Posts Tagged ‘tummy tuck’
Monday, January 16th, 2012
Q: Dr. Eppley, I am a 32 year old African-American female who is in need of a serious tummy tuck. I have had three children, the last two by c-section. I have a large amount of lower stomach skin with a lot of stretch marks. It makes my belly button look odd and almost buried with the loose skin around it. If I get a tummy tuck will they be able use my c-section scar? I need a tummy tuck so bad that if I had to have a new scar above the c-section scar I could live with it. But I would like if possible to keep it low and just have a longer c-section scar.
A: This is a common question and concern and one I think about when doing a tummy tuck in every women that has a c-section scar. I always want to use the c-section scar whenever possible for two reasons. The first is the one which concerns you and that of the unsavory cosmetic issue of adding another scar to the one you already have. But a more important consideration, and the one that I am most concerned with, is the survival of the skin between the two scars if the c-section scar could not be used as part of the tummy tuck. The intervening skin between these two scars may not have a good blood supply and could either not heal well or actually die…which would obviously create a significant after surgery complication. For this reason every effort is made to use a c-section scar in a tummy tuck and if you have as much loose skin as you describe this would not be a problem to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: c-section scar, dr barry eppley, indianapolis, tummy tuck
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Monday, December 26th, 2011
Q: Dr. Eppley, I have had several children and am wanting to get my stomach back in shape. I am only 26 years old and I don’t want to live the rest of my life with this stomach. I am too young for that! My question is what will happen to my pubic area after a tummy tuck. I noticed that it got bigger after having children and I would like to see that area flatter as well. Will it be taken care of if I get a tummy tuck? Also I have love handles that I would like to get rid of as well. Will a tummy tuck get rid of those as well?
A: A tummy tuck will only solve the problems that lie within its zone of tissue excision. When looking at the markings of a tummy tuck, you will see that the love handles and the pubic area lies outside the excision zone. However, the addition of flank liposuction is a part of most tummy tucks with the recognition that the goal is an extended waistline reshaping that wraps around to the back. Pubic or mons reduction, if needed, can be incorporated as part of the tummy tuck procedure whether it is reduced with liposuction or it is lifted as part of the tummy tuck design. You can see in planning a tummy tuck that the entire area must be taken into consideration to get the best overall result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, love handle liposuction, mons lift, pubic reduction, tummy tuck
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Monday, December 19th, 2011
Q: Dr. Eppley, I am a 22 year old female who is 5’6″ and weighs 165 lbs. I used to weigh 220lbs. I seem to be at a plateau for weight loss over the past year of which I am comfortable with that. But I have a remaining overhanging stomach pouch (I think it is called a pannus ??) that has not really gone away that much with the weight loss. It has gotten less full but now hangs down more. I have very large breasts and thick thighs and butt so I know I will never be tiny, but I would like my overhang gone and to have a flatter stomach area. Should I get liposuction or have a tummy tuck?
A: This is classic question posed by many patients who have some amount of a stomach overhang. By definition, the description of an overhang signifies that there is a skin excess problem as well as too much fat. Liposuction alone will only magnify the prior result of what weight loss has done, it will deflate the overhang (aka pannus) further but it will still leave a flap of skin. You need this cut off by a tummy tuck. Liposuction is only useful in your case when combined with a tummy tuck, as it may help contour the waistline better to the sides where the tummy tuck excision does not go.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction, tummy tuck
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Sunday, December 11th, 2011
Q: Dear Dr. Eppley, I am 32 years old and two years ago I weighed 220 pounds. By diet and exercise, I have been able to get down to 170 lbs and I seem to be stuck at this weight now. It won’t budge no matter what I do. The skin on my stomach is very loose and I have old stretch marks that I want removed. I want a tummy tuck but do I need to lose more weight before having surgery?
