctuation, the abdominal wall (muscles and fascia) stretch to accomodate these changes. As you may imagine, the muscles have an easier time returing to their previous size and shape. The fascia, however, may remain streched since it does not have the same contractile properties of muscles. This results in a persistent roundness of the abdominal wall which presents as a fullness or "pooch" especially on side profile.
The process of abdominal wall tightening is really the process of abdominal wall fascia tightening। This is why I prefer the term "myofascial plication". It best describes the process of tightening the abdominal wall. When performing a tummy tuck, during the process of myofascial plication, I plicate of tightent the fascial covering of the abdominal wall and by doing so the abdominal wall muscles are returned to their youthful, pre-pregnancy/weight gain position. This process can be better visualized as tailoring the fabric of a dress or pants to better fit the body. The extra cloth is hemmed or plicated so that it matches and follows the contour of the body, allowing a boxy or oversized shaped to be molded to the underlying silhouette.

To tighten or not to tighten: Is muscle tigtening (myofascial plication) always needed?

The short answer is no. Muscle tightening is a very important part of the tummy tuck procedure. It allows the side and front profile to be improved, making the abdomen look flat from the side and hour-glass from the front. Some patients may simply have excess skin and soft-tissue without laxity in the abdominal wall. These patients may not need or benefit from muscle tightening. My experience is that most people who are candidates for a tummy tuck are also good candidates for muscle tightening. Of course, this is based on the needs, goals, and desires of each individual. I simply give my recommendation as if it were my body and explain the pros and cons of muscle tightening, and allow the patient to make the final decision. The downside of muscle tightening is some extra discomfort and a bit longer recovery process to get back to full speed. I have found that 99% of patients choose to undergo muscle tightening when it is explained.

All the best,

18 comments :

prs10.20 said...

Just came across your blog on tummy tucks - VERY helpful and informative...Thank You!
What are your recommendations and thoughts on liposuction at the same time of tummy tucks. Is it safe and should it always be done for the best results? Also, how would I know if somebody is capable and competent to perform this surgery. Thanks again!

Dr. Remus Repta, Plastic Surgeon said...

Great questions. I strongly believe that liposuction is an integral part of the tummy tuck procedure. It is helpful in thinning and contouring the abdomen, flanks, hips, and waist area to allow complete and uniform rejuvenation of the mid-drift area. With regards to choosing a surgeon I would recommend finding a plastic surgeon that has a passion for body contouring and the tummy tuck procedure. Ideally they should be able to show you before and after photos of patients that had similar body characteristics to your body. Finally, like most things in life we are good at doing the things that we like to do and the things that we perform often.

Thanks for the questions. Keep them coming.

All the best,

Dr. Repta

prs10.20 said...

What is the typical recovery time for this procedure, especially if I prefer to tighten the laxity, as you stated, in my muscles? How long until I can go back to work and how long until I can go back to my exercise routine?

Dr. Remus Repta, Plastic Surgeon said...

The recovery period varies depending one each individual and to some extent the type of tummy tuck procedure performed. Muscle tightening usually is the biggest component of recovery. We generally recommend that heavy lifting and vigorous activity be avoided for about 3 weeks. Activity can be increased slowly as tolerated afterwards.
Most people are able to return to work after about 2-3 weeks depending on their job.

I will provide an in depth post on the recovery process following the tummy tuck procedure in the next few days.

All the best,

Dr. Repta

Anonymous said...

Is it ever beneficial to have the muscle tightening procedure without a tuck? I thought it may be possible to avoid the tuck if the muscle was repaired allowing one to tighten the tummy through exercise.

Thank-you

Dr. Remus Repta is a cosmetic plastic surgeon in the said...

Yes. (see endoscopic tummy tuck post)

If the abdominal muscles need tightening and there is no skin or soft-tissue laxity, than muscle tightening alone can be performed. If there is extra abdominal fat this can be contoured through liposuction or it can be reduced through diet and excercise.

All the best,

Dr. Repta

dom71679 said...

i have a question, I had a full tummy tuck last year ad my dr didnt tighten my muscles and just told me he didnt almost a year later, he wont do another tummy tuck to correct it. i have had 3 years and i know i would have benefited from it. he wont tell me why he didnt do it. i seen another dr a fews weeks ago and he said i had a large hernia in my stomach, could this be a reason he didnt tighten my muscles??? i just dont understand wy he wont call me back, i keep readin that tightening the muscles would have made my stomach flat. whats yr opinion or what are some reasons a dr wouldnt do the tightening on a patient that was explained it would be done? HELP!

Dr. Remus Repta said...

