Endoscopic Abdominoplasty

Endoscopic abdominoplatsy: It's high-tech, it's slick, and it only requires tiny incisions. The downside: Only a select group of tummy tuck patients are ideal candidates.

Endoscopic abdominoplasty can be thought of as minimally invasive tummy tuck procedure. To understand the usefulness of this procedure you may refer to the earlier posts made on this blog regarding the basic goal of all tummy tuck procedures. As you may remember, the main goals are generally to thin, tighten, and flatten the abdominal contour. We'll, there are some patients that really obtain the majority of the tummy tuck benefit from the flattening or muscle plication part of the tummy tuck procedure. In order to accomplish this the soft-tissue on top of the abdominal muscles and fascia (see myofascial plication in the Muscle Tightening post) are elevated to allow access for muscle tightening to occur. Using traditional methods, in order for this to occur, an appropriately long incision near waistline is needed to provide enough space to visualize the soft-tissue elevation and muscle tightening process. When the muscle tightening process is complete the extra soft-tissue laxity is removed and the incision is closed. For most tummy tuck patients this lower waistline incision is needed in order to allow removal of the excess soft-tissue laxity withouth creating folds of tissue at the sides often referred to as "dog-ears". For individuals who have very little excess soft-tissue laxity, however, that still require abdominal muscle plication (myofascial plication) the length of this waistline incision is a big price to pay just to allow muscle plication to occur. It is for these specific group of tummy tuck patients that endoscopic abdominoplasty is a great tummy tuck technique.

The basic details of the procedure are as follows. Most patients still benefit from some for of liposuction of the abdomen. This is usually performed first in a thorough and even manner. Following this, a very small incision perhaps only 2-3 inches long is made within the hairbearing portion of the pubic hair. This incision, once healed is essentially imperceptible and of course completly hidden by even the smallest of bikini bottoms. A second incision is made within the belly button. Through these two incision and with the use of a tiny camera and special instruments, the soft-tissue is elevated from the underling abdominal wall and muscle thightening is performed. In this manner, a patient with laxity of the abdominal wall, frequently seen after pregnancy, can regain the shape and contour of their abdomen without the need for any visible scars. Within a month or two, these patients can be poolside in a tiny bikini with a well toned abdomen making everyone wonder how they regained their body so fast and so well after having a child. :)

All the best,

Dr. Remus Repta

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,

Dr. Remus Repta

Mini Tummy Tuck

What is a mini tummy tuck?

The best description of a mini tummy tuck is that it has a shorter horizontal scar at the waistline without the need for a scar around the belly button. There is some variation to the other components of the mini tummy tuck procedure. This includes whether the abdominal wall is plicated/tighten and whether the stalk of the umbilicus is detached or left alone.

Often, the mini tummy tuck is performed by dissection of the soft-tissue up to the level of the belly button. The excess soft-tissue is removed, but there is no muscle tightening performed and the belly button stalk is usually left undisturbed. The decision of which components of the mini tummy tuck are performed should be based on the needs and goals of the patient.

Who is a candidate for the mini tummy tuck?

The ideal candidate for a mini tummy tuck is someone that is close to their normal body weight and who have some, but not a significant amount of excess skin and soft-tissue laxity. In essence, the mini tummy tuck patient does not have enough abdominal laxity that will safely allow resection of the excess skin and soft-tissue from the initial waistline incision up to and including the location of the belly button. A standard or full tummy tuck in these patients would create a vertical scar in the midline of the abdomen between the new location of the belly button and the location of the final waistline scar.

How long is the scar?

There is some flexibility in how long the scar of a mini tummy tuck can be. Although the exact length may vary, the ends of the scar should not go beyond the first prominent point of the pelvic bone. This point is referred to as the anterior superior iliac spine (ASIS). Any tummy tuck scar that extends beyond these points implies that the laxity of the abdominal soft-tissue were more than moderate and the patient may be a decent candidate for a standard full abdominoplasty.

What are the pros and cons of the mini tummy tuck?

