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The Trillium Show Podcastwith Dr. Jason Hall

american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association
american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons american board of surgery The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association

The Skinny on Tummy Tuck Surgery

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Disclaimer: The discussions on this podcast do not constitute medical advice, an evaluation, or a consultation. Nothing in the podcast episodes should be considered a replacement or substitute for a formal in-office evaluation by Dr. Hall or his associates. Explanation of off-label services and/or products do not constitute promotion and/or endorsement. Information and opinions presented here do not create a formal doctor-patient relationship. Discuss any potential medical procedures or interventions with your physician or surgeon first.

Show Notes

Tummy Tuck in Knoxville Tennessee

A tummy tuck, also known as abdominoplasty surgery, is very common in the United States. Last year (2020), nearly 100,000 tummy tucks were performed in the US. This procedure serves as a safe solution for excess skin and results in the restoration of your natural silhouette.

In this episode, I'll break down what a tummy tuck is - and more importantly, what it isn't. We'll go over the goals of the procedure, the operation itself, and what to expect during recovery. With every surgery, there are always potential complications (which most people don't want to discuss) - I'll touch on those, too.

In this episode, we cover:

  • The three main goals of abdominoplasty - safety, reestablishing your curves, and removing excess skin. (01:57)
  • What goes into a tummy tuck procedure? From determining the incision location to performing the surgery, there is both art and science behind every detail. (17:17)
  • Recovery time: Making recovery smooth, when to return to work, and when to return to working out. (27:26)
  • Complications: Little “p” problems and big “P” problems…hear about what can go wrong. (33:28)

Transcript

Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I'm your host, Dr. Jason Hall.

Dr. Hall: In this episode of The Trillium Show, we are going to talk about tummy tucks or abdominoplasty surgery. In 2020, which is the last year that we have good statistics for—and we're recording this now in Q4 of 2021—there were almost 100,000 tummy tucks performed in the United States. 96% of those, as you might guess, were females. The tummy tuck ranks number six in popularity of cosmetic plastic surgery procedures performed, right ahead of breast lift surgery.

Most of the patients who undergo tummy tuck surgery fall in the range of 40 to 54 years old, but there are tummy tuck patients which have surgery at around all age groups, starting in their 20s all the way up to their 70s. So, those are some statistics to give you an idea of how common tummy tuck surgery is. Now, before we get into the nuts and bolts of abdominal plastic surgery, I'll give you a little outline as to what we're going to talk about today. So, in today's episode, we are going to go over a few different things. First, we're going to talk about what a tummy tuck or an abdominoplasty actually is. And in that, we'll go over goals and expectations from tummy tuck surgery; we'll stop and take some time to explain what happens in the procedure, kind of the nuts and bolts of the operation itself; we'll discuss recovery time and return to work; and then briefly touch on potential complications.

So, first of all, what exactly is a tummy tuck? I'll start by actually telling you what a tummy tuck isn't. A tummy tuck is not a weight loss operation. It doesn't kickstart a health plan; it doesn't help you lose weight; it doesn't get you going on a path to being healthy and fit. With tummy tuck surgery, you really want to be where you want to be first, and let the tummy tuck serve kind of as a—pardon of bad food analogy, but is the icing on the cake to help you finalize where you want to be from a fitness and appearance standpoint.

Ideally, that means being within about 10 to 15 pounds of your goal weight. That's not your ideal weight necessarily, but that's a weight that you're comfortable, and that you can sustain for a long period of time, preferably for the rest of your life. It's not uncommon to have prospective patients call into the office and talk to our coordinator or bring up during the course of a consultation that they are looking to really kickstart a fitness habit and just wanting to feel like if they get rid of a little bit of extra weight, that'll help them get motivated and stay motivated in the gym, and actually it's quite the reverse. You want to be there, you want to use the tummy tuck to finish your weight loss not start it.

So, now that we don't know what a tummy tuck doesn't do, let's talk about what a tummy tuck does do. There are three main goals of tummy tuck or abdominoplasty surgery. And for the rest of this, just for brevity and clarity. I'll refer to tummy tuck and abdominoplasty interchangeably, just kind of as they come up in the course of this discussion.

