"Skin tightening" quick-fix remedies do not solve the real problems of the post-pregnancy tummy!

 

Karen M. Horton, MD answers: Non surgical skin tightening for the tummy?

I am a mother of 4 children. I had my first child at the age of 16. I was told that because of my young age my skin stretched a lot, hence all the stretch marks. Ever since I have had a lot of loose skin in that area is there anything that I can do to tighten it without surgery???

By Karen M. Horton, MD - San Francisco Plastic Surgeon

"Skin tightening" procedures, namely laser-type therapies or injection treatments, do NOT address the underlying issue of a Mom's tummy after she has had multiple pregnancies:

• Excess skin and fat
• Stretch marks
• "Rectus diastasis" = separation of the muscles of the abdominal wall away from one another, creating loss of muscle tone and a bulge

Only a surgical procedure, abdominoplasty (and/or liposuction in some cases), can address each of these factors.

Beware of smooth-talking salespeople who do their best to get you to sign up for a "package deal" of procedures.

Often, minimally invasive therapies such as these prey on those Moms who are frightened of surgery and are looking for a quick fix with supposedly less downtime and fewer scars.

However, the checkbook can often be the area to suffer the most with non-surgical therapies, together with a general disappointment with results!

Visit a Board-Certified Plastic Surgeon with experience in Mommy Makeover surgery to help determine which procedure(s) will best achieve your goals!

More about → "Skin tightening" quick-fix remedies do not solve the real problems of the post-pregnancy tummy!

Full "tummy tuck" closure with DIEP flap breast reconstruction... A good idea?

"It is possible to do rectus plication with DIEP flap donor site closure for a full abdominoplasty result"

Karen M. Horton, MD answers: Possible to do full tummy tuck while doing diep flap procedure?

I understand that the diep flap benefit of a real 'tummy tuck' is not covered by insurance. Is it reasonable to ask for the cost of a full tummy tuck (sewing together muscles, etc.) while the surgeon is performing a diep flap procedure? My surgeon seems very reluctant to even discuss outlying procedures such as abdominoplasty and liposuction, which I believe are both necessary to achieve the best final results. If I'm willing to pay for these procedures out of pocket, I don't know why my surgeon won't discuss them. Any insight appreciated.

By Karen M. Horton, MD - San Francisco Plastic Surgeon

When the DIEP flap (deep inferior epigastric artery perforator flap) is used for microsurgical breast reconstruction, usually a small split is made in the muscle fascia (thick layer of collagen over top of the rectus abdominis muscles) to dissect out the blood vessels used for transplantation of skin and fat from the tummy to the breast.

Usually, the fascial split is simply closed, and the overlying anterior abdominal wall (sheet of skin and fat over the muscles of the trunk) is pulled tighter and closed, resulting in a tummy tuck scar.

It IS possible to perform rectus fascial plication (corsetting of the rectus abdominis muscles of the abdominal wall towards each other in the midline AT THE TIME of DIEP flap donor site closure.
However, doing so may change the pressures inside the abdominal cavity (i.e. on the stomach, intestines, diaphragm, etc) and may increase the risk of complications to the flap circulation in the short term. The worst case scenario would be to perform cosmetic steps during surgery and to lose the flap altogether!

Performing a full tummy tuck closure with the DIEP flap is something I HAVE performed successfully on a number of occasions, but patients must be very carefully selected and we would all have to be willing to accept an increased risk for complications.

I am currently reviewing my results on this combined procedure and will be presenting my work at upcoming meetings and in the form of a scientific paper, to be published on my website.

Often, the best solution is the simplest. On the day of your DIEP flap, it is usually best to focus only on microsurgical success. "Touch-ups" can be done any time in the future, including liposuction contouring of the abdomen (done in most of my patients) together with their nipple and areolar reconstruction, and/or rectus fascial plication, if needed.

See the photographs below of an example of rectus fascial plication done either at the time of DIEP flap donor site closure.  Trust your Microsurgeon to make the best decision for you, and to ensure a SAFE and SUCCESSFUL breast reconstruction as the #1 goal!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
www.womensplasticsurgery.com

More about → Full "tummy tuck" closure with DIEP flap breast reconstruction... A good idea?

