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Q: Dr. Eppley, I am interested in pubic liposuction. I had a tummy tuck over ten years ago and my pubic area is rather puffy and i would like to get liposuction to remove the fat that completely sticks out on each side of the seam in my pants or it is disgusting in my bathing suit. I have an appointment with another plastic surgeon but I like all that you have said about this after tummy tuck problem so you seem to be experienced in what I am looking for.
A: It is very common after a tummy tuck that residual fullness of the pubic region is seen. This is because the fat content of the pubic region has not changed (tissue thickness) while what lies above it has. Since the narrowest portion of a tummy tuck is usually the scar line this makes the unaltered pubic region more evident after surgery. While many patients think that the pubic fullness is persistent swelling from the tummy tuck, this potential cause can be eliminated once one is six months after their tummy tuck. Pubic liposuction is the solution to the puffy mons and is tremendously effective at reducing its profile and making it flatter.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you do liposuction on the pubic area of a woman? The mons pubis I believe? I have attachments some photos of mine which is oversized tremendously. (as you can see in the attached pictures) How much would a procedure like this cost? How is it performed? What is the recovery?
A: It is very common to do liposuction on the mons area (pubic liposuction) and it can provide a significant reduction. However, your mons problem is going to require more than just liposuction due to the excess skin. You need a combined pubic lift to remove and tighten the loose mons skin that will result from it being deflated of fat at the time of the liposuction. Think of it as a reverse mini tummy with an incision in the skin fold at the upper end of the pubic region. This combined liposuction and lift of the mons area is technically know as a monsplasty. This is a one hour outpatient procedure done under general anesthesia. Its total cost is in the range of $4500. There is usually swelling and bruising of the pubic region and mild discomfort and it will take a full six weeks until the true final resut will be seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get a buried penis repair done. How exactly is it done?
A: When you use the term ‘buried penis’ that unfortunately does not tell me what type of tissue problem there is and what needs to be done to make it better. Is it a short penis only, an isolated large suprapubic mound, is there an abdominal overhang or some combination of two or all of them? There are different plastic surgery techniques that are done for the buried penis problem with varying degrees of success. These could include pubic liposuction, a pubic lift, penile release and lengthening or some combination of all of them. Having a picture of the pubic area, ideally from the front and side views, would help me understand the buried penis problem and give you some recommendations on whether plastic surgery would provide a positive improvement. (increased penile show)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 52 year-old male and am concerned after some weight loss that my lower abdomen is still fatty, and my pubis area is sagging. This is not exactly the look I want, what can I do? I have attached some pictures for your assessment from the front and the side.
A: Thank you for sending your pictures. What I see is mainly a pubic sag issue, not so much go an abdomen overhang. While there is some fat in the pubic area, an equal contributor to the problem is loose skin. Your options for improvement are either liposuction alone or liposuction combined with a pubic lift. A pubic lift, in essence, is really an inverted or reverse mini-abdominoplasty. It lifts the skin from above along the waistline.
There is also some abdominal fat, but no real excess skin that I can see. Thus liposuction of the abdominal area could be performed at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, It has been a year since my tummy tuck was done. I had a full spare tire removed and now I can finally fit into reasonable clothes again. I’m very happy with the results. However, I’ve noticed my pubic mound area seems to be bigger now and bulges out. Where the zipper is on my pants is really tight over this mound. My pants fit fine everywhere else on my waist and hips. But my pubic area now looks weird and puffy.
A: It is very common after very large tummy tucks or absominal panniculectomies to have loose skin and extra fat in the pubic area. The reality is that this pubic fullness was always there, it just never became apparent until the spare tire was removed. This this is not a new physical development just a new observable one to you. It is magnified because it sits below a more narrow waistline area abovhe it where the scar lies. This cane be very effectively flattened by pubic liposuction which may require a little bit of a pubic lift is there is any loose skin there.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can the pubic lift affect the nerve supply to the penis or interfere with erection in any way?
A: This is actually a common sexual function question whether it is liposuction or a lift in the pubic region. Men are concerned that it will affect erection while women are concerned that it may interfere with having an orgasm. While the pubic region is near the sexual organs of either gender, neither a pubic lift or pubic liposuction will interfere with their function. The nerves to the penis lie deep and way below the tissue planes for either procedure. While the female clitoris is just below the pubic fat pad, liposuction does not traumatize it even though there is the possibility of some temporary labial or clitoral swelling and bruising as gravity pulls down any blood released during the procedures. Conversely in a handful of cases, I have had reports that a pubic lift in women has enhanced orgasmic sensations which may be due to changing the exposure of the pubic area. For men, pubic reduction may improve penile exposure and length.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am 42 years old and had a tummy tuck two years ago after my third and final child. While I had some rather dramatic improvement and am pleases with the overall result, there is one area that still remains problematic. I have this persistent swelling between my tummy tuck scar and the pubic bone. It has never gone down completely and I don’t understand why. It sticks out in dresses and tight pants like a bulge and is a visible ledge if I try and wear a swimsuit. What can I do to get rid of this swelling?
A: What you have is not swelling and is a not uncommon finding for some patients after a tummy tuck. It is residual fat in the pubic mound area that is below the effect of a tummy tuck. The tummy tuck scar in most patients becomes the narrowest part of the waistline and can look like a constricting band above the puffy pubic mound. Sometimes this is recognized before the tummy tuck and its reduction by liposuction done at the same time. In others, it becomes obvious after a tummy tuck. It can be very effectively reduced with a small liposuction procedure. (pubic mound liposuction)
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I found your website while looking for other penises like my husbands. He is an overweight man of 37 and his penis is slightly hidden. referring to this article– http://exploreplasticsurgery.com/category/buried-penis/ I found you can do surgery to help his “show size”. He basically looks like the pictures within this article. He would not let me take pictures of his body. I hope you can still give me a price idea. Thanks!
A: Thank you for your inquiry. Without seeing some pictures of the problem, I can not even tell if it is improveable. As a plastic surgeon, what I can do for buried penises is to decrease the size of the surrounding suprapubic mound through liposuction or lift away overhanging skin that is contributing to penile concealment. Often times both have to be done to get the best result. But many concealed or hidden penises also have penile contraction due to tissue fibrosis which requires the use of an experienced Urologist to diagnose and treat. In this cases, a combination Urologic-Plastic Surgery approach is needed.
But as a general guideline, I will have my assistant contact you to give you a cost for the combined procedure of a suprapubic lift with mound liposuction, which was what was discussed in that article.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Just had a question about the pubic lift…Can I still have children after the surgery is done or is it something that needs to be done after having children? Thank you so much for your time.
A: The pubic lift is a modified form of a tummy tuck or abdominoplasty. It is very much like the reverse of a mini-tummy tuck or an upside down mini-tummy tuck. During the procedure, the suprapubic area is first thinned out or reduced by liposuction since there is usually a lot of fat within it. (which is one reason it is so puffy) Then skin is removed and the pubic area is lifted up to a predetermined line. The combination of the two creates the pubic lift.
Pubic lifts are often done concurrently at the time of an abdominal panniculectomy or a large tummy tuck as large pubic mounds are usually present in patients that need these procediures. More often, however, a pubic lift is done as a secondary procedure after a large tummy tuck or panniculectomy as they are hard to optimally treat at the same time. The pubic lift is then done using the scar line from the first stage tummy tuck or panniculectomy.
There is no problem having children after any pubic procedure, albeit pubic liposuction or a formal pubic lift. Pregnancy, however, will not help the result and from an aesthetic standpoint one could argue that it is best to wait until one has a more stable abdominal area before investing in that effort.
Dr. Barry Eppley
Indianapolis Indiana