So, there are three main goals of tummy tuck surgery. Number one is that it has to be safe. In elective cosmetic surgery, safety is rule number one. Number two is that we reshape your silhouette and reestablish natural beautiful curves of your trunk and waistline, and number three is to remove skin excess. And that's both skin excess that you can see and skin excess that you can't, and we'll discuss what that means here in a few minutes.

So, goal number one for any cosmetic surgery—tummy tucks notwithstanding—is safety. I tell my patients when they're here in the office and we're going through our consultation that I make my living doing unnecessary surgery on healthy patients. So, if a surgery isn't safe, if I don't think that the operation that would be best for you aesthetically is a safe surgery, then we'll have to come up with an alternative or we just won't proceed. And there are a couple of things that contribute to safety. Obviously, pre-existing chronic medical problems, such as heart problems, lung problems, diabetes which is uncontrolled, those are things that are going to cause us to pause and do a little bit more research into just how problematic these medical problems are before we're going to move forward and elect to pursue surgery.

And in a lot of cases, if there are underlying heart conditions, someone who has had a heart operation or stents, has bad pulmonary disease, we just can't safely proceed. Another thing that contributes to safety is tobacco use, specifically nicotine use. So, if you smoke or you vape, we have to make sure that we have given your body time to clear the nicotine from your system in order to safely do surgery. The reason for this is that most of plastic surgery involves really pushing your skin and tissues to their limits in terms of blood supply. There's an old adage that plastic surgery is the balance of beauty and blood supply.

And that is true in most of our procedures, but tummy tucks especially. And when we get to talking about the procedures, we'll see why that is. But what we do is we detach skin from a lot of its big, healthy, robust blood supply, stretch it as tight as we feel is safe, and then expect it to heal with an inconspicuous, very nice scar. And we rely on the microcirculation—so very, very small blood vessels in the skin—to really make that skin flap—is what we call it—survive. What nicotine does is it chokes those little tiny blood vessels, that microcirculation in the skin, it damages those vessels, it causes those vessels to clamp down and constrict so they don't get enough blood flow through them.

What that means for you as the patient is that our skin flaps are much more delicate, they don't heal as well, and they're much more prone to being stretched past their limits and dying. And with a tummy tuck surgery, that can be a total disaster. So, for any surgery, but specifically tummy tucks, if you're smoking, you need to stop for six weeks beforehand and then continue to not smoke for six weeks afterwards. That gives us time for the nicotine to clear your body, let your body heal, and at that point, you're now a nonsmoker; there's no point in starting again.

The third thing that contributes to safety, especially in body contouring procedures, relates to your body mass index or BMI. And the BMI is an index or a ratio that we use which relates height to weight. It's not perfect. It's not accurate in all patients, but it gives us a good marker for where you are in terms of body composition. As a group of plastic surgeons, we have looked at outcomes from body contouring surgery, and what we see is that the incidence of severe complications, life-threatening complications, such as blood clots, what we call a DVT or PE where you can get a blood clot in the vessels of your lower leg that can break off and go to your lungs—which can be fatal—those things are much more prevalent in patients who have a body mass index or BMI of over 30.

And so for safety sake, I put a hard stop on body contouring surgeries in patients with a BMI of less than 30. And what we do is we have got a number of resources that we give to patients to help them get there so that then we can safely do their operation. And just a little caveat here, there is a lot of—if you talk to nutritionists, you talk to dieticians, they'll tell you that weight loss is done in the kitchen. You get in shape in the gym, you lose weight in the kitchen. So really, dietary modification is a lot of what we talk to patients about to try and get them to a healthy weight.

And things like keeping a food journal, using an app called MyFitnessPal, which I think is a fantastic resource. If you're looking to lose weight, and I've never used MyFitnessPal, it is a great tool. I lost about 20 pounds just using MyFitnessPal and doing nothing else about eight years ago. And we've had a number of patients who have used it with great success over time. So, medical conditions, smoking, and BMI are kind of the big ones in terms of making sure that our surgery is a safe one.

So, it brings us to our second goal, which is giving you curves. Now, curves is really showing off what is underneath the skin. So, that is the silhouette, that's kind of what's buried under skin excess and a little bit of fat excess. So, when we're talking about contouring and restoring curves, what we're really talking about is muscle shaping. And that's something that is not really talked about much, but is a huge part of what makes an abdominoplasty what it is.

