Best option? TT, floating abdominoplasty or reverse TT? (Photo)

Question

I had laser Lipo to my full ab, a year ago, which left me with some irregularities and increased laxity. I have had three plastic surgery consult and I've been given three options. I am trying to decide which would be most appropriate for me. I am 56 years old and have had three pregnancies with vaginal delivery.

J. Timothy Katzen, MD, FACS · Answer

Hello dreambigorwhybother. Thank you for your question regarding the best surgical option for your abdominal concerns.

Given your history of laser liposuction, three pregnancies, and the resulting irregularities and laxity, a reverse tummy tuck will not provide the comprehensive results you're seeking. Specifically, a reverse tummy tuck does not include muscle repair, nor does it address the skin and fat of the lower abdomen.

Based on your history and photos, I believe you would significantly benefit from a full tummy tuck with muscle repair. The muscle repair will help tighten the abdominal wall, addressing any diastasis recti (separation of the abdominal muscles) that might have occurred due to your pregnancies. This will provide a firmer, flatter abdominal contour. Additionally, a full tummy tuck will remove excess skin and fat from both the upper and lower abdomen, giving you a more balanced and smooth appearance.

Floating abdominoplasty (also known as the umbilical float technique) can be an option, but it is typically reserved for patients with less excess skin and fat. It might not provide as comprehensive a result as a full tummy tuck, especially if muscle repair is needed.

In summary, a full tummy tuck with muscle repair would likely be the most appropriate procedure to achieve the results you desire. This procedure will address muscle separation, remove excess skin and fat, and improve the overall contour of your abdomen.

Good luck with your decision and I hope you achieve the results you are looking for.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Chet Mays, MD · Answer

Thank you for your inquiry!   We love to meet with you to discuss your concerns and your options.  Schedule a in-person or virtual consultation with a Board-Certified Plastic Surgery to help you reach your goals.

Ricardo L. Rodriguez, MD · Answer

hello,
The answer to your question would best be answered with an in person consult. However, based on your photos,  some additional liposuction with thin 3mm cannulas could help smooth things out.  Be sure that the surgeon is using thin cannulas. These irregularities  an not only appear with Laser Lipo, but they can also appear with traditional liposuction if the doctor is using  larger 5mm cannulas.  For more liposuction,  Only SMALL cannulas will smooth out some of these irregularities.

The other option would be to remove the excess skin in your abdomen area. If you do not have a separated rectus diastasis muscle, this can be achieved with a panniculectomy. However, if the muscle is separated, you would be better served with a full Tummy Tuck.

Ricardo L Rodriguez MD
Board Certified Plastic Surgeon
Baltimore, Maryland

Good luck with your decision!

Donald Groves, MD · Answer

Hello and thank you for your question. From the pictures you have provided, you have a minimal to moderate amount of excess subcutaneous fat and skin present diffusely throughout your lower abdomen and periumbilical region (around the belly button). There is minimal flank adiposity (excess skin/fat), and no significant upper abdomen adiposity. Based on all this, you would benefit from a traditional abdominoplasty (tummy tuck) to help improve your abdominal/trunk contour. There is always a possibility you might have a residual vertical scar (from the cutout of your current belly button) if it is determined in the surgery that there is not enough tissue to resect. This may or may not be connected to the main horizontal tummy tuck scar. Of course, we surgeons always try to remove enough skin in the operating room to prevent this vertical scar, if it is safe to do so. Some surgeons pull things tighter than others, but the downside of pulling things too tight and resecting too much skin during this procedure is there can be too much tension on the horizontal wound- meaning they might not be able to get things closed in the operating room, or if they do, the wound will be under too much tension which can significantly increase the risk of wound healing complications (wound breakdown, dehiscence, infection, widened or unattractive scars). Weighing these potential risks against the risk of a small vertical scar which almost always heals uneventfully and is minimally noticeable, I'm sure you'd agree that the small vertical scar is worth it. Regarding the transverse lower abdominal scar, it should be well hidden within your bikini or underwear, and if you adhere to proper scar care and sun avoidance after surgery, it (and any potential vertical scar) should eventually heal to be minimally noticeable.
Because your issue is predominantly skin and fat excess to the lower/mid abdomen, none of the other options you listed would adequately address this and provide you with a good aesthetic result. 
Regarding a reverse abdominoplasty (reverse tummy tuck)- this procedure places the incision across your upper abdomen along both inframammary folds and connecting the two. It is beneficial for patients who have little to no lower abdomen and periumbilical adiposity, and whose main issue is focal excess skin and especially subcutaneous fat in the upper abdomen, just below their ribs. It is great if combined with a breast procedure, to help minimize the scars. But unfortunately, your abdominal concerns are located too low for this to even be a reasonable option for you. 
Regarding a "floating-abdominoplasty"- it is essentially the same procedure as a standard/traditional tummy tuck. In this procedure, the stalk of the umbilicus (belly button) is cut and the whole slab of abdominal skin, fat, and belly button is pulled down as a single unit with excess skin and fat resected at the bottom and sutured closed. This differs from a standard tummy tuck only in that the belly button is "floated" down with the rest of the tissue, whereas in a standard tummy tuck, it is translocated- a hole is cut in the abdominal skin at the ideal location and the belly button is brought out and sutured into this new location. A "floating tummy tuck" is generally only an option in patients that have a notably long torso and a belly button which is positioned higher than normal, since the procedure brings down the belly button- otherwise in a patient with a normally located belly button or normal torso, these operations make the belly button look too low which looks VERY weird. Given your goals and current appearance, I feel this would not give you as pleasing of a result as a traditional tummy tuck.
Liposuction is a great adjunct which could provide some additional benefit, particularly to the contour of your flanks, and can be done at the same time as your tummy tuck procedure for the best possible single operation results. 
With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. It sounds like you have already seen multiple plastic surgeons for evaluation, so ultimately you should choose a surgeon who you trust, feel comfortable with, and who you feel can deliver the best results that align with your individual goals. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Daniel Barrett, MD · Answer