Hello dom71679,

Thank you for your question. I would only be guessing to answer what your plastic surgeon was thinking when he/she performed your tummy tuck. What I can say is that I perform muscle tightening (abdominal wall tightening) 99.99% of the time--which is to say essentially all the time. My reasoning for this is that through pregnancy, weight fluctuation, and aging our abdominal wall becomes lax and tightening it improves the shape and appearance of the waist and abdominal area. A ventral or abdominal hernia is even more reason to perform abdominal wall tightening as the process of doing so essentially corrects or repairs the hernia. At this time you will have to decide if you want to go through the tummy tuck process again to have your abdominal wall tightened. If you do it can be done and your recovery will be comparable to the first tummy tuck...maybe a little more sore since the abdominal wall tightening tends to add to a tummy tuck recovery.

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Dangerspice said...

Dr Rectangle, I am considering having this procedure and I saw your recommendation that heavy lifting should be avoided for approx 3 weeks. I have 16 month old twins who weigh 25 lbs. I cannot imagine not picking them up for that long. Do you suggest I wait until they are older?

Dangerspice said...

Dr Repta, I am so sorry. My auto spell check changed your name and I didn't notice!

Dr. Remus Repta said...

Hello Dangerspice,

No worries, auto-correct happens. In terms of timing for an abdominoplasty I would suggest the following. You should be near your goal weight, have plateaued in terms of recovery following having your twins, and should be fairly sure that you do not intend to get pregnant again in the future. After a tummy tuck with muscle tightening you will not feel like picking up anything heavy for at least the first week or so since you will be tender following your surgery. In the second and third week it would be ideal to refrain from heavy lifting. This is not to say that you could not hold one of your twins or that you could not squat down to give your children a hug, but picking them up from a crib or from the ground with arms extended would not fee good and may increase the chance of loosening your muscle tightening or prolonging the post-operative swelling. There is the ideal world of post-operative recover and then there is the real world of recovery where life does not stop and children have to be picked up some of the time :).

I hope this helps.

All the best,

Dr Remus Repta

glorybi said...

hi im glorybi and i just have a tummy tuck and lipo 3 months ago my tummy have a big pouch but the md told me the i have to do a strict diet my muscle on my stomach do not look flat md told me the i have a big stomach muscles but i think the he do not tighten my stomach muscles three womens from the same md have the same problems what can i do?

Dr. Remus Repta said...

Hello,

Where is the "big pouch" located? Is it below your belly button? There are a few reasons to have a fullness or "pouch" after a tummy tuck. Obviously if the abdominal muscles were not tightened enough that could be one reason. Another possibility is that the tightening process was not done evenly. That is the abdominal muscles were tightened more in either the upper or the lower abdominal area more than the opposing area. When this happens the lesser tightened area bulges out. Its similar to squeezing a balloon and having the area not being squeezed get bigger. I would do your best in terms of exercise and diet and give our body a chance to heal. If this does not go away you may need to have the muscles tightened more/properly.

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Anonymous said...

I am 46 years old. In August of 2011 I had a very serious peritonitis infection with diverticulitis and 5 tublar adnoema polyops. A large portion of my large intestine was removed. I am finally recovered from the surgery and all my scans are clean. However my doctor has put me on a strict diet to lose the weight I have another 25 lbs to go before I am at my ideal weight. I can do it! At my check up last week the doctor talked me about my H - hernia and how I might benifit with a muscle tightening and tummy tuck. I guess my question is... will this proceedure be a problem considering my recent surgery? I would dearly love to have a flat belly again.

Anonymous said...

I forgot to mention that I also had a Radical hysterectomy in the mid 1980's and during my recent surgery alot of scar tissue had to be removed to release my large intestine. Will this surgery cause any future problems with scar tissue?

Dr. Remus Repta said...

Hello,

Your tummy tuck procedure should not affect or be affected by your prior abdominal surgeries. The prior abdominal incisions should be taken into account when planning your tummy tuck as this may sometime affect the blood supply to the remaining abdominal skin. With the proper planning and experience your plastic surgeon should be able to safely provide you with the proper improvement you are searching for.

All the best,
Dr Remus Repta
Phoenix/Scottsdale, AZ

Anonymous said...

I have big fat belly. Both upper and lower belly are big and fat.
I am 5ft 1 inch with 75 kg weight. I do excirsize regularly, still not able to reduce fat. I can not do dieting as suffering from gastric ulcer. Please let me know how much cost of liposuction and tummy tuck.

Regards,

Anita

Dr. Remus Repta said...

Hello Anita,

In general a full tummy tuck with liposuction of the abdomen and flanks as well as muscle tightening is about 10K dollars. This includes surgeons fees, anesthesia cost, and operating room cost. Recovery is about 2 weeks. The drain stay in for about 1 week. And you will be wearing an abdominal binder for about 4 weeks. I hope this helps. The link below is to the tummy tuck page of the main website.

http://www.aaaplasticsurgery.com/plastic-surgery/tummy-tuck.cfm

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