San Bruno Tummy Tuck doctors

Mini Abdominoplasty:

Mini tummy tucks are recommended if only a small lower abdominal skin excess is present. A mini tummy tuck has a quicker recovery. After a mini tummy tuck procedure, moderate discomfort can be treated with oral pain medication. Patients can usually return to work a week after surgery.

Standard Abdominoplasty:

After standard abdominoplasty patients should take care in movement for the first week, walking in a somewhat forward flexed position at the waist. Pain is handled with ibuprofen and a narcotic pain pill as needed.  Patients can expect more freedom of movement during the second week. Most are able to drive and move about fairly normally in 8-10 days, and should anticipate ten to fourteen days off work. No aerobic exercise is permitted for six to eight weeks. Additionally, home assistance is required for two full days. Home help should be available twenty-four hours a day for the first three days, and some patients may prefer a professional aftercare facility instead of home recovery. A pain pump which administers a small amount of long-acting anesthetic continuously for three days under the skin of the abdomen can be very helpful. The majority of my patients choose to stay at home after their procedure, and the pain pump helps make this more comfortable.

Extensive Abdominoplasty:

An extensive abdominoplasty usually requires the patient to take two weeks off work and social activities. Home help will be needed for the first 2-4 days, and it is often best to stay in an aftercare facility for the first 1-2 days. An extensive abdominoplasty would be a patient who had significant liposuction of the waist, flank area, and started with a relatively larger amount of fat and skin. When abdominoplasty is combined with breast surgery, such as augmentations or lifts, an overnight stay might be recommended as well.

Endoscopic Abdominoplasty - this is an operation done through a minimal incision hidden in the pubic hair that is designed to tighten lower abdominal bulging without removing any skin. It may be combined with liposuction. The recovery is the same as a mini tummy tuck.

I will see my patients 3-5 days after the surgery. We keep in touch by phone during that time to monitor their recovery. If a drain has been used, it is usually removed between 3 and 6 days after the procedure. It is possible to remove drains this early because I use special Quill quilting sutures to close off the space that has been created in elevating the flaps. The quilting sutures prevent accumulation of fluid that could lead to a persistent collection called a seroma. Before the use of quilting sutures it was necessary to leave the drains in for up to two weeks.

Patients are then seen weekly, and the belly button sutures removed around two weeks. Since the knots are tied on the inside of the belly button, and they attach to the abdominal side underneath the skin, there are never any visible stitch marks.  Most patients return to normal activity and work, depending of course on what they do, between seven and twelve days after surgery.  Although I have had patients run on a treadmill against doctor's orders at two weeks, I recommend that they avoid strenuous activity for six weeks, giving all the internal repairs time to heal properly.

The feeling of tightness that goes along with a nice tummy tuck gradually relaxes during the first month, and most patients are standing up, stretching and comfortable by the time of their second or third post-operative week.

Studies show that swelling starts to go down between three and six months, so you have to be patient. The lower abdominal swelling is what is most noticeable, and the incision line is the last area to soften and flatten between three and six months.  Studies have also shown that there can be some increase in swelling between six and twelve months, and after that it returns to its final healed state.

  You want what every woman having this procedure wants, a minimally visible, well-healed incision scar that will allow you to wear whatever you want, including a bikini. We have all seen before and after pictures of tummy tucks on the Internet that show the scar is way too high, and visible in underwear, let alone a bikini.  The distance between the scar and the belly button is too small and the result leaves much to be desired.

    The key to keeping the scar in the bikini line is in the surgical planning. I have the patient wear their bikini or narrow underwear to the pre-operative marking. The skin of the thigh is then pulled up in the direction of the belly button and the outline of the underwear is marked. By doing this first, the incision will be hidden under the bikini line. If this is not done, it is a foregone conclusion that when tension is placed on the closure, the laxity of the front of the thigh will allow  the incision to rise into a visible area.  The pubic area is also gently elevated and marked, just enough to take out the laxity. It is not overly elevated, because you do not want the pubic area too high, just restored to its youthful position.  If there is a C-section scar, the incision is always marked below that.
    The closure is done with permanent interrupted sutures places close enough together that a finger will not fit between them.  This is the first layer and brings the deep tissues together under tension without allowing tension to be transmitted to the upper layers of the skin where the visible scar forms. The tension across the groin area gives you a sleek, youthful look, but the tension and incision placement are controlled. Therefore, the scar does not ride up, and the scar has the greatest chance of healing as a fine, flat line.
     In addition there are slowly dissolving sutures that go from the abdominal wall just next to the belly button up to the underside of the skin of the hole where the belly button will be placed.  When these are tied, the skin flap is further secured at the level of the belly button, preventing tension from being transmitted to the pubic area and pulling that area up.

    Careful pre-operative planning and secure closure of the incision will predictably result in a low and well-hidden scar.  

How much does a tummy tuck cost.

The cost depends on what the patient needs and how much time is required.  When I do a tummy tuck I do what I think helps to get the best and longest-lasting results for my patients. In my practice a tummy tuck that takes between 4.5 and 7.5 hours of operating rom time, depending on what is done is in the broad range of  11-15,000. But I am sure you can also find a tummy tuck for 7-9,000 in some areas, and more in others. If  breast surgery is part of the procedure, it will cost more. Each patient is individualized according to their needs. These costs are inclusive of my fee, anesthesia, facility charges, Cosmetassure insurance, and follow-up care.

