Advanced Tummy Tuck
Lipoabdominoplasty is an advanced tummy tuck procedure that clearly produces better results than a traditional tummy tuck. As a Los Angeles tummy tuck surgeon, Dr Grigoryants offers this procedure to remove skin excess and fat from the abdominal area and tighten abdominal muscles. Dr. Grigoryants has been performing the advanced procedure, called lipoabdominoplasty, for years and has had much better patient satisfaction than from a traditional tummy tuck . Especially for patients who have fat excess in the abdominal skin, this procedure produces much better flattening of the abdominal contour than a traditional tummy tuck. In this advanced procedure, liposuction is performed of the entire abdomen and flanks (not just the flanks as in a traditional tummy tuck) before the skin is pulled down. This allows to thin out the abdominal skin flap and achieve a flatter contour of the abdomen. Not all Los Angeles plastic surgeons offer the advanced tummy tuck procedure. It is important for a person expecting to undergo this procedure to select a surgeon who performs a large number of tummy tucks in order to achieve best possible results. You should be able to view before and after photographs of patients who underwent this procedure paying attention to the postoperative contour of the abdomen and waist area and whether or not the patient’s scar can be hidden behind underwear. Tummy tuck is one the most commonly performed procedures by Dr. Grigoryants. He places the resulting scar such that it can be easily hidden by the thinnest underwear. Dr. Grigoryants frequently performs liposuction of the flanks when performing a tummy tuck in order to improve the definition of the waist area and pubic area to avoid pubic bulging after surgery. You can view photographs and explanation of tummy tuck patients of Dr. Grigoryants below on this page. To provide you with the safest possible experience, Dr. Grigoryants performs most of his surgeries at the accredited multispecialty surgery center in Glendale, next to a hospital. Patients that travel from far away or those who undergo several combined procedures at the same time have an option of staying overnight at the surgical facility. Dr. Grigoryants published his experience with lipoabdominoplasty in the reputable Aesthetic Surgery Journal (January, 2013).
Who would benefit from tummy tuck?
Patients with stretched abdominal skin and excess fat. Many of these patients state that they tried exercising and dieting with no improvement in the appearance of the abdomen.
Patients who after losing weight have a significant amount of loose skin that does not shrink.
Women after pregnancy with excess fat in the abdominal area and stretched / protruding abdomen which does not improve with exercises.
Patients with stretch marks in the lower abdomen with loose skin.
How is tummy tuck performed?
- First, liposuction of the abdomen, flanks and pubis is performed to thin out the skin flap and improve waist definition.
- The skin is lifted to expose abdominal muscles. Abdominal muscles are tightened in people who have a stretched abdominal wall.
- Next, the skin is pulled down and pubic lift performed at the same time.
Drains may be used in some patients and this option will be discussed with you before surgery. All sutures are internal and absorbable. They do not need to be removed. Dr. Grigoryants avoids using deep permanent sutures as rarely those sutures can become infected in the future, requiring removal.
What is recovery like after lipoabdominoplasty ( advanced tummy tuck)?
Some patients may choose to spend a night at the surgical facility after surgery depending on the amount of work that needs to be done. Dr. Grigoryants will discuss this option with you depending. Most patients choose go home the same day especially when Exparel is injected during surgery for pain control. Exparel is a newer medication which allows to reduce pain for 3 days after surgery (read more about Exparel below). Patients may return to work in 10-14 days after surgery and resume exercise gradually 1 month after surgery.
You may have small drainage tubes placed under the skin to prevent
fluid collections under the skin. Dr Grigoryants will removed these drains around day 5 after surgery,
You will be able to walk the same day. We will ask you to wear an abdominal binder for
support for several weeks. You will notice results immediately.
Over the next several months, swelling will resolve. You may start lifting heavier
objects after 6-8 weeks.
Does a tummy tuck produce permanent results ?
Skin and fat excess removal is permanent. However, it is important not to gain weight after surgery as the remaining fat cells may expand. Those patients who continue to lose weight after a tummy tuck will further improve their results.
Can a tummy tuck be done if I have not had children yet?
It is best to undergo a tummy tuck after childbearing is completed. However, some patients who lost a lot of weight will have significant amount of skin hanging, which causes physical and social discomfort. In these patients, a tummy tuck would be beneficial even before childbearing to remove skin and fat excess. Typically, the abdominal wall will not be tightened with sutures in these patients to allow for abdominal expansion during pregnancy.
Before
After
This patient underwent a advanced tummy tuck procedure (lipoabdominoplasty)Liposuction of the abdomen, flanks, and pubis was performed at the same time. Waist definition was improved and a pubic lift was performed.
Before
After
Advanced tummy tuck with liposuction of the abdomen, flanks, and mid/lower back was performed. Pubic lift and liposuction was performed at the same time. Note that even thin underwear easily covers the scar when the incisions are placed in the correct location.
Before
After
In this tummy tuck and liposuction was performed to improve abdominal contour, waist definition and remove most stretch marks. The area of skin it its stretch marks between the umbilicus and the pubis was removed. Remaining stretch marks aboved the belly button move lower as the skin is pulled down.
