What causes skin and muscles to stretch?

Weight loss, pregnancy, effects of gravity, and age all result in stretching of the abdominal wall. Skin, once over-stretched, has difficulty rebounding to its original shape. The resulting redundant skin and underlying fat take on a loose "doughy" texture forming major folds and wrinkles, often coupled with stretch marks.

How can this be corrected?

An abdominoplasty removes the loose skin, tightens the abdominal muscle wall, and where possible removes some of the stretch marks. Once the skin has been over-stretched there is no other effective way of tightening it other than removing the excess. This operation is not a weight reduction procedure; therefore patients who desire an attractive result must lose excess fat prior to the operation through weight loss or liposuction.

How is an Abdominoplasty performed?

There are several ways of doing this. The following method provides the least amount of noticeable scarring: an incision is made across the lower abdomen and groin creases just at the upper edge of the pubic hairline. The skin and fat are lifted from the underlying muscles up to the edge of the ribs. The umbilicus is released from the surrounding skin and left attached to the underlying muscles. If the abdominal muscles are lax, they can be tightened at this time. The skin is pulled down (like a window shade) and the umbilicus to the pubic hair can be removed as the skin previously above the umbilicus is now stretched across the entire abdomen. The incision is then sewn up as a transverse scar running across the lower abdomen, and the umbilicus is brought through a second small incision. Drains may be used and removed in the following days.

What is a mini-abdominoplasty?

A mini-abdominoplasty is a great option for patients whose primary concern is the portion of their abdomen below the umbilicus (belly-button). It is performed in much the same way as a full abdominoplasty, but there is no incision (and thus no scarring) around the umbilicus. It does not have the same ability to smooth-en the abdomen as a full abdominoplasty does. A mini-abdominoplasty still requires an incision across the lower abdomen at the bikini-line.

What is the recovery period like?

After the day-care surgery, you will need to keep your hips flexed for several days to avoid undue tension to the wound. The wound generally heals in 2-3 weeks. It will usually be one week before walking upright will feel comfortable; you will feel tightness in your abdomin for about one month following surgery and it will take one to two months before you can return to all of your normal activities. Heavy lifting should be avoided for 6-8 weeks following your surgery. Abdominoplasty generally has a less painful recovery than most abdominal operations. Swelling in your lower abdomen will persist for several months but will pass in time.

What about the scars?

Scar tissue is the normal product of the body's healing process, so surgery is not possible without some scarring. However, incisions are carefully planned to promote minimal and discretely placed scarring. You must follow your post-operative wound care instructions from Dr. Horton carefully to promote healing. Your body's healing characteristics are the main factors in determining scar appearance.

Scars from an abdominoplasty tend to be a prominent type of scar. It will fade over the course of a year after your surgery, but will always be visible. However, it is discretely placed in the "bikini line" so that it may be easily covered. The umbilical scar is usually fairly inconspicuous, or can be avoided altogether by opting for a mini-abdominoplasty.

What are some of the more common complications?

An abdominalplasty requires general anaesthetic, so has the same risks and complications of any anaesthetic procedure. The most serious complication under anaesthesia is when blood clots form in leg veins, then dislodge and travel to the heart or lungs. This is very rare, though can be fatal.

Surgical risks of an abdominoplasty are similar to any other abdominal operation, though less serious as the abdominal cavity is generally not entered so there should not be any direct effect on bowel function.

Basic complications like infection, bleeding, and poor scar formation are possible complications in any surgery. The blood supply to the abdominal skin is decreased as skin is lifted and mobilized. Infrequently, this may be reduced to a level where a portion of the skin fails to survive. These areas may open and take longer to heal but will generally close over and heal on their own. There is sometimes a loss of feeling in the skin just above the pubic hairline. Some of this loss of feeling can be permanent.

The pubic hairline may be raised slightly. Fluid (old blood and/or serum) has a tendency to collect under the incision line in some patients. This can be drawn off with a syringe until it stops forming. Postoperative umbilical deformities are noted by a limited number of patients and occasionally small excess skin-folds form at the ends of the incisions. These can be corrected by a touch-up procedure.