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Author: Dr Xavier Tenorio

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Technically known as ‘Abdominoplasty’, this procedure is designed to minimize the appearance of a protruding abdomen, treats the sagging of the abdominal skin after important weigh loss and some stretch marks. The surgery involves the removal of the skin and fat between the umbilicus and the pubis.
A liposuction and a tightening of the abdominal muscles can be associated to this procedure for optimal result.

A mini-abdominoplasty can be indicated when there is little skin excess to be excised. The scar is normally hidden in the underwear and always well accepted.

Introduction


People no longer have to live with the distress that is caused by an unsightly stomach. Beyond the aesthetic improvement, an important quality of life improvement, both functionally and psychologically, helps the patient to take care of his or her weight balance in the future. The good news is that developments in liposuction have transformed this surgery, making it possible to reduce the invasiveness of the surgery and the resulting scar.
Following a detailed analysis of different aspects–such as the state of the skin, quantity of excess fat tissue, tonicity of the abdominal muscles, and general morphology of the patient–two types of surgical options can be proposed:

  1. An isolated liposuction
  2. A complete abdominoplasty.

Isolated liposuction

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Abdominoplasty (Tummy Tuck)

An isolated liposuction will be insufficient in cases where important lesions of the skin, stretch marks or scars are present. In those cases a classic abdominoplasty can solve the problem.

Objectives and principles

The goal of this surgery is to remove the damaged skin (sagging or stretched) and to retighten the peripheral healthy skin. The excess of fat tissue can be treated by liposuction and the flaccidity of the abdominal muscles (diastases and hernia) can be corrected at the same time.

The most common abdominoplasty consists of the excision of the skin, corresponding to the whole or a part of the area located between the umbilicus and the pubis, according to a preoperative plan. The overlying healthy skin, located in general above the navel, will then be extended downwards, to obtain an abdomen with good-quality skin.
The umbilicus is preserved and replaced in its normal position. This surgery always leaves a hidden scar, generally located at the higher edge of the pubic area with bilateral extension. The length of the scar depends on the amount of skin that needs to be excised.

Before the surgery

A preoperative assessment is carried out, in accordance with Federal regulations. A consultation with the anaesthesiologist will be organized at the latest 48 hours before the day of the surgery. Drugs containing aspirin must be stopped 10 days before the surgery.

Types of anaesthesia and hospitalisation

1. Types of anaesthesia

An abdominoplasty almost always requires a traditional general anaesthesia, however a mini-abdominoplasty can be practice with sedation and local anaesthesia.

2.  Hospitalisation

The duration of hospitalisation varies from one to four nights. Mini-abdominoplasty generally does not require a hospitalisation.

The Surgery

There are some principles to understand:
The length of the incisions (corresponding to the future scars), is determined by the localisation and the amount of the skin to be excised. The excess of fat tissue is extracted by liposuction and the abdominal muscles are tightened together to reach a certain tension. At the end of the surgery a modelling bandage is applied. The duration of the surgery varies between 9O minutes and 3 hours, according to the preoperative plan.

Postoperative care

Dressings are used for two weeks after the surgery. I advise wearing a Lycra leotard for two to four weeks, day and night.
Patients should be prepared to be out of work for two to four weeks.

The scar is often visible during the first three months, then it flattens and improves over one to three years. Avoiding direct sun exposure to the scar is highly recommended during at least three months after the surgery. Sports, sexual and physical activity can gradually be resumed over six weeks.

Most patients are satisfied with the immediate result, however the final result can only be judged one year after the surgery. A proper follow-up is guaranteed by regular consultations every three months over one year.

Imperfections

Imperfections are related particularly to the scar that can sometimes be too visible, and even asymmetrical. In certain cases, the scar can become widened, thick and keloid. The navel can be imperfectly exteriorised and can lose its natural shape. Finally, a slight lift of the pubic hair can be observed in patients with a large excision. These imperfections are in general accessible to a complementary treatment carried out under local anaesthesia from the 12th post-operative month.

Possible complications

An abdominoplasty, although carried out for aesthetic reasons, is an important surgical procedure which carries the risks related to any medical operation. It is necessary to distinguish the complications related to the anaesthesia from those related to the surgical procedure.

With regard to the anaesthesia, the anaesthesiologist will inform you about the anaesthetic risks. It should be known, indeed, that the techniques, the anaesthetic products and the methods of monitoring have made immense progress these twenty last years, and currently offer optimal safety.

Concerning the surgical procedure, the risks are minimized by choosing a qualified surgeon.  The complications that can arise during this procedure include:
Thromboembolism (phlebitis, pulmonary embolism, etc), although overall rather rare, is among the most serious complications. Rigorous precautionary measures are used to minimise these incidences. These include, the use of anti-thrombosis agents, early mobilisation and if needed anticoagulant treatment.
Haematoma, in fact rare, can justify a drainage in order to avoid a secondary deterioration of the aesthetic result.
Infection, which is very rare, will require a surgical drainage and an antibiotic treatment.
Seroma, the most common complication, can be observed from the 8th day and results from the collection of lymphatic liquid. It can be simply aspirated generally without any particular after effect.
Localized cutaneous necrosis is very rare and results from excessive tension in certain areas.
Decrease of the sensitivity of the sub-umbilical area can be observed, but this returns within three to 12 months.
Finally, a delay on the wound healing process can be observed in diabetics and smokers.

Conclusion

The treatment of the abdominal wall can be performed by one or a combination of several techniques including liposuction, excision of fat and skin and reinforcement of the muscular wall. The best technique is chosen by the surgeon and the patient, who should have a full understanding of the procedure and its potential complications. Once the surgeon’s skills are put to work, in the vast majority of cases, patients are very satisfied with the results for many healthy years to come.