The advantage of lipoabdominoplasty has been documented in a number of studies and we see it in our practice as well. The advantages include: better ability to flatten the abdomen, more fat removal from abdominal area, better perfusion of flap and therefore better healing. We incorporate the technique called progressive flap suturing which allows us to remove drains faster (as early as 2-5) after surgery and reduced the incidence of postoperative seroma (fluid accumulation) to nearly zero percent. The healing process is also more simplified following this procedure. Dr. Grigoryants prefer this tummy tuck technique as it allows to achieve the best possible result.
Where is the incision placed for a tummy tuck?
The location of the final scar should be easily covered even by thin undewear. So, careful planning and marking the incision before surgery is important. How thick or thin the scar heals depends on how well the surgeon closes the incision and whether the patient is prone to developing thick scars. It is important that each layer of the skin flap is sutured and to minize tension on the skin closure in order to produce the the best possible scar.
Can a tummy tuck be combined with other procedures?
A tummy tuck can be performed at the same time with another procedure. A usual comnbination would be a tummy tuck with liposuction and breast augmenation, tummy tuck and breast lift (or reduction), tummy tuck and labiaplasty, tummy tuck and rhinoplasty, tummy tuck and eyelid surgery. Depending on how much work needs to be done, patient’s age, and patient’s health, Dr. Grigoryants will recommend whether to perform those procedures at the same time or separately.
What is a mommy makeover?
Mommy makeover is not a medical term but a combination of plastic surgical procedures performed to improve the appearance of the body after childbearing. A frequent combination includes a tummy tuck with liposuction and some type of breast reshaping. It could be any other combination of procedures.
Example: This patient underwent breast augmenation with a small lift, tummy tuck with liposuction of abdomen, flanks, pubis (lipoabdominoplast)y, and liposuction of outer thights. Note how proper placement of the tummy tuck incision allowed the scar to be covered by thin underwear.
Will a tummy tuck eliminate stretch marks?
Those stretch marks that are located within the skin area to be removed during the procedure (areas between the belly button and pubis, as marked above) will be removed. The stretch marks above the upper line will move down.
What is a pubic lift?
Patients with a stetched abdominal skin frequetly have loose skin in the pubis as well. During a tummy tuck, the pubis is lifted and liposuction of the pubis is performed to flatten it. If this step is not performed, then the pubis will likely protrude beyond the level of the abdomen after surgery, which is not aesthetically desirable.
How long does tummy tuck surgery take?
Duration of lipoabdominoplasty depends on the width of the abdomen and amount of liposuction that needs to be performed. In general, the procedure last from 3- 4.5 hours.
How soon can I fly after a tummy tuck?
We recommend to our out-of-town patients to stay locally for at least 10 days surgery. You can fly after a tummy tuck but avoid lifting heavy items for at least 2-3 weeks after surgery.
What happens if I gain or lose weight after a tummy tuck?
Losing weight after a tummy tuck will further improve your result. Weight loss will after a tummy tuck will not usually reult in lose or hanging skin. Weight gain after a tummy tuck will thicken the abdominal flap as resudual fat cells will enlarge. In addition, weight gain will increase of intra-abdominal fat amount which may results in an increased protrusion of the abdominal wall. Therefore, it is best not to gain weight after a tummy tuck.
Can I only have liposuction without a tummy tuck?
Patient who have abdominal skin excess are not good candidates for liposuction alone. Performing liposuction in these cases will likely result in skin wrinkling and contour irregularity.
Tummy tuck and smoking
Patients who smoke must stop smoking at least 1 month before surgery and avoid smoking for at least 1 month after surgery. Smoking increases the risk of complications after surgery and affects wound healing.
What about pain after a tummy tuck?
When tummy tuck is performed without muscle tightening when only excess fat and skin is removed, most patients report that they did not have much pain after surgery. In contrast, muscle tightening causes more pain after a tummy tuck. In addition to oral pain medications, we offer an injectable medication called Exparel.
What is Exparel?
Exparel is a bupivicaine liposome injection. It is a local anesthetic (non-opioid) injected during tummy tuck by the surgeon in the abdominal muscle and skin. Unlike lidocaine, Exparel is gradually released by the liposomes providing pain relief for 3 days. If you are interested in having Exparel injected during your tummy tuck, please inform Dr. Grigoryants before surgery.
Can a hernia be fixed at the time?
Some patients presenting for a tummy tuck may be found to have a hernia in the belly button (called an umbilical hernia), or above the belly button (a ventral hernia). During your tummy tuck, Dr. Grigoryants will repair the hernia at the same time. For some hernias, especially umbilical hernias, a mesh may need to be used.
What is a mini tummy tuck?
For patients who have skin excess in the lower abdomen, a mini tummy tuck can be performed. Frequently, liposuction of the abdomen and flanks is performed as well to remove fat excess at the same time. A mini tummy tuck scar may be shorter than a regular tummy tuck scar and there will be no scar in the belly button. A mini tummy tuck will not stretch down (improve) the skin above the belly button but only works on skin excess bellow the belly button.
Case Example 1.
This patient under lipoabdominoplasty (tummy tuck with liposuction of the abdomen, flanks, pubis, pubic lift, and muscle tightening). The procedure resulted in a flatter abdominal contour and better waist definition. Her incision was placed such that her underwear easily covers the scar. Even losing a small amount of weight after surgery allowed the patient to further improve her result.