I see a lot of patients who come in to see me after having children, and one of their main complaints is they can't get rid of the little pooch between their pubic bone and their belly button. You know, these women have, for the most part, always had a flat stomach until pregnancy, and then no matter how much they work out, they can't seem to get that flat stomach back. What causes that is fascial laxity. Now, fascia is the connective tissue that covers all of the muscles, and during pregnancy, that fascia stretches out and gets loose. And you can strengthen those muscles as much as you want to, but if that fascia is loose, they're not going to keep things tight and compressed; you're going to get that little bulge underneath your waist, and in some patients, that bulge goes from their ribcage, all the way down.

We refer to that, when the fascia in the midline—so in the middle of your abdomen, kind of where you see that groove in bodybuilders called the linea alba—when that widens, we refer to that as a diastasis, and that is just a gap between your rectus muscles or your six pack muscles. A big component of tummy tuck surgery is repairing that, fixing that diastasis, actually tightening that fascia with sutures, sewing those muscles back together, which reshapes the waist, reshapes your side profile to flatten your stomach, and really helps to restore an attractive silhouette. Now, it's not only women who have been pregnant who can get fascial laxity, who can have that fascia stretch out, but anyone who has had significant fluctuations in their weight, has gained and lost a lot of weight over time, can experience the same thing. Your body can deposit fat on the inside, around your internal organs, what's called visceral fat, and that can essentially do the same thing as a pregnant uterus and stretch that fascia out, and when that fat goes away, it can leave that fascia loose and cause that protruding abdomen that doesn't seem to get better. The same procedure, surgically tightening that fascia back to where it should go really helps to reshape things in that regard.

Now, muscle shaping is one part. This is also where liposuction can play a role. And now I'm incorporate liposuction, I think a lot of plastic surgeons these days incorporate liposuction into almost every abdominoplasty that they do, and what that is for is to remove stubborn areas of fatty accumulation around the waist, remove those stubborn areas around what we call the flanks and help restore that hourglass figure that a lot of women are looking for. So, restoring curves is goal number two of tummy tuck surgery.

So, that brings us to our third goal which is removing excess skin and this is what a lot of people think of when they think of tummy tuck is removing skin. So, the same factors that cause fascial laxity can also damage the elastic properties of the skin, which means it doesn't bounce back as easily as it did years before. Those factors can be pregnancy, significant fluctuations in weight, even prior surgeries, C sections and things like that, can damage the skin and cause contour irregularities that we address during the course of a tummy tuck. C section scars especially can cause tethering down to the bottom portion of the abdomen, just above the pubic bone which makes the skin excess appear worse. And this is what I hear a lot of women, when we're discussing abdominoplasty surgery in the office, talk about having a flap or a little shelf in their lower abdomen that just drives them crazy because they can't get rid of it.

And that goes away with an abdominoplasty surgery. We remove that old C section scar, we remove the extra skin and pull the rest of the skin tight, and really help to reshape the lower abdomen and remove the skin excess that people find unattractive. Now, it should be noted that there are some skin excess that can be hidden. In the front part of the abdomen, where C section scars are, there are connections between the skin and the muscle covering or fascia which cause transverse bands. You know, there's one right above your belly button, there's one typically it's your lower abdomen, just above your pubic bone.

So, the skin as it gets loose, kind of stops there and creates those the rolls that people complain about over time. On the lateral or outer part of your abdomen, those tight fascial connections between the skin and the fascia don't exist and so there can be a lot of skin excess in the hip region or in the lower back, which doesn't really show itself until you start pulling on other areas. And during the course of our examination, I assess for that laxity because sometimes taking our abdominoplasty incision out further on the sides than we normally would can really significantly improve contour in those areas where you really didn't see a problem initially, but would if we don't do the right surgery and remove some of that extra skin. A lot of times when people have realized that and come in complaining about it, they say, “It looks like my thighs or my butt is just melting into my legs.” That's what is responsible for that, and in an abdominoplasty, we can address some of that by just carrying that incision out a little further.

