Reverse Tummy Tuck

Q: Dr. Eppley, I’m interested in a reverse tummy tuck, I’m at my goal weight and  I’m 48 years old. I’ve had previous liposuction to tummy, buttocks, and thighs.  I’m interested in just tightening the skin in my upper abs.  I do not want any liposuction as this has already caused uneven skin and a permanent wrinkle in my tummy.  I don’t need my muscles to be tightened as they are already pretty tight.  I just want to tighten the skin. When I pull the skin up under my breasts, it does miracles.  I am not looking for perfection.  Even if it protrudes a bit, I’m fine with it.  I just want to fix the uneven skin and the permanent wrinkle that is there.  

Can this be done with local anesthesia and twilight or IV sedation?  I have a real hard time with general anesthesia. Also, where do you tether the incision? The rib or the muscle?  To keep the scar from stretching or moving downward? Does the scar have to go across the breast bone?  Can it be just under the breasts?  I do have large breasts so they may hide the incisions which would be a bonus.  Again, I am not looking for total flatness.  Just get rid of the bumps or unevenness.

I’m also interested in skin removal from my buttocks and outer thighs.  I don’t want a Brazilian butt lift.  I don’t care if my butt is flat.  I have lost weight in my lifetime and gained and lost again.  This has left me with saggy skin and some dimples, maybe due to liposuction as well.  I don’t want liposuction in this area.  If you think it has to be done then that’s fine.  I just want some even skin with no dimples.  Can you suggest something for this area that I have not been able to find?  The only thing I can think of that would help is a skin removal/tightening.  If it can help my outer thighs then great.  Please see my photos.  I would also like this to  be done without general anesthesia.  Is this possible?  Can this be done the same time as the reverse tummy tuck.

A: Thank you for your inquiry and sending your pictures. As reverse tummy tucks go, you are about as perfect a candidate for it as I have seen. They are for women that have either had liposuction, a tummy tuck or weight loss where the tissues below the belly button are taut. But the skin above the belly button is loose and has some overhang exists onto the umbilicus. By simply pulling up on the abdominal skin a good improvement is seen. By definition a reverse tummy tuck is a more simpler form of a tummy tuck, does not involve muscle plication and is a skin excision only procedure.

The key in a reverse tiummy tuck is the incision location. I have done it either keeping the incisions limited to the inframammary folds or crossing the lower end of the sternum. When it crosses the sternum it produces a better skin lift/tightening (due to the central pull) but does have visible scar location in the very center. When the ellipitical skin excisions are limited to the inframammary folds, the effect is not quite as good but still apparent. One has to decide whether more upper abdominal skin tightening is worth the scar trade-off. The upper abdominal tissues are plicated to the fascia over the ribs at the inframammary fold level.

In regards to your buttocks and outer thighs, a partial solution exists. A lower buttock lift can tuck and tighten the lower buttocks through an elliptical excision along the infragluteal crease. It does flatten the lower buttocks a bit but this is not an issue for you as you have stated. The outer thighs is a more problematic area because any effective skin tightening/lift will create a visible scar that would only be an acceptable trade-off in the extreme weight loss patient.

As uncommon as reverse tummy tucks and lower buttock lifts are, they are not in my practice. I have performed them many times although their frequency is in the range of 3 to 4 per year for reverse tummy tucks  and 10 to 12 times per year for lower buttock lifts. Both can be performed under IV sedation although, because of the prone position and airway security, the lower buttock lift should be done under local anesthesia if one is not having general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana