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Archive for the ‘tummy tuck pre-op tutorial’ category

Reader Question – Botched Tummy Tuck?

September 3rd, 2010

I was reading your blog and I was wondering, What should someone do if they received a botched tummy tuck? Other surgeons say it’s borderline malpractice and unfixable “unless a whole lot of skin grew magically from somewhere”.. Yes the doctor was Board Certified and supposedly a reputable doctor. Everything discussed during consult was significantly different the day of/following the surgery. Poor after care as well.

Most patients don’t know a quack when they see one, but in all seriousness it is very hard to prove malpractice. Tummy Tuck results even in the best hands vary quite a bit. I am not saying there aren’t many “Dr Quickies” out there who do mediocre at best work, but they do not define malpractice unfortunately.

You have several options:

(1) Go back to your original doctor and try to find a compromise that works. Maybe you should check him out thoroughly if you didn’t before your surgery to make sure he is the “real thing.” Tummy tuck surgery is not for amateurs.

(2) Find another doctor who is willing to take on a secondary operation. Have a long talk first regarding what is possible in this operation before you decide to have it.

You can also pursue the legal route, but unless things are truly substandard you will probably find this route long and questionable. A poor result is not malpractice and care varies significantly.

Best Regards,

John Di Saia MD

Originally posted 2010-05-06 07:30:26.

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Reader Question: Fleur-de-lis or Inverted T Tummy Tuck for Weight Loss?

July 7th, 2010

Reader Question:

I have lost about 100 pounds and am looking at having a tummy tuck. What is a Fleur-de-lis Tummy Tuck? It it what I need?

A “Fleur-de-lis or Inverted T Tummy Tuck” is a version of the tummy tuck operation in which there is a vertical incision (and later a scar) to take in some of the extra skin in the lower abdomen. These procedures have good points and bad points. On the good side, they do allow more skin to be removed allowing tightening especially in extreme weight loss patients. They also interrupt the circulation more than the alternative procedure increasing the chances for poor wound healing and skin loss (skin necrosis.) It is your surgeon’s judgment as to the risk/benefit ratio here.

Remember that part of what you are paying for with a plastic surgeon is experience and judgment.

Best Regards,

John Di Saia MD

Originally posted 2009-08-24 07:30:08.

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Tags: Fleur-de-lis Inverted T tummy tuck weight loss tummy tuck

Can You Redo My Endoscopic Mini Tummy Tuck?

April 15th, 2010

I had a Mini Tummy Tuck with an endoscope with a tiny cut near my pubes a few weeks ago. My upper abdominals are kinda loose. Should I have had a full tummy tuck?

Endoscopic tummy tuck surgery is kinda a paradox to me. A big part of the average tummy tuck patient’s ideal goal is tightening of the abdominal wall. This is partly accomplished through muscular tightening and partly through skin tightening via removal. You can’t remove much skin without an incision. Endoscopic surgery minimizes incisions.

Treating upper abdominal skin is part of the job of a full tummy tuck. I would probably have recommended one to you if I had seen you before your endoscopic adventure. It might still be possible to do one, but I would need to see you to see how things appear at this point. You will also want to wait until wound healing is mature to have additional surgery anyway.

Best Regards,

John Di Saia MD

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Bad Tummy Tuck? – Maybe

November 18th, 2009

People e-mail occasionally or ask on some of the forums at which I participate whether they are the victims of a “bad tummy tuck.” I found these images on one such forum. There is a pre-op and a several week post-op image. I would like to think a real plastic surgeon did not do this:

: Before Surgery

: 3 Weeks Later

When you go to a doctor for a consultation and he comes back with a quotation that is half of the others you are getting, consider that you may be in the presence of a novice. If a non-plastic surgeon says he will fix your hernia only, you aren’t having a tummy tuck, so don’t expect it to look like one.

If you have the wrong surgery or only part of the right surgery, the result might not be entirely fixable later. This lady probably needs an extended tummy tuck and with that maybe she can get to look somewhat normal again. In her first operation, the tissue planes were likely not separated adequately to allow redistribution the skin after repairing the problem on the muscular layer. This just looks like much less than a tummy tuck to me.

Best Regards,

John Di Saia MD

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Tags: bad plastic surgery plastic surgery complications plastic surgery malpractice tummy tuck

Lemonade Diet – Looks like Starvation

October 27th, 2009

Patients at times ask me about diets to maintain their cosmetic procedure results or get into the weight range they would like before a major cosmetic procedure like a tummy tuck.