All right, so now that we've talked about the goals of the surgery, let's talk about how to actually do a tummy tuck and what goes into a tummy tuck procedure. So, first of all, the surgery takes approximately three hours, but is really variable depending on the patients. Now, it's very common to add-on breast rejuvenation to a tummy tuck surgery, that being either a breast augmentation or a breast lift with augmentation. This is what's known as the mommy makeover. That can push surgery times to four, five, and even six hours in length.

Now, those are long operations, but you've got to remember that this is outpatient surgery, so no overnight stay is required. The way that we do anesthesia is very conducive to patients going home. You recover well in your own bed, in your own house, much better than you would with an overnight stay in the hospital. And, again, we kind of talked about in the very beginning, making this as safe as possible. If you need to be in a hospital for elective cosmetic surgery, that's something that we really have to talk about during the consultation process to make sure that the surgery is as safe as it can be.

So, the incision, like we've discussed earlier when we're talking about removing skin excess, is hidden in the bikini line. I have my patients bring either a swimsuit or a pair of underwear that they want to hide an incision in with them when they come to the surgery center on the morning of surgery. And we actually draw out, sketch out where that swimsuit hits their skin so that I can plan where that incision is going to fall at the end of surgery and trying to land that incision within an article of clothes that you would like to wear after surgery so you can't see it.

The procedure itself starts with the anesthetic. Over the course of 2021, I have drastically changed the way that anesthetics for my tummy tucks are performed, in that I have gotten to where a TAP—that's T-A-P—block is a routine addition to every tummy tuck surgery. So, what this is regional anesthesia. So, I have a portable ultrasound machine plugs into an iPad that in the operating room, after you're asleep, before anything is even done, we use that ultrasound to find where the nerves that give you sensation to your abdominal muscles, to the skin of your abdomen, come out between the muscles of your side, and then while we're looking at it with an ultrasound, put a needle and flood that area with local anesthetic.

This accomplishes a couple of different things. First, it causes the amount of anesthesia that we need to use during surgery to be much, much less. We don't need to use as much narcotic during the operation because your body's not sensing pain even when you're asleep. Where that helps is that it decreases—significantly decreases—the amount of post-operative nausea and vomiting that patients have. It makes your recovery from surgery much nicer because even with standard local anesthetics, not even long-lasting local anesthetics, but standard local anesthetics—bupivacaine, lidocaine and an anti-inflammatory—we can make your first day after surgery, which is typically one of—that is very uncomfortable, make it much more comfortable so that you're up and moving early.

Why that benefits, as I describe it to my patients, is trying to recover from a hard workout. If you've ever had a hard workout, you wake up the next morning, you're sore, all your muscles ache. If you can get up and do an easy recovery workout that next day, you're not quite as sore the day after, which means you can do more that next day, which means you're not sore the next day, and so on. And so that TAP block, taking that extra few minutes at the beginning of the case, to provide some preemptive anesthesia really has a domino effect on recovery and makes the recovery from surgery much, much more pleasant.

So, once the anesthetic is done, then the procedure starts and, you know, the incision is made and, like we talked about earlier, the skin is lifted up. One of the common things that I get asked with almost every tummy tuck consult is what happens to my belly button? And what people don't understand is that your belly button stays attached to the muscles of your stomach. The belly button is essentially a scar itself which is formed from where your umbilical cord attaches to your abdominal wall when you're in the womb, and scars down once you're born. And so we leave that alone, make a little incision around the belly button and then keep elevating the skin so we can see the muscles to repair those and repair all of that around your existing belly button.

Once all of that is done, the skin is stretched—you're actually put in a almost a seated position for most abdominoplasties—and that skin is stretched down to where the incision line is down around your pubic bone, and that extra is removed. Drains are used sometimes but not all the time, then your belly button, we kind of find where your belly button is, make a little incision in your abdominal wall and bring your bellybutton back out through that little incision. The belly button is one of those parts of a tummy tuck that can be a dead giveaway. A bad belly button, which has a circular scar around it and little stitch marks—we kind of jokingly refer to those as the cat's butt, or shotgun belly button—or dead giveaways to a patient who has had a tummy tuck surgery in the past. And so a lot of us, myself included, spend a lot of time trying to make those incisions difficult to find, make that belly button look as natural as possible.

