Patient 8 Gallery

Before and after abdominoplasty and liposuction of the abdomen and flanks in a 38-year-old mother of twins. She had always had washboard abs but after having children, she accumulated extra skin and fat in her lower abdomen, which she lovingly called her “twin skin”. When she did a plank, she felt like her “guts were falling out” and she felt her core muscles were not working properly.

She was right! Rectus diastasis happens when the abdominal muscles that form a “six pack” are separated from repeated pregnancies. They heal with scar tissue in between, resulting in rectus abdominis muscle separation that can really only be repaired surgically. Physical therapy can help to strengthen the abdominal wall, but it cannot undo changes of pregnancy.

An abdominoplasty (tummy tuck) does three things: (1) It surgically removes excess skin and fat from the lower abdomen, including the “shelf” or “pooch” that often hangs over a C-section scar; (2) It repairs the rectus abdominis muscles back toward one another in the midline – this is done via rectus fascial plication using four layers of a strong nylon suture that remains in place permanently – the body heals around it with scar tissue, adding additional strength to the core muscles; and (3) It redrapes the abdominal wall snugly downward, creating a low abdominal scar.

This procedure also repositions the belly button through a new skin opening, like bringing a button through a buttonhole. Liposuction is always added to a tummy tuck, removing excess fat from the upper and lower abdomen, pubic region and the flanks.

Follow up photos are shown just 3 months after surgery, with normal bright pink scars and expected residual swelling. I am often asked by patients why we show ugly, immature scars on our website gallery. We believe it is important to show scars at different stages of maturation, as this is what patients see when they look in the mirror for the first year after surgery. Scar therapy is initiated when all scabs have fallen off and the wounds are completely sealed, often at 6 to 8 weeks after surgery.

Some of our gallery cases show scars at one, two and even 5-10 years after surgery – with faded, flat and beautiful looking incisions. It is not fair for patients considering surgery to only see the very outcome, without knowing what scars will look like along the way. This is a vital component of “informed consent” for surgery – knowing the risks and benefits, expected outcome, alternatives to and complications related to surgery. It is our goal for each of our patients to heal with the nicest looking scars, which sometimes takes years to achieve.