Plastic surgeons often note that patients with severe abdominal deformities - excessive deposition of subcutaneous fat, sagging skin of the anterior abdominal wall, postpartum stretch marks, or flabbiness caused by significant weight loss - perceive these changes with calm doom, because they are sure that none from the medical specialties simply does not deal with such problems. Substantially informing the patient - using illustrative material - about the possible results of correcting such aesthetic defects will help him make a decision that may significantly improve his quality of life.
We have become accustomed to the fact that a patient who is accustomed to associate plastic surgery with operations only on the face is surprised to learn that correction of the abdomen and anterior abdominal wall is included in the scope of plastic surgery.
Nevertheless, abdominal plastic surgery is one of the winning operations in plastic surgery in general, since it is here that it is possible to obtain a very effective and eloquent result that equally satisfies both the patient and the surgeon.
A prerequisite for abdominoplasty is an operation performed by a plastic surgeon
Despite the fact that the main principle of abdominal plastic surgery is extremely simple, understandable and consists in excision of excess skin excess, subcutaneous fat layer and new skin tension, it is still a strictly obligatory condition that such an operation is carried out by a plastic surgeon, i.e. a doctor who feels and knows the laws of handling soft tissues, the laws of aesthetic harmony and symmetry.
Although abdominal plastic surgery is equally indicated for both men and women, it is the latter who venture on this operation much more often. Indeed, for a woman, the question of how she looks is always more relevant, and taking care of her own appearance becomes a habit, which entails increased attention and a sense of responsibility for her own body.
Often, patients come to the plastic surgeon with a feeling of despair and doom, since a deformed belly, which cannot be hidden even with carefully selected clothes, became an obstacle in almost all daily activities, significantly complicates intimate life, led to uncertainty, being the cause of many complexes. Such patients come, exhausted by persistent physical exercises, diets and classes on special simulators, which, alas, did not bring any noticeable improvements. The surgeon must evaluate the main signs of abdominal changes that can be effectively corrected with abdominoplasty, and tell the patient what methods this can be achieved, how figure flaws can be corrected.
The main external signs of changes in the abdomen
The following main signs of changes in the abdomen are distinguished, in which it is advisable to intervene by a plastic surgeon with a further positive result:
skin excesses of the anterior abdominal wall without pronounced fatty deformity of the abdomen. A similar picture often occurs after rapid and significant weight loss. During external examination, large excesses of skin tissue are determined, easily captured by fingers. The skin is largely devoid of tone and elasticity and is usually arranged in longitudinal horizontal folds;
postpartum "stretch marks" and flabbiness of the skin of the anterior abdominal wall. This type of change has an important specificity, consisting in the almost obligatory overstretching of the muscular aponeurotic layer, i.e. the deformation of the abdomen here is, as it were, two-layered: muscular and skin. The severity of the subcutaneous fat layer can be different: strong, moderate and weak. Skin surpluses do not appear as horizontal folds, but have the appearance of randomly located soft atonic irregularities, giving the skin a "crumpled look";
cutaneous fat deformity, mainly due to excess fat, especially in the lower abdomen. You can determine this deformation using the "diver test". It is necessary to ask the patient to stand in the position of a diver, i.e. with a bent back and arms raised up and realistically assess the fat bulge in the middle-lower abdomen. If it turns out to be significant, then this is an indirect sign that there are indications for tummy tuck. With this type of deformation, excess skin is hardly captured by the fingers, and the entire abdomen looks like a protruding tense hemisphere. The skin may have retained sufficient elasticity and firmness. This deformity is very common in men;
skin-fat deformity caused by both skin and fat excesses. With this type of deformation, during an external examination, the so-called skin-fat apron is determined, that is, the condition when the skin-fat excess in the form of one large fold, really resembling an apron, is located forward and downward, covering the entire inguinal region. It happens that the "apron" falls below the groin area, covering the upper thighs.
Deformed abdomen or scar - the decision is up to the patient
It is usually not difficult for an experienced surgeon to correctly identify the indications for abdominal plastic surgery and determine the type of operation. But the final decision, as well as in all other cases, when it comes to plastic surgery, must be taken by the patient himself. In this case, the main problem for him is the problem of choice.
