Posts Tagged ‘abdominoplasty’

A Tummy Tuck is Not a Tummy Tuck is Not a Tummy Tuck

In my years as a plastic surgeon, I find that the term tummy tuck (abdominoplasty) is often used in a way that suggests it is a standard procedure that is done in a similar way for all patients. In reality, this could not be further from the truth. Just as every patient is different, every tummy tuck is a little bit different in one way or another, and sometimes a lot different.

The Classic Tummy Tuck

The “classic” tummy tuck technique involves an incision that is low in the abdominal area and spans from hip to hip. The skin of the tummy is lifted up off of the muscles all the way up to the ribs, leaving the umbilicus (belly button) attached. In some instances, the muscle may be separated, usually due to pregnancy. If this is the case, the muscle is sewn back together. The skin is then pulled downward – think like a window shade – and the excess skin is trimmed. Drains are placed, the belly button is sewn into position, and the incisions are sutured.

Tummy Tuck to Abdominal Contouring

As techniques get better and better, the tummy tuck has evolved into abdominal contouring surgery. So what is different about this? Abdominal contouring allows surgeons to tailor their procedure to the patient’s specific needs. It can vary by the type of incision, by whether or not liposuction or fat grafting is done, and by additional procedures that may help improve the results or the recovery.

Types of Incisions

While the classic hip-to-hip incision pattern is still commonly done, there are patients who benefit from shorter or longer incisions. In an endoscopic approach, the incision can be as small as two inches or even less, hidden low in the pubic area.

In instances when there is skin laxity that extends around the sides of the abdomen, an extended abdominoplasty incision may be the best option. In this technique, the scar typically goes around the side and into the flank area. This type of incision not only allows for additional improvement of the flank area but it can also improve the upper outer thighs.

In cases where the skin laxity is even more severe, the tummy tuck incision can be carried all the way around the back until the right and left incisions meet. This is a “circumferential” abdominoplasty and is most common in patients that have lost significant amounts of weight, such as after a gastric bypass. This helps smooth the lower back and can lift the buttock area.

Tummy Tuck with Liposuction

Over the past several years, abdominal contouring surgery has also evolved as related to how much “undermining” – the separation of the tissues from the deeper layers – is done. Because of this, it has become safe for liposuction of the abdomen to be included with the tummy tuck procedure. This is typically termed “lipoabdominoplasty,” and it can be a powerful tool. This allows the surgeon to not only remove the loose skin but also effectively decrease the thickness of the tissues.

Supplementary Techniques to Tummy Tuck

Additional procedures are often now included with a tummy tuck as well. For example, liposuction can be used to harvest fat, which can be used to smooth or enhance other areas, such as the buttocks. In some patients, the pubic area has become full, and this can be reduced to create a harmonious relationship with the rest of the abdomen. Treatment of other adjacent areas, such as the breasts or thighs, can further enhance the overall appearance.

There are also things that your surgeon can do “under the hood,” so to speak, to enhance your recovery. Progressive tension sutures (or quilting sutures) are dissolvable stitches that are put on the inside to tack the elevated tissues down to the muscle layer. When progressive tension sutures are used, surgical drains are no longer necessary, which is a huge plus.

Another technique which can be incorporated is the injection of long-term anesthetics into the tummy tuck site during surgery. This can significantly reduce the amount of post-operative medications the patient requires and makes it easier to get up and move around post-surgery.

Emory Aesthetic Center

Tummy tucks have grown significantly in popularity over the years, in part because these newer techniques and approaches allow surgeons to tailor their procedure to the patient’s specific needs. If you are interested in finding out the best way to shape your tummy, schedule a complimentary consultation with one our expert cosmetic surgeons at the Emory Aesthetic Center.

About Dr. Eaves

Felmont F. Eaves III, M.D., F.A.C.S., leads the Emory Aesthetic Center as Medical Director. He is double board-certified by the American Board of Surgery and the American Board of Plastic Surgery.

