Q: Dr. Eppley, I was in your office a few weeks ago originally for a consultation about liposuction. However after speaking with you, you informed my that the best procedure for my goals would be the extended male tummy tuck. I’m still considering this procedure however, I’m getting a bit nervous as while I have had surgical procedures before, this would be the very first one that is considered “elective”. While I have a few more questions about this procedure and your practice.
I’m not sure if I should email you these questions or if I should schedule an appointment to meet with you. Therefore, I figured I would try email first and if you recommend me coming in, I’m willing to do that as well. Please see the below:
1. I was looking through your website and while I see some of the procedures you have done with respects to this procedure with women, I didn’t see any regarding men. Are there significant differences between performing this procedure on men then women? Also, if I can ask, how many of these procedures have you performed on men?
2. What would be my realistic outcome should I have this procedure done? I realize that you would have to remember speaking with me regarding this question. However, in the event you do I figured I would ask in this email. I have looked online and have seen many success stories regarding this procedure. However, I have also seen many not so successful stories where the outcome had’t met the patients expectations.
A: In answer to your questions:
1) About one-third of extended tummy tucks that are done (usually due to weight loss) are in men. I have done many. What prospective patients fail to appreciate about any plastic surgery website is that any photos shown are just a small fraction of what has been done and are only there to provide a general idea of the procedure. Also plastic surgeons can only post pictures that patients will allow to be posted and that is often a very low percentage of patients…men are the most restrictive in this regard.
2) There is nothing in men that make any form of a tummy tuck harder than in women.
3) Every tummy tuck patient, men or women, achieves great improvement. I don’t ever recall any patient that has ever said it was not worth it or did not have significant improvement. This is particularly true in weight loss patients who have no other mechanism to get rid of their resultant loose skin or tissues. That being said, that does not mean that in some cases a secondary revision may be done to help some solve residual issues (e.g., dog ears, scars, contour asymmetry) No plastic surgery procedure, particularly one that covers such a large surface area, ever produces a perfect result. Whether any remaining or more minor aesthetic issues are bothersome enough for the patient to undergo a touch up or revision procedure will vary for each patient.
Dr. Barry Eppley
Q: Dr. Eppley, I have recently lost 100 pounds. I still want to loose another 50 pounds but would like to get some information about doing an extreme tummy tuck since my skin and fat hang by my mid thighs. I would also like to get information about a breast lift.
A: Thank you for your inquiry. Congratulations on your success at such a significant amount of weight loss. I would agree that you should maximize your weight loss before any body contouring surgery is done to get the best benefit from the procedure. It his likely that the next 50 lbs will be harder to lose than the last 100lbs but the effort will still be worth it.
Anytime a female loses more than 75lbs there are always going to be the sequelae of loose redundant skin on the abdomen and waistline and the development of breast sagging. While weight loss causes the reduction of fat, no skin is lost and how much skin redundancy remains depends on its natural elasticity and its ability to contract which is often very poor. (men do much better in this regard with large amounts of weight loss) In the extreme weight loss patient, a standard type of tummy tuck is always inadequate so you are correct in that an ‘extreme tummy tuck’ is needed. At the least this is an extended tummy tuck but may be a flour-de-lis type of even a circumferential body lift to create the greatest degree of redundant tissue removal. I would need to see smoke pictures to provide you with a more accurate answer as to the type of tummy tuck you need. For the breasts, the vast majority of time one needs a full or anchor style breast lift. Whether implants would be needed to restore volume is the only issue to be determined.
Dr. Barry Eppley
Q: Dr. Eppley, I am researching tummy tuck surgery and trying to see what can be done for me. I have attached pictures to help you see my severe abdominal overhang problem. I would like your professional opinion on which course of action would be best.
A: It is important to realize that there are different kinds of tummy tuck surgeries depending on the nature of the abdominal problem. While traditionally divided into a mini and full tummy tuck, that historic classification by today’s methods is too simplistic. I divide tummy tuck surgery into six different types and levels which vary based on the amount of tissue removed, the location and extend of the incisions and whether liposuction plays an additive role in improving the result.
