Do any Doctors Tighten Skin on Sides of Abdomen Instead of Cutting at Bikini Line?

Question

I have had 2 pregnancies that has left me with stretch marks and some loose abdominal skin. I am very fit otherwise and have no diastasis. Wear a size 2. I don't like the look of traditional tummy tucks, the way the abdomen looks afterwards. When I pull my skin tight on either side of my abdomen my stomach looks almost like it did before babies. Would any doctors be willing to perform this surgery? Of course I would have 2 scars on my sides, but I still think it would be preferable. Risks?

Otto Joseph Placik, MD · Answer

If you can think it up it probably has been done at least once. I have seen scars running along a patients sides to pull the skin but they look like seams and are very visible in a bathing suit. The tradiional tummy tuck scar is not visible beneath a traditional bikini. Instead of having two outside incisions most surgeons would use a single midline vertical incision but this highly visible as well. Discuss these options or preferences with your surgeon.

Armando Soto, MD, FACS · Answer

Hi there-

	Many modifications to the traditional tummy tuck may be brought to bear for the benefit of any individual patient and her goals.

	In order to understand your goals and the options available to you, however, an exam and careful discussion would be necessary.

	I recommend you find a surgeon certified by The American Board of Plastic Surgery who has a lot of experience in advanced body contouring and schedule a consultation.

	Here's some advice on how to find a surgeon you like and feel you can trust.

Martin Jugenburg, MD · Answer

Sometimes the skin excess is not just up and down, but also to the sides.  This is especially true in patients who have lost a massive amount of weight.  In such situations to tighten the abdomen a vertical scar is added to pull in the sides.  The result is similar to what you described, except that there is only one vertical scar compared to two scars (one on each side) to create the effect that your hands create.

	We have treated a number of women who are in a situation similar to yours.  We modified our tummy tuck to incorporate a vertical scar component to it to create the effect you described.  The length of the vertical scar depends on the amount of waist tightening that we want to create, and usually spans from the horizontal scar to somewhere below the belly button.  Only in patients who have lost >100lb and who have a tremendous amount of excess skin does this vertical scar need to extend above the belly button.

Parham Ganchi, PhD, MD · Answer

While many results look nice when we pull the skin by hand, this often doesn't translate into a real surgical result.  The procedure you are describing can be done, it is almost never done.  This is because almost no one has loose skin only on the sides.  If you have loose skin on the sides from pregnancy, then you most likely have loose skin in the front.  If you only tighten the skin on the sides, you will have an irregular result where tight skin meets loose skin.  From what you are describing, you likely need a tummy tuck.  If you have a lot of loose skin on the sides, then it is quite possible that you need an extended tummy tuck to address the front and sides.  In the end, it is always a decision between getting the result and the scar or no result and no scar.  See a board-certified plastic surgeon to see photos of people like yourself.  See if the results you see are worth the scar to you.  Good luck!

	Dr. Parham Ganchi

Barry Stuart Handler, MD · Answer

The question posed by a size 2,  fit mother of 2 is whether a tummy tuck can be done leaving scars on the sides.

	The answer to this question depends on the particulars of the situation.  In this case, the author indicates the muscles aren't stretched.  This seldom turns out to be the case at the time of surgery after two pregnancies.  Even the most fit mothers often benefit from muscle tightening.

	Other issues to be considered are how much loose skin is there and is it loose  vertically, horizontally or both?  Veritcal skin excess is best dealt with through horizontal incisions like the traditional bikini line incision.  This is the most common situation.  If the vertical excess were confined only to the hips one could, in theory use horizontal incisions on the sides.  I have never found thid to be the case.  The uterus is located in the center of the pelvis and as the pregnancy progresses the fetal growth is roughly midline which accounts for the spreading of the midline abdominal muscles and the central skin excess.  Circumferential skin excess is most commonly seen in the population  having experienced massive weight loss, such as after gastric bypass.  These patients usually have both circulferential and vertical skin excess.  Most contouring procedures will still begin with a horizontal skin removal at the belt line but may go completely around the waist in an attempt to redistribute the circumferential skin excess.  If this proves inadequate then right and left vertical skin removal on the dsides may be the only alternative.  This leaves a scar the entire lenght of the torso on each side.  Such a scar is often satisfactory to a person who formerly weighed 400 pounds but is usually not acceptable to a fit mom who has never been obese.

Susan E. Downey, MD · Answer

This is actually a very interesting question. For patients who have lost a lot of weight either thru diet or thru bariatric surgery there often is looseness in two directions ( horizontally as well as vertically) - therefore a traditional tummy tuck which only reduces the skin in one direction is not adequate. For these patients a lateral excision is sometimes done ( with the resulting scar running along the entire side of the trunk) which then reduces the skin in the second dimension as well. However this may not be the best choice for you - sometimes what you can pull with your hands may not translate to what can work in the operating room . I would seek out the advice of a board certified plastic surgeon, especially one who has worked with massive weight loss patients and discuss this option with him/her.

Do any Doctors Tighten Skin on Sides of Abdomen Instead of Cutting at Bikini Line?

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