Weight loss, pregnancy, effects of gravity, and age all result in stretching of the
abdominal wall. Skin, once over-stretched, has difficulty rebounding to its original
shape. The resulting redundant skin and underlying fat take on a loose "doughy"
texture forming major folds and wrinkles, often coupled with stretch marks.

How can this be corrected?

An abdominoplasty removes the loose skin, tightens the abdominal muscle wall,
and where possible, removes some of the stretch marks. Once the skin has
been over-stretched there is no other effective way of tightening it other than
removing the excess. This operation is not a weight reduction procedure;
therefore patients who desire an attractive result must lose excess fat prior to the
operation through weight loss or liposuction.

How is an Abdominoplasty performed?

There are several ways of doing this. The following is a method, which provides
the least amount of noticeable scarring. An incision is made across the lower
abdomen and groin creases just at the upper edge of the pubic hairline (see
diagram). The skin and fat are lifted from the underlying muscles up to the edge
of the ribs. The umbilicus is released from the surrounding skin and left attached
to the underlying muscles. If the abdominal muscles are lax, they can be
tightened at this time. The skin is pulled down (like a window shade) and the
excess skin and fat is removed. Usually most of the skin from the level of the
umbilicus to the pubic hair can be removed as the skin previously above the
umbilicus is now stretched across the entire abdomen. The incision is then sewn
up as a transverse scar running across the lower abdomen, and the umbilicus is
brought through a second small incision. Drains may be used and removed in
the following days.

The Recovery Period

After the day-care surgery the patient at home needs to keep the hips flexed for
several days to avoid undue tension on the wound. The wound generally heals in
2-3 weeks. It is usually about a week before walking straightened up is
comfortable. There is a tight sensation to the abdominal wall for about one month
following surgery, and it takes one to two months for the patient to return to
normal activities. Similar to a hernia repair heavy lifting should be avoided for 6-8
weeks. Postoperative pain varies from patient to patient but is generally less than
most abdominal operations. Swelling of the lower abdomen will persist for several
months but will pass in time.

What about the Scars?

Scar tissue is the normal product of the body's healing process, so surgery is
not possible without scars. Incisions are planned, executed and closed with care
to promote optimal scarring. Post operative activity and wound care instructions
must be followed to promote healing. Individual natural healing characteristics are
the main factors in determining scar appearance.

The scar from an abdominoplasty tends to be quite a prominent type of scar. It
does fade over the course of a year, but will always be visible. It is, however, in
the "bikini line" so that it is easily covered. The umbilical scar usually is fairly
inconspicuous.

What are the more common complications?

The procedure requires a general anaesthetic and has the same risks of
complications of any anaesthetic. The most serious complication of anaesthesia,
which can occur, with any surgery is when blood clots form in the leg veins and
dislodge travelling to the heart or lungs. This is very rare but can be fatal.

Surgical risks of an abdominoplasty are similar to any other abdominal operation.
The exception here is that the abdominal cavity is generally not entered and
there should not be any direct effect on bowel function.

The basic mechanisms of infection, bleeding, and poor scar formation are
complications in any surgery. The blood supply to the abdominal skin is
decreased as skin is lifted and mobilized. Infrequently this is reduced to a level
where a portion of the skin fails to survive. These areas may open and take
longer to heal but will generally close over on their own. There is sometimes a
loss of feeling in the skin just above the pubic hairline. A portion of this tends to
be permanent.

The pubic hairline may be raised slightly. Fluid (old blood and/or serum) has a
tendency to collect under the incision line in some patients. This can be drawn
off with a syringe until it stops forming. Postoperative umbilical deformities are
noted by a limited number of patients and occasionally small excess skin-folds
form at the ends of the incisions. These can be corrected by a touch up
procedure.