Tummy Tuck, more formally known as abdominoplasty, is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip.

If you're considering abdominoplasty, this will give you a basic understanding of the procedure-when it can help, how it is performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask about Dr. Freedland if there is anything about the procedure you do not understand.

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The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should consider that the vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If you have scarring from previous abdominal surgery, Dr. Freedland may recommend against abdominoplasty or may caution you that scars could be unusually prominent.

Abdominoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Freedland.

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Thousands of these procedures are performed successfully each year. When done by a qualified plastic surgeon, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. Often there is temporary loss of sensation, which may last up to a year after surgery.

You can reduce your risk of complications by closely following Dr. Freedland's instructions before and after the surgery, especially with regard to when and how you should resume physical activity.

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In your initial consultation, Dr. Freedland will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. Be sure to tell him if you smoke, and if you're taking any medications, vitamins, or other drugs.

Be frank in discussing your expectations with Dr. Freedland. He will be equally frank with you, describing your alternatives and the risks and limitations of each.

If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty, also know as a mini-tummy tuck, which can often be performed on an outpatient basis. You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result.

In any case, Dr. Freedland should work with you to recommend the procedure that is right for you and will come closest to producing the desired body contour. He invites you to view before and after photos of his patients.

During the consultation, Dr. Freedland will also explain the anesthesia that he will use, the type of facility where the surgery will be performed, and the costs involved. In most cases, health insurance policies do not cover the cost of abdominoplasty, but you should check your policy to be sure.

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Individuals considering tummy tuck often feel a bit overwhelmed by the number of options and techniques being promoted today. However, Dr. Freedland can help. In deciding which is the right treatment approach for you, Dr. Freedland will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Dr. Freedland also uses this judgment to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

Dr. Freedland's education and training, which he received at the University of Michigan, has helped to form his surgical judgment. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.

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Dr. Freedland will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, Dr. Freedland may have to postpone your surgery.

If you smoke, plan to quit at least two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before surgery and do not go on a stringent diet, as both can inhibit your ability to heal. Though it is rarely necessary, Dr. Freedland may recommend that you have blood drawn ahead of time in case it is needed during surgery.

Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

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Many surgeons perform both partial and complete abdominoplasties in an outpatient surgical center or an office-based facility. Dr. Freedland feels a hospital provides the safest environment for your surgery and therefore performs all of these procedures at a JCAHO accredited hospital.

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While some surgeons use local anesthesia, combined with a sedative to make you drowsy. You'll be awake throughout the surgical procedure. Thus, your abdominal region will be insensitive to pain, but you may feel some tugging or occasional discomfort. Dr. Freedland typically selects general anesthesia, so you'll sleep through the operation and be extremely comfortable throughout the entire process.

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Complete abdominoplasty usually takes one to two hours, depending on the extent of work required. Partial abdominoplasty typically takes less time.

Most commonly, the surgeon will make a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel is typically not moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched.

Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. Pulling them close together and stitching them back into their natural position helps to tighten these muscles. This provides a firmer abdominal wall and narrows the waistline.

The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.

In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.

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For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort, which can be controlled by medication. Depending on the extent of the surgery, you may be released within a few hours or you may have to remain hospitalized overnight.

Dr. Freedland will give you instructions for showering and changing your dressings. And though you may not be able to stand straight at first, you should start walking as soon as possible. Surface stitches, if present, will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. A support garment may replace the dressing on your incision.

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It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after a few days, while others take two or three weeks to rest and recuperate.

Exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably.

Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits. Dr. Freedland can instruct you on skin care products that can help make your scars less visible.

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Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly.

If you're realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.

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