The abdomen, hips and buttock are all affected by weight loss and the effects of pregnancy. The skin of these areas is designed to stretch to accommodate this extra volume, though if stretched to far permanent damage is incurred which can be visible in the form of stretch marks. These stretch marks are commonly located in only the lower abdomen in the multiparous women and in the woman who carries twins or greater, though through significant weight gain in pregnancy and more commonly in the patient who has lost significant amounts of weight after weight-loss or bariatric surgery, these areas of permanent skin damage can involve the outer and inner thighs and buttocks. A tummy tuck or abdominoplasty only addresses the abdominal skin excess and commonly only in the vertical direction, in that it pulls the skin down more than it tightens in the horizontal plane. Abdominoplasty is indicated in the majority of patients though if applied to the patient with excess outer thigh and buttock skin laxity an unsatisfactory result can be delivered. This result can be corrected with an adjunctive procedure such as an outer thigh lift or lateral thigh plasty and /or conversion to a circumferential body lift, though these patients should be identified before any procedure is performed and offered an extended abdominoplasty procedure. These extended procedures can take the form of a circumferential body lift for the patient with outer thigh excess, as well as buttock ptosis or a saggy backside, as well a fleur de lis abdominoplasty can be performed on the patient with mainly central abdominal skin excess both in the up and down direction and in the side to side direction. This can be identified through an above the belly button pinch test where if skin folds and excess outer abdominal skin is present, it will likely be unaddressed with just a standard adominoplasty. This horizontal skin excess is accentuated with central muscle tightening or midline fascial plication which brings extra skin into the central abdomen with this repair of the widened abdominal muscles (diastasis recti). The options for this central abdominal skin excess include a central excision at the time of an abdominoplasty or a fleur de lis abdominoplasty which is a very powerful and one stage procedure which contours the abdomen and waistline though leaves a central abdominal scar in combination with a lower abdominal scar, or a staged central abdominal skin excision can be performed. This is suitable for the patient with a pre-existing abdominal scar or a patient who is accepting of the central abdominal scar in place of the excess abdominal skin. If a patient has excess central upper abdominal skin which is not amenable to a standard abdominoplasty and who is not accepting of the central abdominal scar, then a staged outer abdominal skin removal or flank excision (silhouette lift) can be performed which contours the outer abdominal silhouette though leaves the patient with a scar along the outer abdomen. Both the fleur de lis or staged flank excision or silhouette lift can deliver very stunning changes to the abdominal contour. The main downside to both procedures include new scar placement on the abdomen and a more extensive and/or staged procedure, though the benefit can include a one staged procedure which can provide the result customized to each individual patients requests and needs. Scare care is provided by Dr. Trussler to help decrease the visibility of the scars and through proper care after the surgery and long term scar management these scars can be rendered imperceptible.
Extended abdominal procedures, including circumferential body lifts and central and outer abdominal contouring procedures are individual decisions and the recommended combinations should be discussed during the pre-operative evaluation. Each patient will leave the initial consultation with the reassurance that they will be able to achieve an improved abdominal figure and defined waistline.