Can a muscle repair ever cause more harm than good? (Photo)

Question

I have very little muscle seperation, each consultatuon I have had the Dr.'s say the same thing that I really dont need the MR. My questtion is, can the muscle repair ever do more harm than good? Also, would lipo to the flanks actually make much of a difference in giiving me a more hourglass shape? Thank you all for helping answer so many questions on this site

Gerald Minniti, MD, FACS · Answer

Regardless of what you've been told, actual separation of the the recti muscles is not the only thing that can cause a bulging contour. When you ask surgeons expert in tummy tucks, they'll tell you that they frequently tighten the rectus sheath beyond just bring the muscle together. This is because the actual fascial sheath of the muscles can elongate. Looking at your photo, you have a minor bulging at, and slightly below the umbilicus, and a muscle repair would be helpful to fix that and help bury the umbilical stalk for maximum depth, which is another issue you have: too little fat to make the belly button look natural. However, with some skill and a muscle repair, you'll get a much nicer belly button than you have now. Yes, a little lipo in the flank will help. Here's an important side note: You need a surgeon who will place your long transverse incision very, very low, which will mean that you will also need a vertical incision as well to repair the hole left from detaching the abdominal skin from the belly button. This is the most aesthetically pleasing way to do it. Again, super low long incision and a relatively short vertical incision.

J. Timothy Katzen, MD, FACS · Answer

Hello Lindaw. Thank you for your question regarding the potential risks associated with muscle repair during a tummy tuck and the effectiveness of flank liposuction in achieving an hourglass figure.

Your consultations have highlighted a crucial point: not all tummy tuck procedures require muscle repair. Muscle repair, also known as rectus abdominis plication, is primarily beneficial for those with significant muscle separation due to pregnancy, weight fluctuations, or other factors. Since you have minimal muscle separation, opting out of this additional procedure is a wise consideration given your circumstances.

Potential Complications of Muscle Repair:

Pain and Discomfort: Improperly indicated or overly tight muscle plication can result in discomfort akin to constant post-workout soreness, extending from the ribcage to the pubic area.
Abnormal Anatomy Appearance: Overcorrection can lead to an unnatural flatness or blunting of the natural contours of the abdominal wall, potentially making it harder to achieve a defined 'six-pack' look if that is a goal.
Suture Rejection: There is a small risk associated with the permanent sutures used in the plication process. These can occasionally lead to irritation or infection, necessitating further intervention to resolve.
Flank Liposuction:
Regarding your query about liposuction of the flanks, its effectiveness greatly depends on the existing amount of fat and your overall body composition. In patients who are already lean, like yourself, removing small amounts of fat from the flanks may not dramatically change the silhouette into an hourglass shape. It could subtly enhance the contour, but it would not be transformative.

Given your specific anatomy and the feedback from multiple consultations, it seems more prudent to focus on addressing the excess skin via a tummy tuck without muscle plication. This approach aligns better with your existing body structure and minimizes the risk of unnecessary complications.

Discussing these options thoroughly with your plastic surgeon will help tailor the procedure to your individual needs while avoiding over-correction. Remember, the goal of any cosmetic surgery should be to enhance your natural body structure in a safe and effective manner.

I hope this information helps clarify your concerns regarding muscle repair and flank liposuction. Good luck with your decision-making process and your upcoming tummy tuck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on your photos alone, you seem to be a good candidate for mini-abdominoplasty, without muscle repair or liposuction. A formal in person evaluation is best to confirm this. Doing maneuvers during surgery that are not indicated can sometimes cause complications, so if a muscle repair is not needed, it shouldn’t be done.

Gregory Lakin, MD · Answer

Thank you for your question. Muscle repair regains strength and functionality of the muscles after damage. However, it can sometimes cause complications if post-op instructions are not followed. However, to get an hourglass shape with slack abdominal skin, an hourglass tummy tuck is the most frequently advised surgery. It is a modified version of a regular tummy tuck that concentrates on achieving a curvier contour. This surgery involves liposuction around the back and flanks to firm the stomach and sculpt the waist, abdominal muscle restoration and tightening, and skin removal to create a smoother, tighter abdominal region. Remember that the ideal strategy varies depending on personal characteristics, including general health, desired cosmetic outcomes, and the degree of skin laxity.

Tyler Frew, MD · Answer

Hi there,
Certainly muscle repair can cause issues if done incorrectly over fixed overly tight. The sutures we use to repair the muscle could also become infected, however this is very rare. This usually goes off without any complications and helps return the muscle to their natural position, increasing the wall strength, and making the lower abdomen flatter. 
You appear very thin from the photos you sent so lipo, in my opinion, will likely have a minimal effect in giving you an hour glass shape as there is very little fat to remove
What you may want to consider is getting a full tummy tuck. This will remove the excess loose skin from your abdomen, create a new smaller more aesthetic belly button, and possible repair an umbiilcal hernia if present (possible based on the photo but you would need a physical exam or imaging to be sure).
Mini tummy tuck is always an option was well but would depend on the MD you go to, as we all do it a little differently
All the best

Arif Eroglu, MD · Answer

Hello; you have a midline diastasis; your belly button is too shallow. You have an excess skin in your groin and upper abdomen areas; however, excess skin on the upper abdominal skin; it is not enough for a full tummy tuck. Therefore, I recommend for endoscopic rectus plication and Mini Abdominoplasty for you. If there is looseness in the upper abdominal skin zone; after 3-4 months, Renuvion J Plasma can be implemented. You don't have much fat around your waist area. The distance between your pelvic bone and your rib bone is narrow. Because of these, even if fat is deleted; the hourglass appearance will not emerge.

Gary M. Horndeski, MD · Answer

From your side view, you can see your abdominal wall protrudes slightly forward. If you want the most hourglass shape, I recommend the fascial repair. The muscle is not repaired but the fascia, which is the envelope containing the muscle, is tightened. You would not benefit from liposuction as you appear much too thin for that.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Joel Patrick Maier, MD · Answer

Actually, it looks like you have noticeable diastasis above your umbilicus, leading into the umbilicus causing a small hernia or fascia effacement. A full abdominoplasty will likely rejuvenate nicely. Thank you.

Ronald J. Edelson, MD · Answer

I agree that you don’t seem to need muscle tightening. Muscle tightening is painful and can lead to a sense of pressure inside the abdomen. If you do need it to be done it’s best to do skin only

Ulas Bali, MD · Answer

Liposuction can be helpful when you have extra fat, which does not seem on your pictures. Looking at your photo, it can be said that you have minor bulging at, below umbilicus, a muscle repair will help you to fix your case.

Can a muscle repair ever cause more harm than good? (Photo)

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