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Philosophical Concepts
Women's liberation has taken females to high professional positions, demanding from them, among many traits, intellectual capacity and a good physical appearance, needed to maintain a competitive edge within the business world.
The desire of these patients for better aesthetic physical results have pressed plastic surgeons towards a range of technical resources that have improved their results.
Anesthesia
General anesthesia or epidural anesthesia combined with sedation.
Surgical Plan
Whenever I plan a stomach surgery, I associate, when allowed by the nature of the surgery, liposuction to the regions near the stomach so that in this way I can obtain an aesthetic result which is better for the whole anatomical region.
Normally, the regions that are aspirated are: sides of the rib area, sides of the breasts, waist, sides of the stomach 'tires or love handles', the sacral region, the 'side-bags' around the hips, the internal area of the thighs and the knees.
Incisions
I normally make an incision in the shape of a semi-circle right above the pubic hairs, running laterally each way to the hip.
The length of the incision may be shorter or longer depending on the quantity of skin to be removed. The scar is planned so that it remains hidden by a bikini or by intimate underclothes.
Surgery
After the incision, the skin and fat are separated from the stomach's musculature, up to the level of the ribs.
Because of this separation, I can see the rectus abdominis muscles, which I then bring closer together and hold by some stitches, thus helping to create the 'hour-glass' shape that we all like to have.
The excess skin is removed and a new, naturally looking, bellybutton is created and positioned; everything is finished off with fine sutures that minimize the size of the scar.
Post-Operation
The patient leaves the operating room already dressed with a wide compression tape that she will user for approximately 30 days.
She will be placed to sleep in a semi-seated position, and when returning home, she is instructed to keep this bent position with pillows under her knees so as not to pull the stomach skin that was recently held together.
When getting out of bed, she will have to maintain a slightly-bent forward position, again for 5 to 7 days, depending on the progress of each patient, gradually straightening-up.
Lymphatic draining begins as soon as possible to eliminate bruising of the tissues.
Alimentation should be generous and nutritious, in order to help the body recuperate from the surgical trauma. We prohibit doing diets during this time.
Personal Observations from a Feminine View
- Preparative corset - Depending on the patient, I sometimes
ask that she wear a corset prior to the Abdominoplasty, this is
so that her internal abdominal organs can begin to get used to the
new tighter position which will occur after the
tightening of the abdominal musculature.
- Liposuction of the abdominal flap - Since the year 2000 I have been doing liposuction of the abdominal flap which is being submitted to
Abdominoplasty.
This paper regarding this work was presented
at the 37th Brazilian Congress of Plastic Surgery.
Because of scientific analysis and through patient follow-up, I am convinced that this procedure does not harm the blood-vessels that provide nutrition to this region.
Today, this procedure is has been accepted by a large number of plastic surgeons. I have made a number of presentations at congresses regarding this method, which demonstrates credibility by the Brazilian Plastic Surgery Society. You can see further information within my Curriculum.
- Binding of the oblique muscles- I normally offer patients that are wide at the waist the possibility of approximating the oblique muscles so that the waist can be smaller. There is no woman who does not want to have a thinner waist. The binding of the abdominal muscles has become a routine in practically all stomach plastic surgery.
The routine that I follow is to apply liposuction to the regions near the stomach in order to obtain a greater aesthetic harmony in this region. I believe that it is a waste to just undergo plastic surgery of the stomach if there still is an excess of fat at the waist, the hips, sides of the ribs, etc. Without it, the aesthetic result will be incomplete. All women who undergo Abdominoplasty would like to look in the mirror and see that their body structure really improved.
- Fat grafting - I also suggest the grafting of sections of the patients own fat into regions of the gluteus, which helps provide a better projection to the buttock region. We provide a special treatment to the graft to avoid when possible the re-absorption of this fat. Because of re-absorption, I normally use a little bit more fat, so as to compensate for the natural absorption process.
- A new belly-button – As a woman who wears a bikini at the beach, I know how important it is to have a nice looking belly-button. Because of this, I take allot of care in creating a new belly button with the scars hidden, which looks natural and pleasing to the eye.
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Marking the patient - The day before the surgery I draw a pattern on the patient's skin with a special marker. This marking is done standing-up and in front of a mirror, looking at photographs that the patient may have brought (of a younger period).
Important for when making these marks is that the patient bring with them a bikini as a reference. This is so that I can make sure that the resulting scar will remain hidden by the bathing-suit. |
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Taping – This is a technique that I normally use to maintain the scars as small as possible. Each patient is instructed as to how she can place. The scar will undergo a special treatment that uses generally available medical tape (flesh colored works best) during the six months after the surgery. Taping is a way to provide counter-tension to the scar during its forming process. Remember that any stitch and resulting scar will have a natural tendency to spread apart, specially in areas of the body that are in movement . I have found that consistent taping, daily, during six months, greatly reduces the possibility of creating a wide scar. The scarring process is individual to each persons genetics; some persons will create scars that are better looking than others. Taping helps the normal scaring process but will not stop the formation of keloidal scars, if the patient has this tendency. |