So, if you look at before and after pictures of tummy tucks, that's the first place I always look is the belly button to see how much time and artistry went into creating that belly button. Now, one of the things that's really interesting is that most people assume that your belly buttons right in the middle of your abdomen, and it's not. There have actually—this is the kind of thing that plastic surgeons actually look at—there have been studies done out of the University of Texas Southwestern Medical Center at Dallas, very good plastic surgery program, they looked at women who have undergone tummy tuck surgery, and a lot of the women didn't have belly buttons that were directly in the midline. They were off to one side or the other. You know, that's something that we point out before surgery, but it's also something that after surgery, you should notice is that your belly button probably isn't in the dead center of your abdomen.

The other thing is that their belly buttons aren't naturally round, and so, you know, having a little depression, you know, with a little kind of hood over the top and have your belly button kind of come out in a nice gentle arc below, those are all characteristics of a natural belly button—and if you're interested in talking about that, we can do another show on just the belly button because it's kind of a cool anatomic feature—but look at belly buttons when you're looking at surgeons' before and after pictures on the internet.

Lastly, a very common question that we get are, “Do we need drains?” And drains are usually used, have traditionally been used in abdominoplasty surgery. There are more and more surgeons who are performing drainless abdominoplasties.that's a great option if you're a good candidate for that. Myself, I use the drainless technique some of the time.

There are some patients that I just don't feel are good candidates for that and we can kind of talk about that when you're in the office, but pretty much if you're going to have an abdominoplasty, count on going home with a drain. Now, the drains are small; they're kind of a pain in the butt, but they're only there for a week or two. And it beats having to deal with a seroma, which is a fluid collection under your skin, which usually requires repeated drainage in the office with a needle every other day or two for a week or more to get that to resolve.

So, now that the surgery is over, you're placed in a compressive garment. We use the Design Veronique spandex garments, which are fantastic. They look pretty good, but these aren't fashion show type things. But they are relatively comfortable if you have to be in spandex for a while and they put pressure in all the right places, so we prefer the Design Veronique brand. Some surgeons use abdominal binders. Some surgeons don't use anything. This is kind of where the art of plastic surgery comes in.

I find it decreases swelling and helps to kind of hold things where we wanted it while the skin is trying to adhere down. So, I like having my patients in a garment. Not every surgeon does. Now that we've kind of gone through the procedure, we're into the recovery time, and this is where a lot of questions about abdominoplasty come up is, “What is the recovery like?” People hear that it's just a terrible, terrible recovery process. And it is one of the more difficult procedures to recover from in plastic surgery.

But certainly, there's over 100,000 of them done every year, so it's not something that stops a lot of people from having this done. So, really one of the biggest tips to recovery is movement, is the sooner that you get up and move, the better off you're going to be, the fewer problems we're going to have, and the better, you're going to feel. The TAP block, which is, again, a routine part of my tummy tuck protocol, really helps by allowing you to get up and move in relative comfort that first day. This is also where really helpful family and friends that want to try and wait on you and do everything can really slow you down because you need to be getting up and doing things on your own, even that first day of surgery, getting up and getting a drink, getting up and going to the bathroom.

You're going to need some help, but you want to make sure that you're doing things yourself to get up and move around. This helps with pain, this helps to prevent blood clots in your legs, and it helps to prevent that progressive muscle soreness that can keep you laid up for days after this. The next recovery tip is to have a pain medication schedule and stay on a pain medication schedule for the first few days after surgery. I like to have my patients start by alternating a non-steroidal anti-inflammatory like ibuprofen with something that's got some narcotic in it—whether that is Lortab or Percocet or any of these brand name narcotics—but alternating those so you're taking medicine every three hours.

So, you—you know, example is, you take a narcotic pain pill at 3 p.m. At 6 p.m., you're going to take an ibuprofen. At 9 p.m. before you go to bed, you take a narcotic. Set an alarm, put your medicine out by your bed before you go to sleep, wake up at midnight, take an ibuprofen. You know, make sure your alarm's set for 3 a.m. Get up at 3 a.m., rollover, take a pain pill, go back to sleep.