A: Your question is both a good and a common one. While many people have been successful with a fair degree of weight loss, they sooner or later ‘hit the wall’ and can just not lose anymore. Ideally, I tell my patients that if you are within 15 to 20 lbs of the weight they desire then a tummy tuck is reasonable. If you weigh much more than that then you should wait until you lose the extra weight so you do not create loose skin after surgery should you undergo more weight loss. Realistically, however, once the weight wall is hit for most people that is as far as they will usually get so that has to be taken into consideration. Most patients that I see for tummy tucks appear when they are frustrated with their ongoing lack of weight loss results. You should also understand that only the stretch marks from your belly button to you pubic hair line will be removed. Any stretch marks above the navel will still be present after surgery, they will just be moved lower to a new position below the belly button.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tummy tuck, weight loss before a tummy tuck
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Monday, December 5th, 2011
Q: I am 28 years old and I have lost about 95 pounds over the past year and a half. While I am very happy with my weight loss, I now have.a bit of loose skin around my stomach area. I work out a lot and do a lot of core work and abdominal crunches but this loose skin won’t go away. Is there some type of cream or device that will tighten this skin or do I need plastic surgery?
A: You are to be congratulated on your weight loss efforts and results. Reduction of fat can be rewarded with diet and exercise but your loose abdominal skin will not. Skin is not metabolically responsive like fat nor can it be toned like muscle. Do not waste your money and hopes on miracles in a jar or an exercise device. Only the manufacturer will benefit from your purchase. You will need to consider some form of a tummy tuck to get rid of this loose skin and tighten your abdomen. Whether the scar and the surgery expense is worth it merits a thorough discussion with a board-certified plastic surgeon.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tummy tuck
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Tuesday, November 29th, 2011
Q: I have a big overhanging belly that I want to get rid off. I have two small children and have lost over 30 lbs since my last one but the sagging belly persists. Will exercise be enough or do you think I need a tummy tuck?
A: While I have not seen a picture of you, your description alone of your belly has already answered the question. The idea of an overhang suggests a lot of loose abdominal skin. If some weight loss has not made a difference in its size, then you know exercise is not the final answer. Undoubtably some form of a tummy tuck is what you need. You can’t exercise off loose skin no matter how hard you try. Just ask any gastric bypass patient who undergo a lot more weight loss than you have. This is a surgical problem. When it comes to exercise and weight loss, however, I would recommend that you get in the best shape as possible for a tummy tuck. Preparing for such surgery, like training for an athletic event, will have you recover faster and may also help you achieve a better result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, overhanging belly, tummy tuck
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Monday, September 5th, 2011
Q: Dr. Eppley, I am interested in getting rid of my lower abdominal pooch. The skin has some stretch marks which become really apparent when I lean over. The wrinkly skin really sags when I do this and it is very unattractive. I am wondering if I can just exercise this area away (my husband says I can) or whether this needs liposuction to make it better. (which I think it does) What are your thoughts?
A: Many women, who are not overweight, have developed a little pooch in their lower abdomen between their belly button and their pubis. Its relatively small size suggests that it is a non-surgical problem that can be exercised away. Usually I see women who come in after they have proven to themselves that they can not get rid of it on their own. Your wrinkled skin that sags when you bend over is the key in answering the question of whether this is a surgical or non-surgical problem. This tells you that there is too much skin and it will not shrink down on its own. Excess skin most certainly can not be exercised away. The only real solution is that of some form of a tummy tuck, particularly if you are using the criteria of how it looks when you bend over. Stretch marks are a sign that the elasticity of the skin has been destroyed and no recoil or shrinkage of it can occur. Only surgical removal will solve this loose saggy skin condition.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tummy tuck
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Monday, August 8th, 2011
The stomach area is the number one region that almost all women, and some men, would like to improve. Many have discovered, however, that improving that body area is not as easy as one would like. Many people work hard at it but eventually ‘hit the wall’, get frustrated and may even quit their diet and exercise routinue with no more changes are seen. But the fault may not be your own. Loose stomach skin and fatty bulges at the waistline from pregnancy or significant weight loss are not amenable to internal calorie or fat burning. This brings some to the conclusion that the only way to a more shapely torso is a surgical one.
