Abdominal plastic surgery

Abdominal plastic surgery (Abdominal dermolipectomy)
Through physical exercise and weight control, it is searched the ideal of a toned and defined abdomen, but sometimes, these efforts are not enough to achieve the goals. Besides body fat, people with normal weight and body proportions can also develop a flaccid and prominent abdomen. Pregnancy, aging, weight oscillations and hereditary factors can influence this issue. The abdominal dermolipectomy is a surgical procedure that consists on removing excess skin and fat from the lower region of the navel, as well as the remodeling of the abdominal outline through the reapproximation of the muscles.

Simplifying, the skin region above the navel will reach the pubic area, eliminating all irregularities that were present in this space, such as stretch marks, scars, hernias, excess skin with stretch marks resulting from pregnancy and others.

Who is it indicated to?
Besides the aesthetic indication, there is an indication to increase the abdominal press, repair of large incisional hernias and decrease the effect that large abdomen volumes exerts on the spine.

The ideal for the procedure is that the patient is with the correct weight and had already had the planned children. This does not mean that the patient is prevented from getting pregnant again, but the gynecologist will advise you about the convenience or not of a new pregnancy. The result can be preserved if the weight is controlled by one expert.

It is important to remember that abdominoplasty surgery is not a substitute to weight loss or the appropriate program of physical exercise. Furthermore, the abdominoplasty does not correct stretch marks, although they may be removed or slightly made better if they are located in additional skin areas that will be removed, in general, the treated areas below the navel.

Preoperative
In the preoperative, you must::
- Communicate with us until 2 days before the surgery in case of flu, ailment or other pains and illnesses;
- Hospitalize yourself in the indicated hospital respecting the recommended time;
- Avoid painted fingernails on the surgery day and taking jewelry to the hospital;
- Avoid alcoholic beverages or heavy meals on the surgery eve;
- Avoid any medicine with aspirin basis and to lose weight that eventually is being taken for a 10 days period before the surgery. Communicate the doctor if any medicine is being taken regularly;
- Provide in anticipation the acquisition of a tight abdominal modeling girdle.

Anesthesia
The anesthesia used is usually performed by an anesthesiologist. It can be opted for epidural anesthesia with sedation if the case requires.

Hospitalization
Most of the time, the patient is hospitalized on the day of the surgery, in the morning and discharged on the next day. Eventually, the patient can be discharged on the same day.

Based on texts by SBCP.

Operation
The average duration of the surgery is approximately from 2 to 3 hours. The first part of the operation consists on the dislocation of all the skin and fat from the muscle layer from the pubis area to the stomach height. The navel will be kept in the same place, and only cut in its circumference, and then transplanted to the surface on its projection, resulting in a circular scar around it. The abdomen musculature is approximated through the stitches, which is going to allow a waist reduction in most cases. Subsequently, the removal of skin and fat excess is performed, joining the highest part of the cut with the bottom, resulting in a horizontal scar above the pubic hair and laterally.

The complete procedure of abdominoplasty surgery requires a guided horizontal incision in the area between the line of the pubis and navel. The shape and length of the incision will be determined by the degree of correction necessary. Through this incision, weakened abdominal muscles are repaired and sutured, while excess fat, tissue and skin are removed. A second incision around the navel may be necessary to remove the excess skin in the upper abdomen.

Postoperative
The post-operative stage is characterized by requiring moderation in relation to body mobilization, especially in the first 2 or 3 days. This does not mean it is a painful recovery. In normal evolution, the recovery is practically painless and, at most, presents a feeling of discomfort mainly in the back.

It is important to wear a truss or abdominal modeling girdle, which will be worn for a period of at least 30 days. It helps to decrease the swelling that is common in the immediate period and helps healing.

Caution
In the postoperative, the necessary caution:
- Have relative rest on the first 2 days;
- Avoid excessive and harsh mobilization of the body especially on the first 7 days;
- Do not wet the navel dressings for 15 days;
- Walking with a slight bending of the body on the first four days;
- Keep with normal feeding. Wait for dieting or loss of weight regime after the medical release. Your anticipation may determine hard consequences to resolve.

Scar
The resulting scar from the abdominal plastic surgery is located horizontally on a line passing just above the pubic hair, extending laterally to a larger or smaller extension, depending on the abdominal volume and what will be corrected. This scar is planned to be hidden under bathing suits, and it will basically depend on the extension degree of the scar and on the degree of the problem. Also, around the navel will remain a scar. This, for being circular, in some cases may not be the desired one having, as a result, an artificial appearance. It is subject of correction by “retouch” under local anesthesia after a few months.

Scar stages:
1. Immediate period: until 30 days and is presented with excellent aspect and barely visible. Some cases have little reaction to the dressing.
2. Mediate period: From 1 to 12 months. There will be a natural spacing of the scar, as well as color changing going from red to brown, which gradually will lighten. This is the period that most worries the patients, but is part of the natural healing process.
3. Late period: After 12 and until 18 months. The scar starts to become clearer and less consistent, reaching its final aspect. Any evaluation of the definite result of the surgery should be performed after this period.

In summary, the abdominoplasty procedure will result in an abdominal outline, smoother and toned, becoming more proportional to your body type and weight. The final results may first become obscured by swelling and will have oscillation of the edema for 6 months.

Important: Important: Do not rely on information from well-meaning friends. Get the necessary information directly from the doctor and you will avoid having doubts and anxiety in the postoperative period.

I consider the abdominal dermolipectomy a surgical approach highly resolutive, because it treats the skin excess, fat, adjusts the muscles and “stretches” the entire abdomen.
The biggest challenge is to ensure that the patient has no stigma, that is, we focus a lot on the abdominal outline, on the resulting scar (which has to be hidden in the bikini mark and be uniform, linear and thin) and, especially, in the aspect of the navel, which has to have its natural deflection and no apparent scar (these are the biggest challenges of this surgery).
It is considered a boring postoperative surgery, especially for being in the area of the trunk, which is where there is greater mobilization, with long recovery period. However, nowadays, in addition to ensure safety and results, our effort has been made to allow a recovery with no traumas and fast, in which we guide the patient to mobilize since the day of the surgery and only be in bed at sleeping time. On the rest of the time, the patient should make an effort to act as routine, walking and moving as much as possible (within its limitations, of course).
From the 3rd to 4th days, it is released to stretch out completely, because the surgery will be structured to do so. This, in addition to allow a faster recovery and with less discomfort, strengthen the prevention of thrombus-embolic phenomena, which is our main concern on the current days.

In general, we associate this procedure to a liposuction of the lateral regions to the abdomen (flank) which is an important complement to a better outline. The surgery lasts an average from 2 to 3 hours and a half hours, depending on the extension and association with liposuction, performed under general anesthesia and with discharging scheduled to the end of the same day or on the next day. The patient is released to drive after 4 to 7 days from the surgery, depending on the individual conditions.