The essence of the dilemma is as follows: the patient must decide what is still preferable - a deformed abdomen, which interferes with almost all aspects of everyday life, or a rather long and noticeable scar that always remains after abdominal plastic surgery.
As a rule, the patient still leans in favor of the operation, because the deformed abdomen completely excludes many of the simple and natural joys of life. However, it is very important that the decision to have a tummy tuck is not the result of a sudden emotional outburst, but the result of careful reflection and as many conversations with the doctor as you need.
Such warnings are very important for several reasons. Firstly, the operation leaves a rather large scar and, secondly, abdominal plastic surgery is one of the most traumatic interventions in plastic surgery.
Scar after abdominoplasty
In most cases, the scar is longitudinal, running along the lower abdomen, and connects either the inguinal folds or the iliac bones. The most popular modifications of this scar according to Grazer, Pitanguy, Callia and Reno (Regnault) differ only in the features of its position and shape: i.e., the incision can have a straight, curved or curly trajectory. But in any case, this scar remains visible for life, although it is located in the area usually covered by underwear. It cannot be invisible here (unlike, say, scars after eyelid surgery), because the skin on the abdomen is quite thick, constantly in motion and exposed to friction from clothes.
The scar is especially noticeable in the first 6 months after the operation, when it is dense, has a scarlet color and protrudes above the surface of the skin. Then the scar gradually begins to turn pale, thinner, become soft and compared with the surface of the skin.
Moreover, sometimes - in order to achieve the desired cosmetic effect and based on the peculiarities of the constitution, as well as the nature of the deformation of the abdomen and lumbar region - an additional transverse scar running perpendicularly downward from the navel area is also necessary.
Abdominoplasty injury
The traumatism of tummy tuck directly depends on the competence and qualifications of the plastic surgeon, on his ability to handle soft tissues, stop bleeding in a timely manner, etc.
The patient is required to report in advance about all previous diseases, bad habits, intolerance to certain types of drugs, blood pressure features, etc.
Abdominal plasty procedure
The operation is performed under anesthesia in the supine position, if necessary - with the legs slightly bent at the knees. After a skin incision and further manipulations with it, the surgeon evaluates the state of the aponeurosis - the muscle layer that is under the skin. In case of excessive stretching of the aponeurosis, its plastic surgery is performed - suturing in order to create conditions for the maximum reduction in the volume of the abdomen. Next, excess skin is determined, which is excised. Due to a significant downward movement of the skin flap, a new umbilical opening is formed, into which the navel is fixed. Then the excess skin fat is excised.
The above description is very schematic, since depending on the specifics of a particular case, the operation is supplemented by some components. For example, in case of pronounced fat excess, the operation is supplemented by liposuction, which in this situation is performed by open access.
Lay-by-layer suturing of the wound is a very important step for each abdominal plastic surgery. Since the tissues are sutured with considerable tension, their subsequent favorable healing requires the surgeon to strictly comply with certain requirements. In addition to the basic principles of the ratio and commensuration of tissues (accepted in cosmetic surgery), they include the very high quality of the suture material. As a rule, an intradermal continuous suture is applied to the skin, which subsequently creates conditions for favorable healing and the formation of an inconspicuous scar.
Postoperative pain may last from 1 to 3 days. At this time, patients are offered inpatient treatment, after which discharge is possible.
Regular dressings are needed within 10-14 days. Within a month after the operation, it is recommended to wear special underwear (such as a bandage) to ensure uniform pressure on the skin and its subsequent uniform scarring. Then it is possible to return to the rules of normal life without any restrictions, including pregnancy.
Further visits of the patient are necessary only to assess the condition of the scar and, if necessary, to choose certain methods of its correction.
Thus, tummy tuck cannot be classified as an easy operation, but a great consolation and argument in its favor is the almost lifelong effect, since new deposition of fat and stretching of the skin in the area of operation are possible only to an extremely small extent.
According to the materials of the magazine "Kosmetik international"
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