Recently Dr. Richard Bloom from Re. Plastic Surgery went live on Facebook to compare two surgeries that address excess fat and loose skin of the body. Tummy tucks and lower body lifts. Whilst these two procedures can be quite similar, they target different areas and as a result need to be selected according to the individuals needs.
What is a tummy tuck (TT)?
An abdominoplasty, or tummy tuck, is a surgical procedure aimed to tighten and shape the skin and muscles of the stomach. While it has always been an extremely popular procedure, to improve your shape, fit into clothes better and improve your confidence, there is now overwhelming evidence that the surgery will help with low back pain, core strength weakness, intertrigo as well as urinary incontinence for some women.
The reason how an Abdominoplasty can provide so much help is that as part of the tummy tuck we repair the rectus diastasis (muscle separation after pregnancy) in addition to removing the skin from the umbilicus to the pubis. This not only restores the trunk to its pre-pregnancy shape, but it also re-establishes core strength, essential in allowing your abdominal muscles to function efficiently and effectively. The improvement in core stability is why this is such an effective operation for women suffering the symptoms related to muscle weakness postpartum.
For a typical tummy tuck patient, the skin access is in the front between the hips.
There are three components to a Tummy Tuck. Skin removal, muscle repair and liposuction. An ideal tummy tuck patient has their skin access mainly in the front. They don’t have any rolls on the sides and the buttock is not droopy. All the scars will be hidden under bikinis, so you can go to the beach and you wont see the scar. The muscle tightening helps create a nice waist, a flatter tummy and better muscle definition.
What is a lower body lift (LBL)?
A lower body lift (LBL), or circumferential abdominoplasty addresses the entire lower trunk. It is a more common operation for women who have had massive weight loss. It addresses your tummy area, your lateral thighs as well as the buttock. Basically, if your excess skin extends beyond the hips, you need to consider a body lift over a tummy tuck to get the best result.
The ideal candidate has loose skin in the front, sides and a droopy buttock and often some loose skin on their outer thigh.They are patients who need more than just a standard tummy tuck. From a surgical point of view imagine the scar continuing all the way around the lower body, but still covered by bikini’s and underwear.
It is impossible to lift the buttock and treat that lower back region without doing a lower body lift if there’s loose skin in that area.
How long do the operations take?
Tummy Tuck – Three hours
Lower Body Lift – Six hours
How long do you stay in hospital
Tummy Tuck – Two nights
Lower Body Lift – Three nights
Which operation is better after massive weight loss?
I think that is almost certainly going to be a lower body lift. There is so much loose skin in these patients, particularly on the sides, and the buttock.
Sometimes a massive weight loss patient can get away with just doing a tummy tuck. It depends how much weight loss. And it depends on what the skin quality is like.
Does a Lower Body Lift take longer to heal?
No, not really. Scars heal across the wound, not from one and to the other. Just because you’ve got a longer scar doesn’t mean it takes longer to heal. They’re all just healing across that little skin bridge.
How do you get that contoured look on the back?
It depends on what the problem is. If there is excess skin and fat, then you will need a LBL to get that lower body curve. If your skin is pretty good and its just a fat bulge, then you may be able to achieve that look with just liposuction.
Do you get liposuction as part of a TT or LBL?
Yes, where required. If it is in the area of the surgery and relatively minor then it is included in our fees. If it is outside the are where we are operating (e.g upper back) then there is an extra charge.
Can a lower body lift assist with a thigh lift?
Definitely. But we’re talking about the outer part of the thighs only. That said you can get some improvement in the inner thigh too, but it is less impressive and is not the primary aim of the surgery.
How long does it swelling last after lower body lift?
Generally speaking, it is gone between two to three months.
Certainly patients describe getting some swelling (even months down the track) after certain activities. It can be triggered by doing too much exercise or due to different conditions. It usually settles down very quickly.
Can you revise a tummy tuck to a lot lower body lift?
Absolutely. I have had to do that. I’ve done it a couple of times onmy patients and I’ve definitely done it from patients who have had their tummy tucks elsewhere and they have decided they need a LBL because of bulges on the side or their buttock sags. It’s pretty straightforward to do. They can be easily done as two separate procedures.
What happens if you don’t like the belly button?
That wouldn’t happen with our patients. I saw someone recently who didn’t have a great belly button from another surgeon and we’re going to revise it. You can generally revise it. Sometimes if it’s terrible, you might need to actually just cut it off and make a new one, which is possible to do.
Do scars ever disappear?
No. Scars fade but they never disappear. It can take one or two years for the scar to fade to its best. I think they disappear in a patient’s mind with time as you just get used to your new body, you stop even thinking about what you used to look like or your surgery.
In addition, we have our dermal therapist, who does laser treatments at eight weeks and 12 weeks, which certainly helps. You receive two treatments as part of your surgery package.
How often do we revise scars?
Maybe five to ten percent of patients overall.
The revisions are often to do with dog ears, rather than the quality of the scars, and usually we can just do that in the office under local anaesthetic.
How often are appointments after the surgery?
You will see our nurse at one week and your surgeon at two weeks. If everything’s fine, then another four weeks. Then we’ll see after you’ve had your laser usually around the four month mark.
We do like to keep seeing our patients. They become part of our Re. family. So we will usually see you again at 12 months. Also then we can get some really good photos!
When can I get back to exercise?
If you’ve listened to our podcasts, you would have heard us speak to Penny, whom we have developed a program with. You actually can start doing gentle exercises quite early, surprisingly early, but until you’re back doing everything, it’s usually around six weeks or even two months.
Should I take vitamins or increase my protein before surgery to help with healing?
There’s not a lot of evidence for any of these things. Vitamins, sound great but there is no evidence that any of them improve healing. Any studies that have looked at vitamins and healing have usually focused on patients with severe burns, which is very different to elective surgery.
In general, if you’re fit and healthy, and you’ve got a normal diet then you don’t need to do anything different. The problem with some supplements is that they might have things in them that you aren’t aware of that and make your blood a bit thinner which would put you at high risk of bleeding, which is a way bigger problem than wound healing.
We generally advise to stop, any supplements 10 days before any surgery.