Dear dreambigorwhybother,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Carmina Cardenas, MD · Answer

Your abdomen will be difficult to fix because of the prior laser liposuction and the fibrosis which will prevent the skin to be fully pulled down or up. 
So you must acknowledge your skin will remain with certain degree of saggy and lumpy appearance, and the scar of the belly button. 
You will be ideally candidate for Regular TT, tight muscle repair to create a flatter abdomen and remove the saggy skin on your lower abdomen. You will end up with a vertical incision in between the belly button and the TT incision. 
Be encouraged!
Dr. Cárdenas

Camille Cash, MD · Answer

Based on your photos and description the recommendation is a standard tummy tuck.  Liposuction can be added for further contouring if desired.  This would address contour irregularities, excess fat and skin, as well as correct abdominal wall laxity.  I've included a video on tummy tuck options that I hope you find helpful.

Malik Abaci, MD · Answer

Hello. Thank you for your question and aproved photos. İf ı were you ı did full tummytuck and muscke repair and lipo

Mats Hagstrom, MD (license on probation) · Answer

Personally, I’m not a big fan of the floating belly button Tummy tuck.
Once the umbilical stalk has been severed, it eliminates the possibility of reverting to any other type of tummy tuck.
My recommendation would be a standard tummy tuck with a very low set incision that may require an additional small, vertical scar representing the opening made around your current belly button position.
While you may have significant skin laxity, the scar tissue created from previous Liposuction will have reduced skin elasticity, and this may limit the amount of skin that can be successfully removed with a tummy tuck procedure.
With limited ability to remove excess skin, placing the incision on the low side, may make it difficult to remove skin all the way up to the belly button. When that happens, the additional small vertical midline scar is created in order to still have a low set scar. To avoid the additional small vertical scar the main scar will need to be placed slightly higher.
Judge tummy tuck results based on who gets the most natural looking belly button with low sets scars that follows an atomic contours naturally and evenly on both sides, leaving the torso, looking attractive, balanced, and proportion it from all angles.
Ask providers to show you before and after pictures of previous patients who have similar body characteristics to your own. An experienced plastic surgeon should have no difficulty showing it before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. Being shown a pictures of patients who have different characteristics than your own body does is not representative of what your results are likely to look like. Familiarize yourself with what quality tummy tuck results should look like and take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures.
It may be helpful to bring in pictures of your own body to use as a reference, when reviewing before, and after pictures. It’s important to focusing on pictures of other patients who had bodies that look similar to your own.
I generally encourage people to have as many consultations as possible before scheduling surgery.
As you probably know from your previous Liposuction experience provider selection is paramount when it comes to getting consistent quality long-term outcomes.
When is doubts slow down and schedule more consultations.
Best,
Mats Hagstrom, MD

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