Everyone knows that a tummy tuck is the removal of skin and fat with muscle tightening to get a flatter stomach and better waistline. While it is almost always a very satisfying procedure, and many patients say afterwards they wish they had done it sooner, it is major surgery and is not just a weekend recovery. When considering a tummy tuck, be aware of the following considerations.
There are two basic types of tummy tucks. If your excess skin and fat is mostly located below the belly button, you may do just fine with a mini tummy tuck. Because the skin and fat removal is done below the belly button, there is a shorter incision that can be placed very low and the belly button is not moved. There is also a slightly shorter recovery with emphasis on the word ‘slightly’. If the loose skin and stretch marks are above the belly button, only a full tummy tuck will do. With that comes a longer scar, a bellybutton scar and a longer recovery.
I have seen recent treatment approaches, particularly online, that tout a ‘scar-free tummy tuck’. There is no such thing and this is just marketing spin to say they are offering stomach liposuction. That raises a question that many people would like to pursue…liposuction instead of a tummy tuck for their flabby and sagging stomachs. That has become a popular request, particularly since Smartlipo (laser liposuction) technology has become available. While it is true that Smartlipo does have some skin tightening ability, it is quantitatively different than what many people need. Smartlipo tightens skin as measured in millimeters, most people need stomach skin tightening as measured in centimeters. With this understanding, it is easy to see that liposuction is not a substitute for a tummy tuck.
Liposuction, however, is very often a part of a tummy tuck. But it isn’t necessarily used to make the tummy part looking better. It is used to shape the areas outside of where the effects of the tummy tuck occur…the outer waistline and back. (i.e. muffin tops) A tummy tuck alone is a 180 degree or frontal torso change. By adding waistline and back contouring with liposuction, the results becomes more of a 270 degree torso change.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, smartlipo, tummy tuck
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Monday, May 30th, 2011
Q: I am in need of an abdominal panniculectomy but my insurance has denied me saying it is cosmetic. They denied me saying it is not medically necessary because it is not preventing me from being functional. I have plenty of documentation with all my medical care providers in support of this need. What can I do?
A: The request for abdominal panniculectomies , or an amputation of overhanging abdominal skin and fat, from insurance companies is very common. As a result, they have a very specific set of criteria to be eligible for coverage. These typically include the following; a pannus that hangs down onto the thighs (photographs are required), a documented history of recurrent skin infections underneath the pannus that requires topical medications, and a six month history of these recurring skin infections that has failed non-surgical treatments.
If a proper predetermination has been done and the insurance company has denied it, then there is nothing you can do. You are legally entitled to an appeal of which they tell you how to do it on their denial paperwork. But once an appeal has been denied then that debate is over. The insurance company controls what they will pay for or won’t pay for. Their determination is based on their policy requirements and the determination of their medical director. They obviously have determined, no matter how unfair you think it may be, that your abdominal pannus does not qualify. Your only option is to have the procedure done on a cosmetic fee basis.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominal panniculectomy, dr barry eppley, indianapolis, insurance coverage for abdominal panniculectomies, tummy tuck
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Saturday, May 7th, 2011
Q: I’m 46 years old. I have a spare tire around my middle. I don’t want to lose weight because I end up losing my breast and butt. What procedure do you recommend?
A: When someone has a ‘spare tire’ around their middle, they could be referring to two basic types of waistline problems. The first would be fat only. They have thickness around the middle and waistline due to a fat collection but there is no loose or overhanging skin. The other problem is one in which there is both too much fat but with excess skin as well. Each requires a different solution. The fat only problem is treated by liposuction of which Smartlipo (laser liposuction) is my current choice. For a fat and skin problem, a tummy tuck or an abdominoplasty is needed. Often liposuction must be added to the tummy tuck to get those muffin tops which wrap around the sides of the waistline into the back.
You are correct in assuming that some surgical intervention is needed if you are not willing to try some weight loss efforts. Such ’spot’ body contouring changes require surgical treatrment.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tummy tuck, waistline liposuction
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