As years go by, the contour of the abdominal wall will change, it’s an inevitable process which varies from person to person. Only because of the natural loss of elasticity of the skin in itself, the abdominal wall will already become more feeble. Other influencing factors are figure, body weight (local or total fat deposits) and possible pregnancies with stretching of the vertical abdominal muscles.
In case of persons who have lost a lot of weight, a so called ‘fat apron’ might occur. In this case the stretched skin and subcutaneous fat tissue are hanging like a kind of apron on the abdomen.
Complaints about a changing abdominal wall contour differ. Sometimes shame is the biggest problem.
People might wrongly think the person is pregnant, one does not find fitting clothes or is ashamed in relation to the partner. Sometimes there are also mechanical drawbacks, clothes are too tight and the back hurts as a consequence of wrong stress on the lumbar muscles. In case of a ‘fat apron’, there might sometimes occur hygienic problems too, like for instance soiling of the skin in the abdominal wall fold.
An operative correction of the contour of the abdominal wall can not be considered as a possibility to lose weight. When suffering from overweight, it’s vital that one tries to reach a normal weight in other ways, because overweight enlarges the risk of complications and negatively influences the result after a tummy tuck.
There are several techniques to correct the abdominal wall. Usually, the choice of a specific technique of treatment is determined by the results of the physical examination. Important factors are skin elasticity, condition of and aspects of the vertical abdominal muscles and the extent of local fat deposits.
Liposculpture
Liposculpture is the most suitable treatment for persons with good skin elasticity, tight vertical abdominal muscles and local fat deposits in the lower part of the abdomen. After a local anaesthetic, fluid is injected in the areas to be treated and the excess local fat is aspirated with a tiny liposuction cannula. The operation takes approximately 45 to 60 minutes. The risks of this operation are minimal, post-operative complaints are rare and the recovery period is short. One can as well expect a positive result.
After the liposculpture, it’s advisable to wear a lipo-panty. This panty creates some pressure on the treated area so that bruising will be limited and a more even slimming-down of the treated area is ensured. This panty has to be worn for more or less 4 weeks.
Mini-abdominal wall plasty
Mini-abdominal wall plasty in combination with liposuction is the most suitable treatment for persons with a less good skin elasticity, less tight vertical abdominal muscles in the area under the bellybutton and persons with some local fat deposits. Through a crosswise incision in the abdomen (under the bikini-line), the skin and subcutaneous tissues are freed from the abdominal wall to the bellybutton. The two vertical abdominal muscles are pulled close together in the middle of the abdominal wall. Further on, the separated skin flap is tightly stretched down and sutured, after removing excess tissues.
This treatment might be combined with liposuction of local fat deposits in the higher part of the abdomen or side. The operation lasts approximately 60 to 75 minutes. This treatment has the advantage of being less radical than a total abdominal wall plasty, of leaving less scars and of having a rather fluent recovery.
Abdominal wall correction (Tummy tuck)
In case of a patient with a bad skin elasticity or stretched vertical abdominal muscles, a complete abdominal wall plasty is the most appropriate treatment. Through a crosswise incision under the bikini-line the skin and subcutaneous fat tissue are freed from the abdominal wall to the ribcage. The umbilicus is released from the abdominal skin and if necessary the two vertical abdominal muscles are tightly pulled together. Then the excess tissue is removed and the wound is sutured. Finally, the belly button is sutured in the tight abdomen. Therefore a round hole is made in the abdominal skin.
The operation takes approximately 90 to 120 minutes. This operation might be combined with liposuction of local fat deposits in the same area. After an abdominal wall plasty, one gets a special corset and must stay in bed for one or more days with slightly angled legs to decrease tension on the wound. It’s advisable to wear this corset for the next 4 to 6 weeks, until the vertical abdominal muscles are tightly pulled together.
Furthermore, drain tubes are left in the wound to drain away excess wound fluid and blood from the wound. The average stay of these drains is three to five days.
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Possible complications
After a liposuction, one can expect some bruising. Strong bruising occasionally occurs and wound infection is rather unusual. Strong bruising is the most usual complication after an abdominal wall plasty, local wound infection is more common (5 to 7 %). Small healing disturbances of the wound, without severe consequences, occur as well.
After 6 to 12 weeks the final result is visible. Little differences in the thickness of the remaining subcutaneous tissue might be created. The prick holes of the liposuction procedure will be hardly visible, like a small scar. After an abdominal wall plasty the abdomen is normally flat. Right after the operation, the horizontal scar in the abdomen will generally become wider, and sometimes thick and red as well. This scar will smooth and fade but usually stays conspicuous.
The scar around the umbilicus is mostly inconspicuous. It’s vital to regularly treat the scars with a skin cream and to massage them for some months to make the scars supple. Because the skin is freed over a big region of the abdomen, the feel in the abdominal skin will temporarily disappear. This causes a strange feeling when touched, but it will largely recover, as months go by.
An abdominal wall correction is not an appropriate treatment to obesity. Those who have overweight should slim first.
The result of the procedure will then be more beautiful and more satisfying.
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