The abdomen is an area of the body that is vulnerable to physical changes and disfigurement. Pregnancy and weight changes can result in loose skin, stretch marks, and fat accumulation in the abdomen, suprapubic area, and flanks. In addition, the abdominal muscles tend to stretch and shift laterally, causing bulging of the abdomen and loss of abdominal wall tone and strength. A lipoabdominoplasty or “tummy-tuck” is the ideal procedure to obtain a flat and contoured body.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors, such as Dr. Todd Pollock, creator of the progressive tension suture technique which revolutionized the surgery of abdominoplasty, and Jeffrey M. Kenkel, a top leader in the field of body contouring.
An abdominoplasty or “tummy tuck” is a powerful body contouring procedure that removes saggy skin, stretch marks, c-section scars, and fat from the lower abdomen through a hidden incision placed below the bikini line. Furthermore, during this procedure, the abdominal muscles are tightened and repositioned to their natural state, producing a flat, toned abdomen with an attractive belly button. This procedure is commonly combined with liposuction of the abdomen, flanks, and posterior trunk to further enhance the body’s silhouette.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (e.g cigarettes, nicotine patch, vape, etc), if you have uncontrolled high blood sugar levels (eg diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Learning About Patient’s Surgical Goals
Dr. Couto has a deep discussion with the patient to learn what are the areas of concern and surgical goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Physical Exam
A focused physical exam of the areas of interest, usually the anterior and posterior trunk, is performed. In this part of the consultation, we evaluate the distribution of abdominal fat, degree of skin laxity, and the presence of recti diastasis or hernias. These factors determine whether a patient is a candidate for a liposuction only, skin tightening energy based devices (eg JPlasma), lipoabdominoplasty /tummy-tuck, or min tummy-tuck.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and also discuss the steps involved to book the procedure with us.
Patients with poor abdominal contour as result from excess skin laxity, stubborn fat, and/or loose abdominal musculature are typically ideal candidates for a lipoabdominoplasty/tummy-tuck. This procedure is not a weight loss method. Therefore, patients should be in a relatively normal body weight, and continue an active and healthy life after the procedure to maintain the improved results. Furthermore, patients considering this procedure can not be actively using nicotine products (eg. cigarettes, vaping, chewing tobacco) and any medical conditions, such as diabetes mellitus, should be under control with glycosylated hemoglobin (HbA1c) of 7 or less.
On the day of the surgery, Dr. Couto will draw markings on the patient’s body. These markings are used as a guide to determine the areas to be contoured and location of the incision. The majority of tummy-tucks are combined with liposuction of the superior abdomen and flanks, as this allows narrowing the waistline and further accentuating the body’s silhouette. Furthermore, we always like to emphasize to our patients that the body should be visualized as a cylinder, a figure that needs to be treated circumferentially. Therefore, we always recommend complementing the tummy-tuck with a 360 liposuction. This way one can achieve an aesthetic transition between the anterior and posterior trunk and enhance the buttock silhouette. The liposuction is performed first, followed by the tummy-tuck.
There are different tummy-tuck techniques, which are characterized by the incision length and degree of intervention. The type technique is dictated by the amount of abdominal skin laxity, and if tightening of the abdominal muscles is required.
There are five different techniques that Dr. Couto uses to perform a tummy tuck:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen, and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 2-3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that using any nicotine products (eg. cigarrettes, vapig, nicotine gum/patches) will affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery.
Following surgery, the patient may have drain tubes placed, which helps prevent fluid collection in the abdomen and expedite the recovery. They are typically removed 10 days after surgery. The patient will also be placed in a specialized compression garment that helps minimize swelling and maintain the body contoured.
Swelling and bruising are to be expected, and they can be noticeable for several weeks. In order to minimize the swelling and inflammation, we have our patients undergo lymphatic drainage massages. It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized postoperative pain medication protocol provided by Dr. Couto.
We normally recommend our patients to take 10-14 days off from work (less if working remotely from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house. Patients can resume their aerobic exercises (eg. running, spinning, biking) 4 weeks after surgery and strengthening/abdominal exercises 12 weeks after surgery. It may take 3-6 months for the swelling to completely subside and see the final results.
The most common concern of patients regarding a tummy-tuck is the length of the incision and if the scar would be visible. In a tummy-tuck, a scar is unavoidable; the patient is trading a flatter and improved abdominal contour for a scar. However, the scar is placed sufficiently low in the abdomen, so that it cannot be noticeable when wearing a bikini. The length of the scar is determined by the type of tummy-tuck performed, and most importantly, the amount of abdominal loose skin that requires resection.
A panniculectomy is a reconstructive surgery, while an abdominoplasty/tummy-tuck is a cosmetic procedure. A panniculectomy is a surgery that strictly eliminates lower abdominal skin and fat that hangs over the groin and pubic region. It is typically performed on patients in which the overhanging abdominal skin is affecting their functionality or quality of life. Unlike an abdominoplasty/tummy-tuck, the panniculectomy does not address any excess skin/fat above the belly button, does not narrow the waistline, and does not tightens stretched abdominal muscles.
A tummy-tuck will not affect your ability to get pregnant; therefore, it is safe to undergo this procedure prior to having children. However, a woman that has birth after undergoing an tummy-tuk may experience re-stretching of the abdominal skin and muscles. When this occurs, the firmer, flatter contour can be restored by either performing another lipoabdominoplasty or a mini tummy-tuck. We typically recommend patients to finish having children before considering a tummy-tuck. This will maximize the longevity of the results
We published a scientific study, which showed that elderly patients undergoing an abdominoplasty had the same risk of complications as a patient of young age. The conclusion of this study was that chronological age does not matter, what matters is physiological age. In other words, any patient at any age can undergo this procedure as long as their health allows it. We have performed this procedure in patients as old as 70 years old with excellent results and high satisfaction rate.
Surgical drains are usually used for this procedure, since it helps maintain the desired contour by preventing fluid from accumulating in the abdominal region. Surgical drains are commonly removed 10 days after surgery. We also perform drainless tummy tucks; however, these are only indicated in a specific patient population.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 8 weeks before surgery.