You should be at your ideal weight and fitness level before a "mommy makeover"

Karen M. Horton, MD answers: Tummy Tuck for skin, fat, and stretch marks after pregnancy?

I'm 5'11 and 249 lbs. After pregnancy, I have a hanging mass of skin, fat, and stretch marks. I went from 186 lbs to 277 lbs. I have zero elasticity, and 1 week after I had my daughter, I had dropped from 277 lbs to 231 lbs. I am still overweight and currently trying to lose the weight, but I have this hanging mass on my stomach of stretch marks and fat. It's horrific. I want a tummy tuck and have done a lot of research, but how much will it cost me? How much do I need to lose before I should have the surgery? I don't accept blood at all, is that a concern?


By Karen M. Horton, MD - San Francisco Plastic Surgeon

For any Mom considering Plastic Surgery such as a "mommy makeover", I always advise women to achieve their weight loss goals prior to seriously considering surgery.

You should have lost as much weight as you feel is reasonably realistic, be physically fit, and have healthy nutrition as part of your lifestyle.

There should also be "calmness" in your personal and/or professional life. Chaos is never a good fit with surgery!

Most Moms seek a full abdominoplasty (tummy tuck), which removes excess lower abdominal skin and fat (including some stretch marks!), tightens the muscles of the abdominal wall back together, and decreases the waist line. Sometimes liposuction of the flanks and/or upper abdomen are added to the procedure, if needed.

For women who have not yet reached their ideal weight but who have a large overhang of skin and fat (a "pannus") in their lower abdominal region, it is possible as an interim procedure, to do a limited "panniculectomy". This will only remove the overhang but will not address the abdominal muscles or the upper abdomen.

Be sure to visit a Board-Certified Plastic Surgeon with a great deal of experience in these types of procedures!

Karen M. Horton, MD, MSc, FRCSC

More about → You should be at your ideal weight and fitness level before a "mommy makeover"

Abdominoplasty and liposuction have different goals and outcomes

Home > Answers from Karen M. Horton, MD

Karen M. Horton, MD answers:

Lipoabdominoplasty vs regular abdominoplasty for post pregnancy body?

"Does it make a difference? I've had 3 kids and definitely need some help in my stomach area, but I'm not sure what procedure I would need to get my pre-baby figure back."

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Abdominoplasty and liposuction have different goals and outcomes

Answer by Karen M. Horton, MD

San Francisco Plastic Surgeon

If you are a mother who has completed her childbearing, congratulations both on your wonderful family you have created and to entering the next stage of motherhood!

Many women find their abdomens have permanent changes following pregnancy, including stretch marks, loss of abdominal tone, excess skin and extra fat deposits that have accumulated since having babies.

Most mothers do not have complete recovery of their bodies after children.

Moms often seek rejuvenation of their tummy areas once they have finished having kids.

A "mommy makeover" surgical procedure should only be considered at least 6 months after the birth of your last child so that your body has the chance to recover as much as possible and to enable you to achieve as much as you can on your own, with a healthy diet and regular exercise.

Two main Plastic Surgery procedures apply to the post-pregnancy tummy:

Liposuction will remove excess fat in areas that are stubborn to weight loss, such as the abdomen, flanks, pubic area, and thighs. Liposuction will not address excess skin or stretch marks, and will not help to tighten abdominal tone.

An abdominoplasty or "tummy tuck" addresses both the inside and the outside of the abdominal wall, in a three-dimensional manner:

Tummy tuck surgery not only removes excess skin and fat from the lower abdomen (including some stretch marks), it tightens the muscles of the abdominal wall through "rectus plication" which "corsets" the fascia overlying your abdominal muscles together in the midline and truly decreases the diameter of your waist from the inside!

Depending on your particular situation, either liposuction or a tummy tuck, or both, may be recommended to achieve your specific goals.

Be sure to consult with a Board-Certified Plastic Surgeon with specific experience in these types of surgeries to learn more and to evaluate all of your options.

More about → Abdominoplasty and liposuction have different goals and outcomes