Dr. Renato Calabria Explains Common Abdominoplasty Mistakes and His Tips for Success
The topic of today is abdominal contouring and, in particular, abdominoplasty. Again, abdominoplasty is a very common procedure, and it’s done very frequently. But, there are some tricks that I implement when I plan to do an abdominoplasty that makes a big difference.
Again, it seems an easy operation, but if you want to do it well, it takes a lot of hard work in order to do it. I’m going to present first the case; then, I’m going to talk about common mistakes that plastic surgeons make when they perform the operation and all the tricks that I use to maximize the results.
Again, there are many ways to do abdominoplasty, but there is only one way to do it well.
So, here is the patient, a 29-year-old female who had an early pregnancy and was left with a lot of loose skin. I’m going to show you the picture first. This is the three-quarter view. You can see there is some diastasis of the muscle, which means the muscle is relaxed. This is a very important view that pretty much shows you how much muscle relaxation there is, and again, here we are with a different view, you can appreciate how much loose skin there is. So, it’s a lot. And here is the patient making fun of her loose skin and showing you really how much loose skin there is.
So, let’s start focusing on the details of the pre-planning of the surgery, so you can appreciate how much different it is from other techniques that plastic surgeons use.
One of the most important parts of the entire procedure is planning for it. Now, abdominoplasty is one of those operations that seems to be easy, and then the details make the operation truly successful.
Let’s start with the common mistake that plastic surgeons do: it’s to place the incision too high on the abdomen. So, what happens is, when the skin is pulled, the incision ends up in this area here, and it shows.
Also, the other mistake is to take it too far up, and then you cannot wear a low-cut bikini.
So, the most important thing is where the incision is going to be, and that is the main concern for the patient, for the incision to be very very inconspicuous.
So with different planning, the incision in my planning is done very low, very low, just above the pubic hair, and is extended laterally, but still in a place where it can be hidden in a low-cut bikini. Even if it has to be extended up, it is still a low-cut incision.
Another obvious problem that happened is that patients and plastic surgeons don’t address the area of the pubic area, which is usually relaxed and, sometimes — not in this case though — has some fat present in here. So it’s important to de-fat this area here and move it up as well to give a pubic area a very youthful appearance.
So, again, the incision, its placement, is probably the most common mistake that plastic surgeons make, and a well-placed incision and a well-sutured incision will leave the patient with a very nice scar, and you are able to wear a low-cut bikini with impunity.
The second mistake plastic surgeons do, some of them, is that there is a fair laxity of the skin in this area here too.
So, when I do the surgery, I come up all the way to the subcostal margin here and release the entire skin all the way up to this area here. A lot of times patients are left with relaxed skin in this area here, and this is due to the fact that the plastic surgeon was too conservative and they released only up to this area here and left a bunched-up area here, so that’s a common mistake.
So, a wide undermining of the skin all the way laterally, all the way here, and in this area here, it’s the key for success. So, it takes time and a lot of finesse, but it’s a key to success. It’s like when you make a bed in the morning, you want to stretch your sheets widely in order to get all the folds out.
Now, the third mistake is that there is a lot of muscle that is loose in the periumbilical and in the central area. So the muscle, its rectus muscle, runs laterally in this shape here. This is the muscle on one side, it’s a rectus muscle, and this is the muscle on the other side right here. Now, very often with pregnancy, the muscle relaxes and there is an area centrally that is called diastasis of the rectus, which is loose.
Now, it’s very important to tie this area together. Before pregnancy, the rectus muscle was more central, right here, and it was really tied together. So, what we want to do is bring back the muscle centrally and tie it with the two layers of suture right here, so that’s very important. That needs to be done in this area here, so we bring back the six bags you had before pregnancy.
The third thing, also it’s very important, after we release the skin, is to re-drape it properly. So, it means that we pull the skin down this direction, and we basically make a little incision around the belly button. The skin will pull back and this little incision ends up right in the part of the skin that needs to be removed, so it’s not visible.
Now, after we pull the skin up, and we have removed the excess of the skin, one of the most important thing that I do — and is very time-consuming, but it’s very important to give definition — is to place quilting suture, means sun sutures underneath the skin from the skin to the muscle, so basically we pull the skin back, and at the same time, we place these sutures underneath the skin all around, moving the skin down. So, the sutures are placed from the skin to the muscles. So, what they do— two things — is, one, they minimize that space that there is underneath, so you have less incidence of what we call seroma or fluid collection, which is one of the complication of surgery, and two, will give you much more definition of your abdomen, because it delineates much better than muscle.
Most of the doctors don’t do the suturing. It does take time, it’s time-consuming, takes about an half an hour later, or more, but again, most of the doctors just pull the skin, tighten it up here and an hour and a half they’re done with surgery, and that’s it. And I think it’s a big mistake. Again, abdominoplasty, it’s the finest operation and needs to be done properly. So, once the suture plays underneath the skin, we’re dealing with suturing the incision right here, and again, this has to be done perfectly in order to maximize the healing process. Another trick that I use is I pull more in this direction on the flanks. So, what is happening is, because of the tightening of the muscle underneath, you also improve the contour here. So, basically the contour here is tighter because the skin outside is looser too. So, lots of tricks that I use in the pre-op and during the operation that makes a huge difference in the success of the surgery itself. Now, let’s go to the before and after picture to show the result.
So, this is the before, and this is the after picture of this 29-year-old female who underwent a abdominoplasty with all the tricks and details that I showed you.
And again, you see there is massive skin relaxation and you can see the skin is so tight here you can appreciate how the internal abdominal contouring is improved with the muscle tightening and this internal suture, and also you can appreciate how low was the incision.
So when you wear low-cut jeans, you don’t see a scar. Again, this is the front view of the before and after picture. You can see how much contouring improvement has been achieved with the technique that I use, which is different, that other plastic surgeons use a lot more extra tricks to deliver a fantastic result. Again, the incision is placed very low so she can wear a low cut jean, which is very important, and again, the contouring that we obtain even at the flank area, it’s remarkable.
So, there are a lot of ways to do abdominoplasty, you can do a very detailed operation with a lot of tricks or do it in the wrong way, and end up with not very optimal results.