APPROXIMATE TIME UNTIL COMPLETELY HEALED:

You will be happy with the initial results immediately. You will probably look good three months after the operation. However, it takes a whole year for everything to be completely healed and normal.

THINGS TO CONSIDER BEFORE YOU SET A DATE

There is a fat pad lying below the belly button that is physically exclusive to women. Men develop a "spare tire" around the middle of their body instead that can be treated with liposculpture with tumescent technique. Also, after several pregnancies many women develop wrinkled and hanging abdominal skin, particularly if an umbilical or abdominal hernia has occurred. If you want to eliminate these conditions, liposuction will not be enough to do the trick. You will need to have an abdominoplasty, commonly known as a tummy tuck.

Like liposuction, a tummy tuck may work as an alternative to initiate a program of weight loss, like a trigger, to follow learning program of two years in order to choose the daily different meals to control the weight.

The tummy tuck or lipectomy will improve your abdominal silhouette by giving you a smoother and flatter stomach and a waistline after a year or more. However, if you gain a lot of weight, your abdominal wall may increase in size by the remaining fat cells that once again may expand.

The trade-off with a tummy tuck is a flatter, smoother abdominal wall versus a rather conspicuous permanent scar. Depending on the amount of skin to be removed, the scar can be anything from a small incision to a long line running from one hip across the pubic area, above the hairline average of three inches from the hairline to both hips. It depends on the more or less hanging skin. So before you decide on surgery, be very aware of the trade off; you will have a flatter and unwrinkled tummy that will look great in a one piece bathing suit, but buck naked you will be left with an obvious scar.

Like in the case of any other surgery, liposuction or abdominoplasty need a complete medical check up, an electrocardiogram and blood tests such as a complete whole blood count, partial tromboplastin time, prothrombin time, platelet, HIV and a complete urine test. Antibiotics such as Augmentin, Cipro or Ceclor are given two days before surgery and also after the surgery.

If a patient is suffering from a massive apron of fat (such as after a huge weight loss) a resection above the hips and on the back can be done to move buttocks to a higher position and to improve the contour of the thighs. Symptoms relevant to this surgery include a breakdown of the abdominal muscle structure, strain on the lumbar spine, chronic low back pain and difficulty in walking. This procedure is definitely more therapeutic than cosmetic in nature. If you feel you require a panniculectomy, discuss it in great detail with your plastic surgeon.

PRESURGICAL INSTRUCTIONS

• You will be given blood and lab tests approximately two weeks prior to surgery. Take no aspirin or aspirin -containing products such as motrin or ibuprofen, for two weeks prior to your surgery and 10 days after. You may take Tylenol or Codein.
• If you take medication daily, notify your doctor. Also inform him if you develop an illness or cold within a week of your surgery.
• If you smoke or drink alcohol you should clearly understand that nicotine and alcohol can impair and delay healing because of bleeding during surgery. Most offices will suggest quitting a week to 10 days before surgery. We suggest that you stop smoking a minimum of three weeks prior to surgery and not touch a cigarette for a full month post-op. Who needs to be left with scars worse than normal and other complications as a result of smoking through the pre and post surgical period?

THE DAY BEFORE SURGERY

Do not eat or drink anything after midnight. You can take water in the early morning two hours prior to surgery with the antibiotics only.

THE DAY OF SURGERY

• You may rinse and brush your teeth, but do not eat or drink coffee or tea.
• Wear no make-up and remove your contact lenses and dentures for surgery. Do not put any moisturizer on your eyes or face. Please remove the paint form from your nails.
• Do not bring any jewelry or valuables. Wear a robe, housecoat or warmup suit that buttons or zips in the front and flat shoes. No tight-fitting clothes.
• Someone must drive you home or to the recuperation place you choose and spend the first night with you.
• Postoperative instructions regarding activity, medications and office visits will be given following your surgery.

THE SURGERY

This surgery takes approximately three to four hours. Add an additional half hour for preparation and local anesthesia and sedation. There are normally five people in the operating room with you: the surgeon, the assistant surgeon, the anesthesiologist and two surgical nurses. You will be given antibiotics through your I.V. during surgery. Because this is considered major surgery, the doctor may choose to have an assistant present and the procedure may take place in the hospital rather than in the office surgical facilities.

Unlike liposuction, abdominoplasty is a rather extensive procedure. An incision is made from under one hip bone, down under the low abdominal crease across the pubic area and up to the other hip bone. An incision may also be made around the umbilicus (belly button).

The skin is freed up (separated) from the abdominal incision line clear up to above the rib cage area under the breasts. The abdominal fat pad is surgically removed, and if hernia repair is necessary (which is quite common), the surgeon tightens the loose underlying tissue and two muscles, Rectus Abdominis, together with sutures. This procedure will diminish the size of the waistline to a certain degree after six to twelve weeks after surgery, but don't look for an hourglass waistline post-op- this will not happen.