Dr. Eaves’s leadership is apparent in his impressive accumulation of distinctions. He serves as Director of the American Board of Plastic Surgery, the board that certifies plastic surgeons nationally. Previously, he served as President of the American Society for Aesthetic Plastic Surgery; he is currently a Trustee.


Request an appointmentor call us at 404-778-6880.

When is the Best Time to Get a Tummy Tuck?

eac-250x250A tummy tuck or abdominoplasty is a surgical procedure that removes the unwanted excess skin and fat from the lower abdomen improving the abdominal contour. It can be limited and only involve the front of the abdomen, or it can be extended to also address excess fat and/or skin in the back. Abdominoplasty typically involves reestablishing the native abdominal anatomy, i.e. restoring the muscles that have been affected by childbirth or weight gain. The procedure can be done with or without liposuction depending on your overall appearance and goals.

So now the question…when is it the best time to have a tummy tuck procedure?

When I meet with patients who want to improve their abdominal contour, it is generally due to life changes that have affected their midriff. These changes can be due to the birth of a child/children, the loss of significant weight, or just the process of aging in general. Depending on the specific change, my recommendation is to wait until that change has plateaued. Meaning, if the abdominal excess is related to childbirth, I recommend that your family is complete prior to having a tummy tuck done. If it is related to weight loss, I recommend that your weight be a number you can maintain long term.

Additional questions typically follow. “Can I get pregnant after a tummy tuck? I don’t know if our family is complete.” That’s OK if you are uncertain. You can successfully carry a baby after a tummy tuck. The pregnancy may affect the result and a revision could be necessary in the long run.

“What if I gain the weight back?” If you gain some weight back, the abdomen will appear fuller again but likely the skin excess will not be present so I would encourage you to again lose the weight before any revisions are considered.

Recovery is another component to consider if you are ready to schedule your tummy tuck. I recommend at least 1 week off of work to get through the most painful part. The first few days can be hard and having to go back to work will add unnecessary stress. Try to schedule the surgery during a less busy time in your job, and when you have accrued enough leave time.

If you are ready for a change, and it’s the right time for you based on the information provided in this blog, let the Emory Aesthetic Center help you realize your vision of you. Come in for a complimentary consultation with one of our board certified cosmetic surgeons.


or call us at 404-778-6880 to schedule a consultation

About Dr. Anderson

anderson-ericaErica Anderson, MD, is board certified by the American Board of Plastic Surgery and currently holds an appointment as Assistant Professor in the Division of Plastic Surgery at Emory University. Dr. Anderson completed her general surgery residency and plastic surgery residency at the University of Colorado Health Sciences Center and associated hospitals in Denver, CO. She completed a year of advanced training in Aesthetic Surgery at Grotting Plastic Surgery in Birmingham, Alabama.

Dr. Anderson returns to Emory University after being in private practice in Arlington, Virginia. While there, she maintained a busy aesthetic and reconstructive practice and also served as Medical Director for the Wound Healing and Hyperbaric Center at Virginia Hospital Center.

Dr. Anderson’s academic and research interests are largely focused on clinical outcomes with regards to cosmetic surgery. Her areas of clinical interest are diverse including cosmetic surgery of the breast and body as well chest wall reconstruction and wound care.

Dr. Anderson is married with 3 children, Trent, Connor and Fiona, and 2 vizslas, Max and Mimi.

Non-Surgical and Surgical Body Contouring: Setting Realistic Expectations

Body Contouring Expectations

As we kick-off the summer months and have officially reached bathing suit season, it is natural that many of us take a look in the mirror and think about how we might change our body.  In addition to keeping a healthy diet and exercising regularly, there are now more choices than ever in how we might achieve our goals. But with so many choices, both surgical and non-surgical options, choosing what body contouring procedure is best for you can be difficult.  How can you know which is best, and how can you make sure that your expectations are realistic?

 At the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), held this year in Montreal, Canada, plastic surgeons from around the world discussed exactly these kinds of questions. This year, I participated in back-to-back panels on body contouring, and thought that the folks here in Atlanta would be very interested in hearing what the experts are saying about the various body contouring procedures and the kind of results that can be expected.