If you stay on that pain medication regimen, it's going to make the next day much more bearable, as opposed to falling behind overnight and waking up unable to move. So, that's a really good tip is to have your schedule, stay on your schedule, and don't play catch up. The other tip is, when you're taking narcotic pain medicine, make sure you're taking it with something on your stomach. A lot of patients who complain of nausea with narcotic pain medicine because they're taking it on an empty stomach and then they get sick to their stomach. So, make sure that you have something, even if it's just a couple of crackers, on your stomach, before you take your narcotic.

Okay, so now here's the big one is return to work, is when can you go back to work after a tummy tuck? Because of some of the mobility limitations, drain tubes, if you have a really active job, you're up on your feet or you do a lot of walking at work, I like to tell people, take two weeks off, just to make sure that you've got enough time to recover. Even at two weeks, you're probably still going to be a little slow, but you'll be able to get back to work. With COVID and a lot of people transitioning to remote work, being able to get back to remote work happens a lot faster, you know, because for that, you just need to be sober. You need to be off narcotics and taking just some Motrin or something like that during the day and be able to get on your computer.

And for that a lot of our patients are off of narcotics within the first week and can get back to remote work in about seven days. So, that has been—you know, remote work has been huge in allowing patients who otherwise wouldn't have the time to be able to have surgery and recover and not take a whole lot of time off of work. You do have to remember though, that you will be in your compression garment. You know, with my patients, you're in compression for about six weeks, and mainly to help minimize the swelling. A lot of our patients do get a second garment just to be able to rotate the two, but it does—I won't lie to you, the garment gets a little bit old.

One tip that a patient of ours had was to get a pair of the, kind of, full body Spanx. They're not as compressive as the Design Veronique garments, but they look a lot better, they hide under clothes, and they will give you some support during the day. So, that's been a trick that some of our patients have come to. And then, you know, lastly, exercising. You're not going to really feel like it, honestly. It's going to be six weeks before you're going to really want to get back to exercise. That's when I want you out of the gym is for about six weeks.

After an abdominoplasty, your exercise and your therapy is really getting up and moving around the house, going to work, and doing those things. Budget six weeks out of the gym. Stick to that, and really that should be one of the things you consider when you look at timing is making sure you have enough time to recover.

Lastly, we've got to talk about complications. Now, nobody wants to talk about complications. Nobody really ever mentions the complications. You really don't hear much about the complications until your consult, but you have to understand that cosmetic surgery is still surgery. There is no surgery that is complication free.

Now, fortunately, the incidence of complications with elective tummy tuck surgery is low, but things still happen. I kind of group these as two categories of problems. There are the problems with the lowercase p, which are small problems: minor, annoying, but really don't compromise your long-term outcome, or compromise your health, or risk your life. And then there are the capital P problems. These are big problems; these are serious issues that can and sometimes are life threatening, and these are the ones that we really work hard to pick out and prevent before surgery.

So, let's talk about the small p problems. Things like suture spitting, which is where some of the dissolving sutures that we use to close the incision, the ends of those can start poking through the skin and cause a little open spot in the incision line. These are relatively uncommon; I would say 5% of the time maybe, and these are simple things that can be treated with in-office removal. They heal within a day or so, and you forget about them, and really has no long-term cosmetic or health consequence at all.

Another small p problem is a seroma. And we kind of talked about that during the procedural part. We try and prevent these by using drains in surgery. Sometimes even with drains, seromas can happen. And these are little fluid collections underneath the skin.

When you skin your knee, your knee kind of oozes until it forms a scab. That's your body trying to heal itself. On the inside, the same thing happens after a tummy tuck is that your body produces fluid as the skin and the muscle we're trying to heal back together. If your body is making more fluid than it can absorb, that collects in a seroma cavity. These are really more annoying than they are dangerous.

In my office, use an ultrasound, find them, drain them with a needle. Usually it requires a few trips. The larger the seroma is, the more trips it takes back to the office to drain these, but most all of them go away just with in-office aspiration, and can typically be treated in about a week or two.

Wound infections are another things. These can be relatively mild: some redness, swelling, and tenderness, a lot of times around drain sites. These typically will show up about ten days after surgery and can usually be treated with a short course of antibiotic pills without any real issue. Occasionally, there will be something that we'll have to address in the office, but that fortunately, is relatively rare.

