Dr Remus Repta

Phoenix/Scottsdale Plastic Surgeon

Buttock Lift

What is a buttock lift?

Any procedure that removes excess skin and soft-tissue laxity to correct or improve the shape and contour of the buttocks can be referred to as a buttock lift.

As with any "lift" procedure--whether it is a breast lift, face lift, etc.--the amount of skin and soft tissue laxity that is present determines the extent of the incision and subsequent length of scar that is needed to correct the laxity and achieve the best contour possible.

Where is the scar located for a buttock lift?

The short answer is wherever the patient prefers it. The best location, however, is at the level and in the shape of the underwear line. Imagine a pair of appropriately sized and located underwear that are worn snug. The indentation of the underwear line gives a good idea where the final buttock lift incision should lay.

What is the recovery process like?

Surprisingly straightforward. Most of my patients who have undergone combination procedures including a buttock lift have reported that the recovery process was fairly easy with more of a general feeling tightness rather than significant discomfort.

No special restrictions are needed. Patients are allowed to sit and sleep on their back. I recommend using plenty of cushion and minimizing sitting in one place or position for extended periods of time.

Summary

The buttock lift procedure can be performed in a variety of ways but (no pun intended) the general idea is to remove the excess skin and soft-tissue laxity by resection tissue using an incision at the level of the top portion of the underwear line. It can be combined with buttocks augmentation or with a body lift (circumferential abdominoplasty). The recovery process is fairly straightforward.

All the best,

Dr. Repta

Phoenix/Scottsdale Plastic Surgeon

Buttocks Contouring

In an earlier post we discussed buttocks fat grafting; the plasti sugery procedure designed to increase the size and shape of the buttocks through the method of removing fat from unwanted areas and grafting (injecting) the fat into the buttocks. Buttock fat grafting is actually a part of the the larger concept of buttock contouring. As with all cosmetic plastic surgery procedures, the right procedure should be tailored to each individual for their specific needs and goals.

Since the buttock area is a significant part of human health and sensuality, we will disuss in greater detail, over the next few weeks, the concept of buttock contouring.

What is buttocks contouring?

Buttocks contouring is the general term used to describe plastic surgery procedures that are used to improve the shape, size, and appearance of the buttocks. These collect group of procedures include:

Buttock:

-Lift

-Fat grafting

-Liposuction

-Implants

We have covered buttock fat grafting in an earlier post. Later this week we will discuss buttock lift. This procedure is designed to correct skin and sofy-tissue laxity. It may be used alone or in conjunction with other body contouring and/or buttock contouring procedures.

Stay tuned for the buttocks lift procedure later this week.

All the best,

Dr. Repta

Phoenix/Scottsdale Plastic Surgeon

Reverse Tummy Tuck

Does this procedure really exist?

Yes, there is actually a procedure called "reverse tummy tuck" or "reverse abdominoplasty". We actually included a separate chapter on it in The Atlas of Abdominoplasty.

The reverse tummy tuck is a unique procedure designed to improve the shape and contour of the upper abdomen while hidding the final scar location in the breast fold.

Who is candidate for the reverse tummy tuck?

Good candidates for the reverse tummy tuck are usually not significantly overweight, have excess skin and soft-tissue laxity primarily above the belly button, and may also be planning on a breast procedure that will result in a breast at the breast fold. The last part is not a requirement since the scar is well concealed but certainly allows performing both the breast procedure and the reverse tummy tuck without additional scars.

Can muscle tightening be performed with reverse tummy tuck?

Yes. Most candidates for reverse tummy tuck are not in great need for muscle tightening, however, if it is deemed beneficial it can be performed. The process of muscle tightening with reverse tummy tuck is very similar to that performed with endoscopic tummy tuck (see earlier post on endoscopic tummy tuck).

Can liposuction be performed with reverse tummy tuck?

Yes. Liposuction can and is often used in combination with all of the tummy tuck procedures.

What about the belly button?

The belly button is usually not released during the reverse tummy tuck and therefore there is no scar around or inside the belly button. The upward pull of the reverse tummy tuck procedure has a natural rejuvenating effect.

Drains?

Although not manditory, drains are still highly recommended.

Look for posts on circumferential abdominoplasty in the near future.

All the best,

Dr. Remus Repta

Phoenix/Scottsdale Plastic Surgeon

Buttocks Fat Grafting

What is buttocks fat grafting?

Buttocks fat grafting is a procedure designed to augment or increase the size of, as well as to improve the shape of the buttocks by using fat from other areas of the body.

The buttocks is a very important part of human sensuality. It is represented throughout different cultures past and present in art and fashion. Just as there are different procedures to improve the shape and appearence of breasts, so too are there a range of prcedures designed to shape and improve the size, shape, and appearence of the buttocks.

The procedure available to improve the size of the buttocks include implants, autologous flap (more on this procedure in later posts), and fat grafting.

How is buttocks fat grafting done?

Buttocks fat grafting is performed by removing fat from one area(s) of the body and using that fat to increase the volume and improve the shape of the buttocks. The fat is obtained through liposuction in a special manner. Any of the area of the body is a potential source for fat, with the abdomen, hips, thighs, flank, and back being the most common sources. Through liposuction fat is removed and the area being liposuctions is contoured to the desired effect. The fat is prepared in the operating room and reinjected into the buttocks through tiny incisions that are less than a few millimeters long.