The first panel, which I chaired, was on non-surgical body contouring, and how it compares with liposuction. Anesthesia is not required for these non-surgical procedures and usually one can return to full activities virtually the same day. Such procedures include cryolipolysis, radiofrequency, and different types of external ultrasound. These technologies all work differently but are designed to accomplish the same thing – remove unwanted fat without surgery. Cryolipolysis, better known as CoolSculpting®, does this by freezing the fatty tissues; radiofrequency treatments heat the tissue under the skin; and ultrasound uses sound waves to break up fat cells.

After the panel discussed issues for an hour, several “take home” messages were clear to the doctors. First, non-invasive body contouring procedures do work and are well tolerated by patients, but the results can be significantly less dramatic than those from liposuction. Second, to get the desired results, most patients need repeat treatments of the same area. And third, not everybody is a good candidate for non-surgical fat reduction. The best patients for non-surgical body contouring are at an overall good body weight, have firmer, elastic skin and have a limited number of areas to treat. Patients who will do better with liposuction or a tummy tuck include those who are older or have less skin elasticity, women post pregnancy who may need a tummy tuck, or those with larger, more diffuse fat collections.

The second panel was on abdominoplasty, otherwise known as tummy tucks.  Despite the new non-surgical technologies that are emerging, the number of tummy tucks done each year in the United States continues to grow. There are several reasons for this continued growth in the number. First of all, tummy tucks really work, and the results can be among the most dramatic of the body contouring procedures. Second, there have been significant improvements in the way abdominoplasties are performed. These include better ways to control pain after surgery (for example with pain pumps and long lasting local anesthetics), the eliminated need for drains in many patients, and better control of scarring. Third, as many are working hard to control their weight and keep their body in shape, they realize that neither non-surgical treatments nor liposuction will tighten their loose skin, something that is at the core of abdominoplasties.

So as you look in the mirror, how do YOU make sure that you choose a body contouring method that is best for you, and what should you expect? The most important thing is to have a consult with a physician who can offer you the entire spectrum of options – non-surgical, liposuction, or tummy tuck. Listen to what they say. In some cases, patients will have loose skin of the abdomen and weak muscles after pregnancy, and in these cases, nothing short of a tummy tuck will give significant results. In other cases with isolated, small fat pockets, non-invasive CoolSculpting® may be an excellent option. And still in other cases where there are many body areas a patient may want to treat, liposuction may be more effective and cost less in the long run than non-surgical treatments. Ask the doctor about how your skin will change after the procedure, what your recovery will be like, how many treatments will be necessary, and how the treatment options compare. Working with a cosmetic surgeon who has experience with all the options is the very best way to set expectations that are realistic for you.

There is a great old saying that “if the only tool you have is a hammer, the whole world looks like a nail”. In the world of body contouring, nothing could be more true. Many centers that offer non-surgical treatments can’t offer you liposuction or a tummy tuck, so guess what? They’ll offer you what they have. Even worse, in many cases you might not even be evaluated by a physician who is trained in all the different techniques, so they can’t help guide you to compare realistic expectations between the options. And for those who are not good candidates for non-surgical technologies, this can be a prescription for disappointment.

At the Emory Aesthetic Center, we not only offer the full spectrum of body contouring options – from CoolSculpting® to liposuction to abdominoplasty (tummy tuck) – but we also require that all patients interested in body contouring have a consultation with one of our board certified physicians to discuss exactly these issues. We want you to love the results of your treatment, and we will work with you to help you find the best body contouring option for you and to set realistic expectations.


About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

Tummy Tucks 101: Answers to Frequently Asked Questions

tummy tuck 101Tummy tucks – also known as abdominoplasties – have grown significantly in popularity over the past 15 years, and they are now one of the most common procedures performed by plastic surgeons. Part of the reason why tummy tucks have grown in popularity over the years is our increased focus on health and fitness, but another big reason is that tummy tucks can provide dramatic results. There have been recent advances in the procedure that offer better pain control and a better recovery. Now may be a good time to take a fresh look at some of the most common questions that patients ask us about abdominoplasties.