So, large P problems. And again, these are the things that fortunately, are really rare, as in you typically will read about these are the paper. And these are the life-threatening problems that we take very seriously on the front end to try and prevent. These are things like DVT or pulmonary embolism. These can be and are fatal problems.

There are lots of things that we use to assess your risk on the front end of surgery to make sure that we take every precaution necessary. And so that's a reason that during the pre-operative discussion, we ask a bunch of questions about health history, and previous clots, and birth control pills, and things that we know are risk factors for DVT and PE. And if you score above a certain level on our risk assessment, then we'll use a blood thinner shot before surgery to help prevent you from developing a clot in the operating room. There are some patients whose risk of DVT and PE is high enough that we can't operate at all safely. So, you know, this is something that we do take very, very seriously.

The other thing is hematoma, which is a blood clot under the skin. These also fortunately are very rare, and can sometimes be large enough and serious enough to require a blood transfusion. These do typically require drainage in the operating room, and so is also something that we take great care in preventing these from occurring in the first place.

And lastly, is a very serious complication that we try and prevent on the front end are wound breakdowns, or areas that don't heal. These are typically the result of a compromised wound healing and immune system, and often occur in patients who are diabetics, who are smokers or vape nicotine-containing juice, or have other immune system problems that can affect wound healing. This can include inflammatory bowel disease, rheumatoid arthritis, or any of the other rheumatoid problems that require chronic immune suppression drugs, and so if you fall into that category, we're very careful. Some of these immunosuppressive conditions or wound healing or conditions that adversely affect wound healing are things that we can control on the front end, such as modifying anti-inflammatory medication schedules. And some of these conditions such as poorly controlled diabetes or significant smoking, we just have to say no on the front end and eliminate that as being a risk factor because wound breakdown in a tummy tuck is a terrible complication because these wounds typically are large, the skin is tight to start with, so there's no extra that we can use—recruit—to try and close a wound, so you're left with a large wound that has to heal in on its own, which can take months to resolve, and also typically looks terrible. So, for that reason, we're very vigilant up front on trying to prevent wound breakdowns, as well as all of the other big P problems that we talked about just a minute ago.

So, abdominoplasty surgery is far and away one of the more common cosmetic surgeries that's performed in the United States. It is a safe procedure; it is a procedure with a very high satisfaction rate, and I think it's important that when you're considering an abdominoplasty, that you keep in mind the three goals that we discussed at the very beginning of the podcast, which are: it has to be done safely; that a tummy tuck really is to give you your curves back, so shape your waist and trunk; and then lastly, to remove excess skin, which is that's excess skin you can see in the front and that excess skin laxity that can accumulate on the sides and back that we can take up during the course of a tummy tuck surgery.

So, this wraps up our episode on abdominoplasty. We've got a couple of topics that we can pull out and really make podcast episodes of their own, such as anesthesia, talking about drains and belly buttons and things like that. So, stay tuned for those upcoming shows. Hope you enjoyed it, and we'll see you next time.

Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at @jhallmd on Instagram and Twitter and @DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.


KNOXVILLE, TN

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Complimentary Phone Consultation

Step 1

Schedule a complimentary phone consultation with one of our knowledgeable surgical consultants who are trained by Dr. Jason Hall. They will answer many of your questions, discuss pricing, and happily schedule you an in-person consultation with Dr. Hall if you are a good surgical candidate.

Dr. Jason Hall - Trillium Plastic Surgery Knoxville Tennessee

Dr. Hall's Plastic Surgery Consultant

Complimentary Phone Consultation

15 minute

Phone call

To reserve your in-person consultation with Dr. Hall, you will be charged a $100 consultation fee. Should you decide to move forward with surgery, this fee will be applied to your surgical procedure.

Step 2

Meet with Dr. Jason Hall for your in-person consultation.

Preparations & Surgery Day

Step 3

After you reserve your surgery date, Dr. Hall and his team will make sure you are well informed and prepared for your big day. Preparation is a very important part of your plastic surgery journey.

The post-op phase is an important time of healing and recovering so you can enjoy your amazing results and your improved quality of life that you have envisioned.

Step 4

Enjoy the Results