Mr Richard Baker Weekly Blog

How to improve results in tummy tuck surgery?

This week I’ve been thinking about how to improve results in abdominoplasty, or ‘tummy tuck’, surgery. The commonest causes of dissatisfaction after abdominoplasty are residual excess skin, particularly when bending forwards, excess skin in the flanks and fluid collection under the skin (seroma). It is important to warn patients before surgery that though the skin can be very tight on the day of surgery, it naturally relaxes over the following weeks to months so that inevitably there is some degree of returning laxity over the following year. However, it is nowhere near to the same extent as before the surgery. In addition, the patient doesn’t get new younger skin, they simply have the excess removed. Unfortunately, aging, weight gain and pregnancy all have the effect of thinning the skin such that it loses the firmness and elasticity of youth. Liposuction helps in removal of loose skin because the suction of the fat layer allows you to stretch the skin further. Obviously, this is more effective the thicker the layer of fat.

Excess skin on flanks is difficult to address with a tummy tuck. The only way to remove a lot of skin from the flanks is to take the incision all the way around to the back in a so-called ‘body lift’. This creates a scar all the way around the waist and is a bigger operation with more risks, and therefore does not often appeal to patients. However, it is particularly suitable for people who have lost a great deal of weight following a gastric bypass, for example.

Lastly, fluid accumulation occurs because a tummy tuck, by definition, creates a large raw cavity under the skin of the abdomen on top of the muscles. I find putting dissolving stitches between the skin and the muscle can help to close off this cavity, although the stitches can sometimes cause discomfort. Drains are helpful for draining fluid in the initial few hours after surgery, although I don’t believe it makes a difference in the subsequent weeks. It varies enormously between patients, and I think different patients react differently to surgery and it is impossible to predict which patients will produce fluid and who won’t. Surgeons have tried spraying various chemicals into the wound to try to stop fluid production and no-one has found a good one yet. However, I am sure in the future research will generate an agent that will allow the skin to stick back down to the muscles and eliminate this problem.



Mr Richard Baker Blog

Some great new technologies – HIFU and Miradry

I attended the CCR expo in London which is the aesthetic surgery conference and exhibition.

I was particularly interested to hear about the new technologies such as HIFU, which is high frequency ultrasound treatments for tightening the skin and reducing the fat content which helps improve the contour of the face, neck and body; I’m thinking about introducing this to my patients.

The other technology that appeals to me was something called Miradry which is a device that turns off some of the sweat glands in the armpit so you have permanent reduction in sweating. Neither of these treatments require needles or incisions of the skin involved and no anaesthetic is required.

I was also interested that the British Association of Prosthetics Plastic Surgeon’s Council has issued guidance to its members, for which I am one, that they do not recommended aesthetic plastic surgeons in the UK to undertake large volume fat transfer to the buttocks in a procedure known as the “Brazilian Butt Lift”. This is because there is a mortality or death rate associated with this procedure of 1 in 3000 and this occurs because of fat getting into the blood vessels and travelling to the heart and lungs. I think BAPPS have made a sensible decision although, they haven’t defined what volume of fat they regard as “large volume”. In my practice, I think the buttock area can be reshaped very well with liposuction alone i.e. removing fat from where there is an excess, this means that the buttocks can be made into a more aesthetically pleasing shape, also at the same time reducing the overall size of the buttocks. If the volume of the buttocks still requires increasing, the alternative is to use special implants.