“Do I need a full tummy tuck, or can I have a smaller scar – say with a “mini” tummy tuck or just liposuction?”

There is not just one type of tummy tuck – abdominal contouring can include a variety of approaches depending on one’s individual situation. It is often helpful to think of a tummy tuck in terms of where the problem is. Is there too much loose skin, is there too much fat, or have the muscles been stretched or separated by pregnancy? If your skin is relatively tight then you may be a good candidate for a reduced scar approach, such as liposuction (tiny scars), an endoscopic abdominoplasty (1-2 inch scar), or a mini-abdominoplasty (a scar about the length of a C-section). On the other hand, if there is a lot of loose skin that you will need tightened, that will require a longer scar. If there is too much fat, then liposuction can be combined with the removal of skin – a very common situation. If the muscles are separated, then some sort of tummy tuck with muscle repair is needed, however the incision can be short or long depending on the skin.

“Do I have to have a drain after a tummy tuck?”

Historically the answer to that question was “yes”; however, new techniques have eliminated the need for drains in many cases. We now can use special stitches – known as progressive tension sutures – to seal the tissue together so that there is no need for a drain. The progressive tension technique has another advantage as well; it often allows us to remove a bit more skin than we could otherwise. Although I currently can’t prove it, I also suspect that the sutures help make the scar from the tummy tuck better because they reduce the tension on the skin during healing. Patients love it when they don’t have to have drains.

“How much pain will I have after a tummy tuck?”

Historically tummy tucks were one of the more painful operations that plastic surgeons performed, especially when repair of the muscles was required. Over the past several years, the development of some new ways of controlling pain has helped this situation a lot. First came the development of pain pumps – these are devices that push a local anesthetic through a small tube and into the area of surgery. These were very helpful and many surgeons still use them, but it requires a tube coming out of the skin. More recently there has been the development of a long lasting local anesthetic which can give significant pain control for up to 3 days, and it doesn’t require a tube. Good pain control clearly makes the recovery more pleasant. It also means that less narcotic pain medicine is required; therefore, there is less chance of a reaction to the medication. In addition, it may make the surgery even safer by allowing patients to move around more easily and to be more active.

“How long is the recovery after a tummy tuck?”

Well, the answer depends on several factors and to what level of recovery you are thinking about. If you don’t need the muscles repaired, it is likely that your recovery is going to be easier and quicker. Most patients having a full tummy tuck (with muscle repair) find that they are generally able to drive a car within a week, depending on their pain level (remember you don’t want to drive when on narcotic pain medicine). Many patients can work remotely from home, and find that they are able to log on to their computers, answer emails, or even have a conference call after only a few days, although they won’t feel like going in to work for maybe 2-3 weeks post surgery. Light exercise (e.g. walking or gently peddling on a stationary bike) can start by this time as well. By 6-8 weeks, most patients would consider themselves fully or nearly fully recovered, although it is worth remembering that the nerves will continue to heal, the scar will continue to fade, and the swelling will continue to go down for several months.

“Will the results last?”

Yes! As long as your weight remains stable over time, abdominoplasties are typically a ‘once and done’ procedure, never needing to be repeated. Of course your skin will age a bit over the decades, but it usually never gets back to the looseness that you may have experienced before surgery.

“After pregnancy, my tummy needs help, but my breasts do, too. Can you work on both at the same time?”

Not only is the answer “yes”, but combining a tummy tuck with a breast lift or breast augmentation – popularly called a “mommy makeover” – is very common. Moms love their little ones, but it is great to get their bodies back, too!

Will a tummy tuck help my stretch marks?”

That depends on where the stretch marks are located, but the answer is usually “yes”. A full tummy tuck removes most of the skin in the lower abdomen, and any stretch marks in this zone will be removed along with the loose skin. Stretch marks outside of that zone are not really going to be helped.

The board certified physicians at the Emory Aesthetic Center keep up with the latest developments in abdominoplasty. We are happy to work with you to help create a plan that is best for you.


