Nip This Tuck That

 Just finished a very interesting case.  Patient had an upper Tummy Tuck (Abdominoplasty) about 5 years ago by another Plastic Surgeon.  The Tummy Tuck is performed to remove excess skin over the abdominal area and to tighten the abdominal muscles.  She was never really happy with the amount of excess skin that remained after the procedure.  We had removed her Saline Breast Implants, that had encapsulated making the breasts hard and mis-shapen and replaced them with slightly larger ones over a year ago.  Today she was back to flaten out her abdomen with another Tummy Tuck (Abdominoplasty).

 I’m not a big fan of the upper Abdominoplasty because the scar goes across the top of the abdomen but she had already had the procedure perfomed using that incision and approach.  In simple terms, the blood supply to the skin of the abdomen comes from above, below and the sides.  Once an incision was made along the top, that blood supply wass compromised so…if I made an incision from below, as is done in a standard Tummy Tuck (Abdominoplasty), the blood supply would have ben compromised from top and below.  The result could be dead skin and a big mess.  So reluctantly, I made an upper incision for the Tummy Tuck.  This illustrates an important point in my line of work…sometimes you are forced to do things differently then you would like by the patients previous surgical history.  This was just such a case.

 The procedure went very well and she should be happy.  I tacked the upper edge of the skin incisioin to the deep tough tissues of the chest to keep the incision and gravity from pulling it downward.  I also placed multiple quilting sutures that go between the underside of the elevated skin and the underlying muscle fascia (thick tough layer over the muscle).  Placed one dain to drain blood and fluid from under the skin flap that exits on the side of the belly button where it shouldn’t leave a noticeable scar.  Abdominal binder for a couple of weeks and no strenuous activity for 6-8 weeks.  Closed the incision in multiple layers with dissovable stitches.

 The patient had a Laser Face peel elsewhere that left a line of demarcation on the neck, so I used some 30% TCA to feather that edge.  Also used the TCA to perform a lower lid chemical peel.  She’ll go to the after care facility for several days where muscle relaxants will make her comfortable.  I’ll see her postop after my surgery cases tuesday.  I will follow up with her after replacing her Breast Implants a few months back….she had them done years ago by another plastic surgeon and just wanted them slightly smaller and more shapely.

 While I was busy in the OR…Robyn, my wife and Master in Nursing, was busy doing Botox and Restylane injections one after the other.  Warm weather makes people more conscious about their skin and Botox, Restylane, Radiesse and our Francis R Beverly Hills Skin Care Products get very…very…popular!

Read more about Abdominoplasty (Tummy Tucks) here:

http://www.drfpalmer.com/Abdominoplasty.html

Read more about Breast Augmentation with Breast Implants here:

http://www.drfpalmer.com/BreastAugmentation.html

Dr. Francis R Palmer, III