The freed up skin is brought downward, and the surgeon cuts a new opening for the belly button that is then sutured closed around the navel. the excess skin is trimmed away to fit the abdominal incision, and two drains are inserted into the abdominal area for a week to drain local anesthesia and serum. The abdominal incision is immediately closed with sutures that will be removed in 14 days. Steristrips or staples may also reinforce the sutured incision line. After two weeks and for two months a firm elastic binder is applied to the entire area clear up to the rib cage .

POSTSURGICAL INSTRUCTIONS

1. Physical activity should be limited to movements that are comfortable. For the first two days you should stay reclined with bent knees, getting up only to go to the bathroom. Stay close to home the first two weeks after surgery.
2. Wear the supportive garment that was selected prior to the surgery 24 hours a day for four to six weeks. As a general rule, the supportive garment should be worn until the bruising and discomfort have subsided.
3. Polysporin Ointment or Vit. E could be applied to the sutures daily until suture removal (approximately seven days). Use a cotton tipped applicator to apply the ointment.
4. Continue the antibiotics as instructed. If you develop diarrhea, discontinue the antibiotics and notify your doctor.
5. Anesthetics and pain medication tend to produce constipation. High-fiber diets and stool softeners will help reduce the likelihood of constipation following surgery.
6. You may shower after surgery whenever you wish. Remove the surgical garment and dressings. After showering, pat the incision areas gently with a towel. Reapply Polysporin Ointment and a clean cotton dressing.
7. Keep your surgical garment clean. It is machine washable and dryable. It is a good idea to have two surgical garments so you can wear one while the other is being laundered. Bicycle pants work very nicely as an alternative corset.
8. No driving until pain medication has worn off.
9. Take a multivitamin and an iron supplement following surgery. Be sure to discuss your dosage with your doctor before medicating (it depends on your blood loss).
10. No exercise or aerobics for six to eight weeks post-op.

Supplies to have at home: Polysporin or Vit. E. ointment, two-by-two-inch cotton gauze squares and paper bandage tape.

THE RECOVERY PERIOD

Because abdominoplasty is major surgery, you should expect to feel rather weak for several weeks post-op. It usually takes at least eight full weeks to recover your normal energy and stamina. Do not be surprised if you experience some depression for a few days after surgery. It is a common reaction, and it will pass as you regain your strength.

Be prepared for some serious discomfort following this surgery. You will need to remain in a sitting position in the first two to four days. In other words, even when you lie down or stand up, your knees must remain bent at all times. If you straighten up, you will rip out your stitches! The first couple of weeks are really tough, and you will need to take some prescribed pain medication during this period and perhaps even a little longer.

Because everything has been pulled down and repositioned so tightly, you will not be physically able to stand up straight for about two weeks after the operation. Please don't fight this and attempt to straighten up too soon. Many patients develop temporary lower-back problems as a result of having to stay bent all this time, but the back problems usually clear up once they're walking normally again. Low-back exercises are frequently helpful, but only after six to eight weeks post-op and with your doctor's permission. Prepare yourself for some serious swelling and bruising for several weeks; wearing your surgical girdle religiously will help control the swelling.

Another temporary problem that often develops is a sloughing of the skin in the area. This condition clears up as the area begins to calm down through more progressed healing, usually after the fourth week post-op. Actually, you will see some skin sloughing around most all surgical incision lines, whether they've been pulled tight or not. It all goes away.

Don't become depressed if the abdominal scar looks thick and puffy. The scar will flatten out in 6 to 12 months, and many people opt for a little liposuction to reduce any remaining fullness around the healed incision. Sometimes an unacceptable scar will remain, and you will want to have a scar revision at a later date. Scar revision surgery is reasonably uncomplicated, and a knowledgeable and careful surgeon can accomplish major improvements with this procedure.

If you are dieting, do not start any extreme programs until at least three weeks after surgery. For proper healing purposes you need to maintain a healthy and balanced diet those first few post-op weeks.

You can usually return to work (depending on the extent and severity of the surgery) three to four weeks after the procedure.

Absolutely no exercise or aerobics until six to eight weeks post-op, and only with your doctor's permission.

PROBLEM SIGNS

If there is any sign of infection, call your doctor at once. Raised, sore areas and uneven (one-sided) swelling are symptoms that could indicate internal bleeding, and your doctor must be informed immediately.

Any build up of fluid in the abdominal area is a serious problem that your doctor will need to know about right away. The area will be swollen and you will actually be able to feel water in there. Your doctor will surgically drain the fluid out of the area as soon as possible.