About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Tummy Tucks Part II – Tummy Tuck Recovery Expectations & Results

Tummy Tuck Before After

In the past, tummy tucks were one of the more difficult aesthetic surgery procedures to recover from, but recent advances have improved the recovery period significantly.

For instance, the use of certain deep suturing techniques – called progressive tension sutures – have eliminated the need for postoperative drains in many cases. In addition, new methods of pain control including pain pumps and long-lasting injections of local anesthetic can make it much easier to get comfortable and move around during the early post-operative period. Furthermore, these types of pain control often mean that you need fewer pain pills by mouth, and that helps prevent constipation after tummy tuck surgery.

Overall recovery after a tummy tuck varies for every patient, but most patients are driving a car in a week or less and are often able to return to work in 2-3 weeks, depending on the physical requirements at work. Light exercise like walking is encouraged early in your recovery, and your physician will guide you in how quickly you should advance to a full workout. Most of the swelling from surgery is gone by 3-4 weeks, but it may take 3-4 months are longer until all of the swelling is gone. The scar will continue to fade and improve for at least a year.

Tummy tucks are becoming more and more popular because they work . . . after you are healed, the results can be dramatic. Patients feel they look better in their clothes (and out) and many patients who have shunned bathing suits for years feel comfortable letting their midriff show at the pool or beach. A tummy tuck can really give a sense of freedom and confidence.

If you are thinking about a tummy tuck or other body contouring procedure, come and visit us at the Emory Aesthetic Center. We can help you figure out the options that are best for you and fit your needs.

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Tummy Tucks Part I – Which Abdominoplasty Procedure is Right For You?

Fifteen years ago the tummy tuck – or “abdominoplasty” – wasn’t even in the Top 10 of aesthetic surgeries performed. But now with many Americans putting more effort into getting in shape and looking fit, we are paying more and more attention to our midriffs. Despite all our hard work to do the right things, sometimes eating healthy, controlling our weight, and working out just can’t give us the results we want due to the effects of weight loss, pregnancies, or aging. Tummy tucks are now the 3rd most common cosmetic surgery performed.

Many patients who come to see us for consultation are confused about what type of procedure would be best for them to improve their “ab” area. Is it a tummy tuck? Mini-tummy tuck? Liposuction? Body lift? Belt lipectomy? It seems confusing, but figuring out which cosmetic procedure you need may be easier than you think, and it all comes down to assessing 3 factors:

  • The skin – Is it loose? Are there stretch marks? Or is the skin smooth?
  • Fat deposits – Are there none, a little, or a lot?
  • The muscles – Have the muscles in the front of the tummy separated as a consequence of pregnancy or other factors? Is there a hernia?

If the skin of the abdomen is loose or has a poor appearance, then a tummy tuck can be used to remove the excess skin and fat. While a tummy tuck leaves a longer scar than liposuction, tummy tucks do something that liposuction cannot – dramatically tighten the skin. If there is little fat, liposuction alone (if the skin looks good) or liposuction in combination with a tummy tuck (if the skin is loose) is a common strategy. If the muscles have been stretched apart, then repair of the muscles is generally done as part of an abdominoplasty.

Patients often ask about a short scar or “mini-abdominoplasty”, and for some patients, these can be a great option. In some rare cases, an endoscopic abdominoplasty can be considered. Endoscopic abdominoplasty is a procedure which is performed using a small camera (an endoscope) that is attached to small surgical instruments, resulting in an even smaller scar than a mini-abdominoplasty. However, it’s important to remember that if scars are shorter, then less skin can be removed – resulting in less ability to tighten the abdominal skin. If you really need tightening, longer may be better!

The best time for women to have a tummy tuck is after they are done having children. For both men and women, it is also important to make sure you are at a reasonable, stable weight. Tummy tucks, liposuction, or even non-invasive body contouring like CoolSculpting work best when your weight is at a healthy level. Your Emory Aesthetic Center surgeon can help you figure out whether or not some weight loss before surgery would produce better results in your case.