The Lemonade diet (also called Master Cleanse) looks like starvation to me. Starvation isn’t sustainable so it is not really good for surgery preparation or anything else for that matter. I certainly wouldn’t recommend this kind of diet while a patient was recovering from surgery.

Best Regards,

John Di Saia MD

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Posted in liposuction pre-op tutorial, tummy tuck pre-op tutorial

Tags: Lemonade diet Master Cleanse

Avoiding Tummy Tuck Swell Hell.

October 23rd, 2009

One of the most common points of mutual complaint on the tummy tuck internet forums is post Tummy Tuck “Swell Hell.” This refers to the tendency of patients after tummy tuck surgery to swell in the abdomen and flanks. It can last months, but planning can make it less severe or avoid it entirely.

The patients most plagued by the problem tend to be larger cases meaning cases in which more work is done. Swelling after surgery often follows with the degree of trauma the tissue sustains. Swell Hell most commonly affects patients who have had tummy tucks with liposuction in the abdomen or flanks at the same time. Liposuction does not have to be part of a tummy tuck to get good results. In fact, I personally avoid liposuction in those areas with tummy tuck surgery to optimize healing and minimize tissue trauma. I am also a huge fan of properly fitted post-operative garments.

All tummy tucks are not the same. Technique and your surgeon’s post-operative attention in follow-up are big parts of the equation. These differ enormously in different practices.

Best Regards,

John Di Saia MD

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Pre-op Tummy Tuck – Beware Dr Quickie

October 2nd, 2009

A common point of dissatisfaction I see posted over an over again on tummy tuck forums is the appearance of the belly button. Fortunately these are patients done by other surgeons on these forums.

While belly button repairs in some cases can be difficult (when there is a hernia or the tissue has been stretched to make it very thin,) most patients do not realize that all tummy tucks are not the same. I refer to the docs who do them in 2 hours affectionately (of course) as “Dr Quickie.” This operation frequently takes me longer and I actually work the whole time. This “extra” time is spent fine tuning amongst other things the belly button. I do an umbilicoplasty…meaning a more complicated belly button reconstruction with my tummy tucks. One of my tummy tuck belly buttons and a few from “Dr X” are featured on my website page linked below.

“When you go for consultation and one surgeon is really cheap relative to the others, you need to wonder if you are in the midst of Dr Quickie.”

Best Regards,

John Di Saia MD

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Reader Question: Too Old For Tummy Tuck?

September 24th, 2009

Reader Question:

I am 64 years old and want a full abdominoplasty fairly soon. Can someone be too old to have the surgery? My health is excellent and I work out several times a week.

I have performed even extended tummy tucks in patients over 70 years of age with few problems. In my opinion, it is the patient’s overall health that either makes or breaks the operation as long as you are in good hands. You will need pre-operative clearance from your internist and of course a complete evaluation by a good plastic surgeon who is experienced in tummy tuck surgery.

Best Regards,

John Di Saia MD

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Reader Question: Tummy Tuck and Skin Necrosis

September 21st, 2009

Reader Question:

I am having a tummy tuck and I smoke. I am worried about Skin Necrosis. What exactly is it and how can I not get it?

Skin necrosis is the loss of skin usually from a poor blood supply. This loss produces wounds that can take a long time to heal. It is more common in larger Tummy Tuck operations and in smokers. The process starts usually within days of surgery. The skin changes to a red and then dark red color over a few days after surgery. It may seem cool to the touch. Then it may blister and peel and then turn black over a week or two. Smokers who quit cigarettes are still at higher risk, but it may be reduced somewhat by quitting. Necrosis varies in extent. In larger cases, areas near the pubes are affected. In lesser cases, areas of the scar can scab and take a long time to heal. In non-smokers this is very uncommon. Many surgeons believe that back liposuction may contribute to the risk. Some surgeons do not perform back liposuction at the time of a tummy tuck to reduce this risk.

Best Regards,

John Di Saia MD

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Reader Question: Diastasis Recti Repair Without Tummy Tuck?

September 10th, 2009

Reader Question:

I think I have Diastasis Recti, but I don’t want a Tummy Tuck. Can I tighten those muscles with exercise?

Diastasis Recti is literally a separation of the bands of the Rectus Abdominus muscle. It commonly occurs in pregnant women, but can appear in others as well. Affected people typically have a ridge that rises up along the upper center of their tummies with increases in intra-abdominal pressure (such as when exercising or lifting a heavy weight.) As the area is bare of muscle between the bands of the Rectus Abdominus muscle, exercise will not improve it. Too much exercise may indeed make it worse.

This problem requires a surgical correction. A tummy tuck can repair it amongst other issues and is probably the most commonly performed operation to fix Diastasis Recti.