Abdominoplasty

There are several types of abdominoplasty, each tailored to address specific concerns and goals. Dr. Demirkan will help you choose the most appropriate type depending on factors like the extent of skin laxity and its three-dimensional distribution around your trunk, the amount of fat deposition above and below the umbilicus and in the waistline, and whether you need a concomitant breast procedure or liposuction as well.

This is the most common type of abdominoplasty. It involves a somewhat elliptical incision made from hip to hip, between the pubis and the belly button, allowing for the removal of excess skin and fat from this region. The belly button is incised and its origin is left intact. Striae, which are commonly located within this region, will be excised.

The abdominal muscles might be tightened in the midline, providing a spontaneous toning of the abdomen and a reduction in the waist circumference. The closure of the abdominal defect is performed by first undermining the skin in the upper part of the belly button (the blue areas in the left illustration) and then pulling it down. After this redraping of the upper abdominal skin, a new belly button hole is opened at the level of the navel and it is brought out for repositioning.

This procedure is suitable for patients with significant excess skin and fat only in the upper and lower abdomen. It can be combined with vaser liposuction of the upper abdomen and waist.

A mini abdominoplasty is a less extensive version of the classical tummy tuck. It involves a smaller elliptic excision, typically just above the pubic area, and focuses on laxity concerns in the lower abdomen, which become manifest in sitting or leaning-forward positions. The skin undermining (blue shaded area) is limited, as well as the resultant length of the scar, leading to a quick recovery.

The belly button location is not changed; therefore the vertical dimension of the resection is limited to prevent downward dislocation and hooding of the navel. If there is an associated muscle laxity, the umbilicus may just be separated from the skin, dissection may be extended up to the chest and an endoscopic muscle plication may be performed, after which the umbilicus is sutured back to its original location.

This procedure is designed to address sagging of the upper abdominal area with minimal or no laxity in the lower part. In such cases a classical abdominoplasty is not possible, as the total laxity in the abdominal wall is not enough to close the defect resulting from the large resection it requires. A mini abdominoplasty is also not possible in these cases, as the tightening effect of a mini abdominoplasty does not extend above the belly button.

In a reverse abdominoplasty, the incision is made in the natural crease below the breasts. A limited skin undermining (area in blue shadow) is performed downwards, and then the skin is pulled upwards and the excess part is excised. It is less common than other abdominoplasty types and is typically combined with other procedures like breast lifts. In some cases the closure scar may traverse the midline, and this might be a nuisance if it is not covered by the breasts.

An extended abdominoplasty is suitable for patients with excess skin and fat extending around the sides and on top of the thighs. It involves a longer incision, often encircling the hips, allowing for removal of more tissue from the upper part of the lateral thighs. The major benefit of this procedure is that it does not only tighten the abdomen but also lifts the outer upper thighs. Muscle plication in the ventral region may be performed if required. This procedure is often chosen by individuals who have undergone significant weight loss and upper thigh liposuction.

A belt lipectomy, similar to a lower body lift, is an extensive procedure designed to address the entire midsection, including the abdomen, waist and lower back. It involves a circumferential incision around the waistline. It is often chosen by patients who have lost a substantial amount of weight and have excess skin throughout their midsection, but not in the buttock region. Muscle plication and other maneuvers of the classical abdominoplasty are performed when necessary. This procedure requires turning over the patient during surgery. It may be combined with liposuction. The recovery period is longer.

The 360 lift is an extensive procedure which aims to combine a belt lipectomy with a gluteal lift. It is required in cases with extensive weight loss and skin laxity involving the gluteal region as well. In these cases, there is too much skin and comparatively less subcutaneous fat left in the gluteal region. A regular skin excision in that area may cause a flattening of the buttocks. Therefore, preservation of the fat underlying the excised skin is an essential step (as seen in the lower left illustration). These fat flaps are then used as an auto-implant to augment the gluteal projection.

The design and use of this fat flap may show variations between surgeons. A liposuction to slim the waistline and back area is also usually required. The recovery period needs controlled sitting and torso straightening to decrease the tension exerted on the 360-degree circumferential suture line.

This variation of abdominoplasty is often recommended for patients who have experienced massive weight loss and have skin laxity not only in the vertical direction but in the horizontal axis of the torso as well. None of the above procedures will be adequate without excising a significant amount of skin vertically from the upper abdomen. The resected skin, or its defect, will look like a lily as in the French heraldry (fleur-de-lis). The closure will look like a “T” or “anchor” shape. Fleur-de-Lis abdominoplasty allows for significant removal of excess skin both horizontally and vertically.