There is no question you would get tremendous benefit by an extended tummy tuck. (level 5) This is a tummy tuck where the removal of excess tissue wraps around the side of the waistline or encompasses about 300 degrees around the waistline. (it does not cross the midline in the back like a full circumferential body lift does) If you do not chase the excess skin around the waistline (a traditional or level 3/4 tummy tuck stops at the hip bones) you will be left with big dog ears of skin and protruding tissue over the hips. In addition, it is important in any tummy tuck particularly when there is an overhanging abdominal pannus (apron) that a simultaneous pubic lift be done. This is often overlooked because it is hidden underneath the pannus but will become unmasked when the pannus is removed. Thus the excisional pattern of the tummy tuck should incorporate the design of a simultaneous pubic lift in its pattern. I have attached some picture showing a before and after an extended tummy tuck with a pubic lift. Note that the resultant tummy tuck scars wraps almost completely around the waistline.
Dr. Barry Eppley
Q: Dr. Eppley, I had gastric bypass six years ago and lost over 100 lbs. My weight went down from 324 lbs to 205 lbs and has remained stable for the last three years. While I am not small by any means, I am comfortable with my body where it is now. I will never be less than a size 14 but that is okay. It is just that I need to get rid of this inner tube around my waistline as it is heavy and interferes with a lot of activities and the wearing of clothes. My question is what type of tummy tuck do I need? Would a body lift be better than a tummy tuck? I have attached some pictures that show my unholy inner tube.
A: Losing a lot of weight always create a frontal pannus and skin excess that extends around the waistline and into the back. The fundamental difference and question to consider between an extended tummy tuck and body lift is your concern about the buttock area and any sagging that it may have developed. A body lift involves a 360 degree excision of tissue around the waistline and its effect is essentially like ‘pulling up one’s pants’. Based on your pictures, I would say that I see little benefit to the addition of an excisional area completely around your back. When it comes to incisional length and location, the more relevant issue is whether your extended tummy tuck should include a vertical component in the front, known as the fleur-de-lis type tummy tuck. This adds the extra dimension of pulling in your sides more by a vertical tightening down the middle. This would produce for you more benefit in my opinion than anything done in your back/buttock area.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in some form of a tummy tuck. I am 42 years old, totally done with babies, 5’6” and my highest weight was 235 (pregnant) and I’m down to 150lbs and has been that weight for over a year. I’m trying to come down 10 more lbs. Should I get down 10lbs more before I have surgery? If I do the surgery, will I be okay to lose 10 more and possibly work off that top fullness, or will it look lose again? I go to the gym three to four days a week and I’ve been working really hard for a really long time. It’s getting the point where I’m starting to get really discouraged, because the more I lose, the worst my stomach looks. 🙁 I have attached pictures of my stomach from all sides. I did try to get the best photos possible (I am attaching a back view—just in case) since I’m not sure if I need an extended tummy tuck or the body lift. Do you think I need it or will the extended TT will be sufficient? I mean, obviously the hanging belly is the biggest issue, but I really want a good contour. I am also very self-conscious about my mons area, and hope it will get pulled up (maybe a tiny bit of lipo on it?) in the process. (It’s totally embarrassing!) Will that happen? I really like how your previous patient (2nd attachment–tummy tuck after) turned out—the scar symmetry, the low profile, and how the mons area looks. I also have attached another photo from the web that I thought looked similar to me in the before photos. Do you think I could achieve a result like that?
A: Your pictures were great and show exactly what you need. You definitely do not need a body lift and just a bit of an extend tummy tuck. Your mons will be liposuctioned and lift at the same time as the tummy tuck. Whether any patient can achieve the result that another patient obtained can not be precisely predicted. But if you look similar before surgery, then a similar result may be possible.
If you are within 10 to 15lbs of your weight goal, there is no reason to lose any more. The surgery process will take care of that weight. (what is removed during surgery and the weight loss after surgery during the recovery)
Dr. Barry Eppley