My experience with Tummy Tuck and Body Lifting Procedures

This is a review of improvements in tummy tucks after 48 years of performing them. My first tummy tucks (abdominoplasties) were done during my residency in the USAF. The procedure took about 6 hours, bled profusely, required drains, the umbilicus did not look natural, the recovery time was extensive, and it was excessively painful. If fact, it was the most painful operation that we did as plastic surgeons at the time. The drains were required and stayed in for 5-10 days, and patients hated them, and I did too. Still, people had them done because an apron of skin hanging over your belt or pants was and is so distasteful and unacceptable.

Initially, I was taught to place a plaster cast over the lower abdomen at the end of the procedure. The weight of the cast was supposed to splint the abdomen. This in combination with the drains were intended to reduce the incidence of the fluid collection called a seroma. Seromas usually require several needle aspirations, and the incidence of seromas varied from 10 to 25% according to the surgeon performing the procedure. We have come a long way since then.

Then came the technique of using the Bovie coagulator for dissection, which is a small blade that does the cutting for us instead of a scalpel or scissors. This reduced the bleeding, but an understanding of what it could really do literally took years. Now using the Bovie coagulator, both dissection and coagulation can be done simultaneously if the blade is used properly. Although the blade is moved very slowly, time is saved because the surgeon doesn’t have to go back and coagulate any arteries or veins. Plus, with no bleeding, there is much less postoperative discomfort, fewer seromas and bruising, and recovery time is faster.

The next big frontier for both my patients and me was the “No-drain” or drainless tummy tuck. This procedure was invented and developed by a plastic surgeon and his plastic surgeon son, Drs. Pollock and Pollock from Dallas. This was a monumental advancement in abdominoplasty technique. It requires a specialized suturing technique called Progressive Tension Sutures. These sutures simply suture the abdominal skin/fat flap down to the underlying muscle rather than relying on the drains to suck the flap down–which did not work effectively. When these sutures are used, no drains are needed. Without these sutures, the flap slides around on the underlying muscles with any motion of the body or even coughing. This explains why the seroma rate is so high with standard tummy tucks with drains. With the no-drain TT, the seroma incidence is almost zero. Plus, the recovery time is much less, the discomfort is less, and there are no dreaded drains to tend to for 5-10 days or longer.

An additional advancement was the method of closing the horizontal incision. There is a layer of fascia between the skin and muscle called Scarper’s fascia, which has to be closed properly with either permanent sutures or sutures that dissolve very slowly. This keeps the scar from indenting at a later date. The result is a better scar. Properly sutured, there should never be suture or staple marks.

The last advancement in technique up to now has been the treatment of the “belly button,” (the umbilicus). Now the umbilicus is reconstructed with a small flap at the lower part, and this creates a very natural umbilicus, far superior to those with a simple circle or oval shape.

Liposuction is usually routine in most tummy tucks, according to the patient’s weight and excess fat.
Postoperatively no binders are used for the first 4-5 days, and this has prevented the creases caused by most binders and actually speeds up the recovery time. Following this period of time Spanks or biker’s shorts are used for mild compression.

Finally, there is a long-acting anesthetic called Exparel, which is injected into various specific areas around the abdominal muscles which lasts for 48 hours dramatically diminishing discomfort.