Avoiding Complications in Tummy Tuck in Los Angeles

Dr. Kenneth Hughes has revised hundreds of tummy tucks, and there

irrespective of the manner of closure or techniques utilized.

A high scar for a tummy tuck can be lowered by removing more skin below
the scar and pulling the scar lower. However, this is ineffective for
most revisions. Most of the time, this revision requires re-dissection
of the tummy tuck flap higher to the level of the xiphoid process and
the costal margins to allow greater recruitment of the tissue to lower
the scar. Although many plastic surgeons may refer to dissection to the
level of the xiphoid process, it is rarely done due to the precise and
careful dissection required.

An asymmetric scar can be rectified by using one of the two revision methods above depending upon the degree of asymmetry. Raising a lower portion of the scar is also a method
that may be appropriate.

True dog ears can be avoided in the vast majority of cases by removing the exact area of tissue and pulling the flaps together at the most favorable angles. However, many patients
want the smallest scar possible. If a patient has extensive skin laxity
that extends well beyond the normal tummy tuck scar, the surgeon should
not chase the scar another 3 or 4 inches to try to avoid a dog ear.
Many of these slight dog ears resolve over time.

Sometimes not enough skin and fat are removed or the patient has a particularly lax
skin envelope. This revision can involve removing more skin and fat at
the bottom while maintaining scar position or lowering scar position if
necessary. Sometimes, the laxity is so great that repeating the entire
tummy tuck dissection is the only reasonable option.

Belly button necrosis or death occurs due to violation of the blood supply.
This may occur because the first surgeon divided the belly button stalk
with an umbilical float procedure. Another common scenario is division
of the stalk during previous umbilical hernia repair. Dr. Kenneth Hughes
is familiar with all of these scenarios and their remedies as well as
techniques for belly button reconstruction to rebuild a belly button.

Flap necrosis or flap death, aside from patient factors like from tobacco
consumption or smoking, can result from violation of the blood supply of
the abdominal flap. This can occur from liposuction of the central
abdominal flap. This can occur following previous surgeries such as
open appendectomy or open cholecystectomy as well as dozens of other
procedures. Patient evaluation and proper planning as well as precise
surgical execution is necessary to avoid such an adverse outcome.

Inadequate superior dissection and inadequate tightening of the upper abdominal
musculature is another unfavorable outcome from tummy tuck. If the
abdominal flap is not dissected as superior as possible, the best
recruitment of tissue is not achieved and less skin and fat can
ultimately be removed. In addition, lack of superior dissection
prevents the ability to tighten or plicate the abdominal musculature to
the top of the abdomen. This can result in a protuberant upper abdomen
in some patients. Unfortunately, the only way to correct this is to
redo the tummy tuck.

Some patients who seek out tummy tuck to improve abdominal contours
have anatomic or previous surgical considerations that cannot be
overcome. Some tummy tuck candidates may need to revise their thinking
about possible results.

Weight loss patients and postpartum patients constitute the two major
groups who seek out tummy tuck for improvement. Many tummy tuck
patients have had weight loss surgery. Any placement of a port that
connects to an intra-abdominal device needs to be located prior to tummy
tuck. Frequently, these ports are placed near the midline and prevent
any meaningful plication or tightening of the abdominal fascia. Thus,
if these patients are going to retain that device, these patients are
going to have a suboptimal tummy tuck result despite optimal surgical
execution.

Patients who have a very large open cholecystectomy or any large
horizontal scar above the level of the belly button will retain that
scar. Furthermore, the risks for partial flap necrosis will be higher.
Finally, in an effort to prevent flap necrosis or death, the dissection
must not undermine the older horizontal scars. Thus, the relative
level of flap recruitment will be suboptimal as well.

Certain patients will have such weak fascia that fascia tightening of
any kind will be extremely difficult. Even if the plication can be
performed in an unconventional way the healing and integrity of this
fascia will always be an issue. This is an important point to consider
with all major hernia and diastasis cases. Recurrence is common.

To view more information on the tummy tuck procedure in Los Angeles, please visit Dr. Kenneth Hughes’s site at

https://www.hughesplasticsurgery.com/body-procedures-los-…

To view Dr. Kenneth Hughes’s before and after tummy tuck photos in Los Angeles, please visit

https://www.hughesplasticsurgery.com/los-angeles-before-a…