Does buttocks fat grafting last?

Yes. Fat grafting has been around for some time now and it has been clearly shown that fat grafting does last. There is some debate about how much of the graft "takes" and how much gets absorbed, however, the fat that does take stays forever. Most plastic surgeons agree that at least 50% of the fat graft usually takes. In my experience, the percentage of fat that takes is more like 75%. This fat then increases or decreases with weight gain and weight loss respectively just like the rest of your body....since it actually is your body.

What can I expect after surgery?

The recovery for buttocks fat grafting is similar to most liposuction procedures. You'll have garments on the areas where liposuction has been performed, there will be some soreness but nothing too remarkable, you can do most activities as long as they are not strenuous, heavy, or prolonged. With regards to sitting, if the patient is comfortable and able, I recommend resting some of the time on your stomach since this will help with the swelling, otherwise when sitting it is important to have plenty of padding and to relieve some pressure periodically. Brusing and swelling will be present as expected.

Summary

I believe buttocks fat grafting is a wondeful procedure for patients that do not have enough volume in their buttocks. It works well, lasts the rest of your life if you mantain your weight and health status, and most importantly it feels real because it is real.

All the best,

Dr. Remus Repta

Extended Tummy Tuck

Extended Tummy Tuck

What is the extended tummy tuck procedure?
The extended tummy tuck also referred to as extended abdominoplasty, is an abdominal cotouring procedure that is designed to remove a maximum amount of extra skin and soft-tissue laxity without a scar that goes all the way around the waist (circumferential tummy tuck or body lift). Most patients that have a significant amount of extra skin and soft-tissue laxity around the waist are best served by a body lift also known as a circumferential abdominoplasty. However, for various reasons, patients may either not want a body lift or may not be an ideal candidate to undergo the body lift procedure. In these cases the extended tummy tuck is a great procedure that will allow maximum improvement of the extra skin and soft-tissue laxity.

How long is the incision?
The short answer is that it is as long as your body needs it to be to remove the extra tissue without creating folds of tissue at the ends of the incision which may be seen when too short of an incision is used. By definition, the incision used for the extended tummy tuck is longer that a full tummy tuck procedure but shorter than a circumferential tummy tuck. As a general rule the extended tummy tuck incision spans from about one palm witdh beyond each hip bone on both sides or about 3-5 inches longer on both sides than a full tummy tuck.

What else is involved in the extended tummy tuck procedure?
The goal of the extended tummy tuck procedure is the same as any other tummy tuck procedure, namely to thin, to flatten, and to tighten. To accomplish this, liposuction of the abdomen, hips, and flanks is performed when needed/or deemed beneficial to the overall result. In addition, muscle tightening or muscle repair is also performed to help flatten the abdominal wall. Finally, the extra skin and soft-tissue is removed, allowing the tummy to be tighter in profile and shape.

Next up. The body lift or circumferential abdominoplasty.

All the best,
Dr. Remus Repta

Phoenix/Scottsdale Plastic Surgeon

Drains: Annoying but Necessary.

Whats the deal with the drains?

The lowly drain must be one of the least appreciated and liked components of the tummy tuck procedure. They are nuisance to deal with early on, they get in the way, they require extra work to take care of and to record the output, and when you can't stand them anymore there is the hesitation or fear of having pulled out.

So are drains necessary following the tummy tuck procedure.

The simple answer is yes. Although there is a tummy tuck technique that does not require drains, lets call it the "French Method" since it got its start in France, the procedure in my opinion takes longer and gives a less powerful result than the tummy tuck techniques that do not require a drain.

The body naturally creates "healing" fluid whenever surgery is performed. When there is a large elevated or undermined area such as in the tummy tuck procedure, the amount of healing fluid is fairly large and there is a large space for it to accumulate if left alone. Some of this fluid will naturally result in scar tissue and/or pseudobursa (see previous post) if not properly managed. To prevent this, we place a drain(s) and use the compression of an abdominal binder to decrease its production, expedited its removal, and allow the abdominal soft-tissue to adhere to the underlying abdominal wall. The vast majority of the tummy tuck procedures including endoscopic, mini, full, extended, reverse, and circumfrential tummy tucks require both a drain and an abdominal binder.

How long is the drain(s) going to stay in?

I always like to answer this question with: "as long as your body needs it and not a day longer". This is an accurate answer since the length of time varies from individual to individual. I prefer to see about less than 25-30 ml of drain output per 24 hours. This usually takes about one week to ten days to achieve.

Doe it hurt to have the drain removed?

Again, it varies on the individual, type of drain, how its placed, etc. I honestly cannot remember the last time a patient did not remark how easy and painless drain removal actually was. I use a flutted or tapered drain, make sure the drain passes easily through the skin during surgery, place numbing medication at the skin site, and usually bring the drain out through the incision or just below it. This not only avoids an additional scar but this area is usually numb in the few weeks following surgery.

In summary, the drain, although annoying at times is necessary to get a great result. We want your tummy to be thin and flat and the extra scar tissue that would build up without a drain is just not acceptable in my opinion.

All the best,

Dr. Remus Repta