This is what is involved in a tummy tuck.

If the patient has extra thickness of fat of the abdomen and waist or flanks, the tummy tuck starts with infiltration of all these tissue layers with tumescent salt solution followed by treatment with vaser ultrasonic liposuction.

If I am confident that all the lower abdominal skin can be removed, including the hole where the belly button was freed, I make my incision initially above the belly button and join it to the lower incision.  Then I elevate the upper flap and leave the lower skin to be removed afterward to preserve body heat.

I do not consider a patient with excess fat of the abdomen or waist to have had a proper tummy tuck without treating all these areas. At the end of the procedure I want the patient to have a sculpted, natural look. I try to bring out the underlying shape of the waist and hips.

All tummy tucks are individualized, but all include careful elevation of the upper abdominal flap in a way that preserves the maximum blood supply to the skin that must join the lower incision. This is usually referred to as a tunnel from belly button to lower tip of breast bone. Undermining is limited to just the width needed to bring the rectus muscle together. Some doctors undermine all the way up to the rib margin and lose this blood supply. This takes less time but makes it easier to bring the flap down for closure without having to use other techniques such as discontinuous undermining and more flexing of the table to relieve tension.

If there is any excess fat after remaining after elevating the upper flap, it is carefully trimmed at the appropriate level from below. The margins of the flap, particularly laterally, are carefully tapered and trimmed to fit nicely with the thinner skin of the anterior thigh and hip below the incision. If not already removed, the lower abdominal skin is then removed.

The next step is a multiple-layer closure of the rectus muscle in the midline. This is done along the entire length of the rectus, not just above and below the belly button. Otherwise there will be little improvement of the waist. I prefer multiple figure-of-eight sutures of permanent suture, followed by a double row of slowly dissolving Quill sutures. I take care to go all the way up, and all the way down to the pubic bone to avoid unsightly bulges in the upper and/or lower abdomen.

I next trim the flap to precisely fit the lower incision without dog ears. I often use the Lockwood flap marker to ensure that no extra skin is left behind.

I then determine the umbilical location with the flap temporarily closed with atraumatic clamps to set the tension properly before measuring where to place the belly button. I always place the umbilicus at a distance from the pubic incision that is normal, at least 10-13 cm depending on patient height and pre-existing height of their belly button. Nothing is more unattractive than a high incision and a low belly button relative to the incision.

Sutures are placed between the opening for the belly button and the abdominal wall adjacent to the belly button after removing fat around the opening. Doing this creates a youthful valley in which to place the belly button.  The sutures are tightened and tied after the next step of re-attaching the flap to the abdominal wall. The belly button is tailored, according to patient preference, to be vertical, small and not show too much old belly button skin. That skin often has a different color, or is wrinkled.

The pain pump catheters are placed, if the patient has chosen to have a pain pump. A single drain may be placed.

The elevated abdominal skin is re-connected to the abdominal wall with special Quill quilting sutures.  This is a recent technological innovation that allows the skin to be progressively snugged up, top to bottom, without needing individual sutures or knots. The entire open space of flap elevation is closed off. This allows rapid removal of the drain, if used, and decreases any risk of fluid collection or seroma.

The incision closure takes about two hours and is done to last a lifetime and minimize the chance of any unfavorable scarring. My goal is to have such a secure closure that the scar will heal as a fine pencil line after the redness fades. There are three or four separate suture layers. The deepest layer is permanent and the others are absorbable. Scar maturation takes a long time, and the longest-dissolving absorbable sutures have long lost their tensile strength before the scar has reached its maximum strength and matured.

First, the central two-thirds are closed with a deep layer of permanent suture placed close enough together as individual sutures that a finger cannot be placed between them. This creates the high-lateral tension that distributes the tension more to the groin area than the midline. This decreases the possibility that there will be any excess tension in the pubic area that can lead to wound healing problems or unnatural elevation of the mons. The closure is very secure and allows a sleek distribution of tension across the front of the thigh to the abdomen. This gives a lift to the anterior thigh as well, eliminating pre-operative sagginess.

The next layer is a slowly-dissolving Quill suture that brings together the subcutaneous tissue and covers the permanent sutures. In a very thin patient, this layer may also serve as the subdermal layer closure. This is followed by another Quill suture that brings together the dermal-epidermal layer so they are just kissing. Since there is now no tension now on the layer of the skin that forms the visible scar, the most favorable conditions have been created for a hairline, flat scar. The final layer is a rapidly dissolving layer of absorbable suture that brings the skin together as finely as in a facelift.

The belly button closure is finalized by a deep layer of dermal sutures for strength and multiple individual half-buried mattress sutures of nylon that very precisely line up the umbilical skin with the abdominal skin with no sutures passing through the abdominal skin side and all knots on the belly button side. These sutures can be left in for two weeks for excellent healing without leaving any visible suture marks.

I usually cover the incision with a layer of Dermabond. This is a biocompatible tissue adhesive for incision coverage. It gradually comes off over 2-3 weeks. There are no other dressings required. The abdomen and flanks are covered with Topifoam sponge which greatly reduces bruising in any place where there has been liposuction, and a non-constricting binder is placed. A Velcro belt with a drain pouch is provided if a drain has been used. The pain pump has its own carrier.

As you can see, the tummy tuck described above is a highly technical and refined operation. It deserves the time required in my hands to achieve the goal that patients want: a youthful, slim figure.