The mini tummy tuck procedure is designed for patients that have some laxity of the abdominal soft-tissue but not enough to allow a full abdominoplasty to be performed. The pros are that the total length of the scar is shorter and the need for a scar around the belly button is avoided. The recovery time, cost, and the other variables may be quite similar since some surgeons, myself included, perform most of the other components of a standard tummy tuck if deemed beneficial to the overall result. These may include liposuction of the abdomen, hips, flank, and mons area as well tightening of the abdominal muscles. To do so, the belly button can be detached to allow access to the entire length of the abdominal muscles and then reattached at the completion of the case.

The cons are seen only when the mini tuck is used for patients that are not ideal candidates. These include patients with significant laxity, poor skin that may have stretch marks up to or beyond the belly button, and a belly button size, shape, and position that would benefit from rejuvenation. The mini tummy tuck is simply not designed to accomplish all of this.


We have mentioned, and will be discussing abdominal muscle tightening with many of the other tummy tuck procedures. In order to better understand this process a post specifically on abdominal muscle tightening or myofascial plication will be made in the next few days. Stay tuned.

All the best,

Dr. Remus Repta

Before we discuss specific tummy tuck techniques

In order to understand the pros and cons of each different tummy tuck technique, we have to understand what a tummy tuck or abdominoplasty procedure is designed to accomplish.

Although the needs of each individual may be different, the final optimal outcome of all abdominal contouring procedures is very similar. These include:

1) Removal of excess skin and fat
2) Tightening of the abdominal wall
3) Rejuvenating the appearance of the belly button or umbilicus
4) Improving the overall contour and silhouette of mid-drift
5) And finally, doing all this with scars that are thin and well concealed by swimwear, undergarments, and summer wear.

As one of the leaders in body contouring has told me, "the goal is to thin, tighten, and flatten".

The different tummy tuck techniques that exist are selected based with the above goals in mind and tailored to the individual needs of the patient. Since the unique characteristics of a 30 yo females body which for example has had two kids defers from that of a patient who has experienced significant weight loss, the tummy technique that will best be able to accomplish the above goals will naturally be dramatically different as well.

We will start later this week with mini abdominoplasty and progressively advance to more extensive tummy tuck techniques.

All the best,

Dr. Remus Repta

What is a tummy tuck?

The majority of people would be able describe the basic idea of a tummy tuck. Most people know that it is a plastic surgery procedure designed to improve the appearance of the abdominal area and that the secondary result is a scar that is located near the lower waist. While this is the essence of the standard tummy tuck, the components that allow for a truly remarkable cosmetic result are not often known. In addition, few people know that there are quite a few different type of tummy tuck procedures. Enough to fill an entire plastic surgery textbook. Over the next handful of posts I will take you through the myriad of tummy tuck procedures that are available. We will also discuss the ideal candidates for each type of procedure, the benefits as well as the drawback of each procedure, and some of the recovery/what to expect issues.

Below I have composed a rough list of the tummy tuck procedures available. We will go through each one in successive fashion approximately one every week. If substantial discussion develops on any one technique or if there are other tummy tuck topics that arise in between each session then the next session will follow in time.

All the best,

Remus

Tummy Tuck techniques
Endoscopic
Mini
Full
Extended
Circumferential
Fleur-de-Lis
Reverse
Liposuction
Tummy tuck with lymphatic preservation
Related body contouring procedures

All the best,

Dr Remus Repta

Welcome

This is the first entry in what I hope will become the primary site for information sharing concerning the tummy tuck procedure. I encourage anyone with questions, concerns, or information regarding tummy tuck to post here.

The tummy tuck procedure can be a wonderful way to rejuvenate the appearance of the abdomen. In the words of one of my mentors, the tummy tuck procedure can "thin, tighten, and flatten" the shape and contour of the abdomen. Since every patient and abdomen is different, a unique tummy tuck technique must be selected to deliver the best result possible.

Recently released, The Atlas of Abdominoplasty, is a comprehensive plastic surgery textbook on the tummy tuck and the related body contouring procedures. It is 15 chapters and covers all of the different tummy tuck techniques. In addition to sharing information and answering questions I will periodically post the details about each unique type of tummy tuck procedure, the ideal candidate, the recovery process, as well as some of the pros and cons associated with each procedure.

All the best,

Dr Remus Repta