Thinking about getting a tummy tuck? If you’ve been wondering “what is a tummy tuck,” you’ve come to the right place. We sat down with Plastic Surgeon Dr. Shlomo Widder to get the full scoop on tummy tucks.
Q&A with Dr. Shlomo Widder
Read the Q&A with Dr. Shlomo Widder as he answers questions like “what is a tummy tuck” and beyond.
Q: What is a tummy tuck?
A: A tummy tuck is a cosmetic surgery procedure that helps to create a slim abdomen appearance.
There are several factors that cause the tummy to appear pudgy or saggy. Sometimes, it’s due to weight fluctuation, pregnancy, or even genetics. Although core exercises can greatly improve the abdomen, it may not be enough to achieve the chiseled form you want. During tummy tuck surgery, sophisticated tightening techniques will be used to remove excess skin and unwanted fat, as well as muscle tightening for a slender figure. However, prior to your procedure, Dr. Widder will sit with you to discuss all your cosmetic concerns and desires to create a treatment plan that will yield the best results possible.
Click here to view some incredible before and after photos, like the one below.
Q: What happens during a tummy tuck? What can patients expect?
A: There are two approaches to a full tummy tuck. They are:
- Skin Tightening Only
- Skin and Muscle Tightening
I do literally only the skin and muscle tightening variety. After having children, during pregnancy, both the muscle and the skin are getting stretched, so you need to remove the excess skin and bring the muscles back together. You have to do what we call “plication” to tighten them back up. And there are also different techniques in that regard.
I use permanent sutures and I run them continuously from north to south. Then, if necessary, I also stitch them horizontally, in the lower and upper abdomen. Why? Because a baby is 3-dimensional. During pregnancy, the stretching of the muscle is sometimes in three dimensions. That’s why you need to tighten it sideways, from north to south, horizontally, and up and down. Not many doctors do the horizontal stitching; I’m one of the few who do horizontal. I use it quite frequently.
Here’s how it works: After completing tightening the muscles, I pull the skin all the way up to the ribs, to the costal margin. And then I bend it, flex it, and pull the skin down as much as possible. The goal is to bring the hole of the bellybutton all the way down to the pubic area so the patient doesn’t have a scar in the middle of their lower abdomen. And then I do quilting sutures, meaning I put multiple dissolving sutures all the way from the ribs to the groin area and the pubic area. The purpose of this is to combat fluid buildup.
An important part of the muscles tightening, I stitch it to the pubic bone to prevent unwanted tissue bulge. Unfortunately, I’ve seen a lot of tummy tucks where this technique is not used, and it results in the patient’s pubic area bulging out, almost like a man’s crotch. Women do not want this and find it very unattractive.
Once I stitch the skin to the pre pubic fascia, I find out the location of the bellybutton and mark it, cut a hole, and remove the fat as well. Then I stitch the bellybutton to the new location, to the new hole in the skin. That’s the new bellybutton – the way it’s being seen when the patients stand up!
Once I’m done with the bellybutton, I then completely stitch the skin to the groin and pubic area. I use very strong dissolving sutures between the fascia of the skin and the fascia of the groin and pubic area. Then I stitch the skin with dissolvable sutures under the skin – little subcutaneous stitching – so no sutures need to be removed. It’s very nice. The patients love it.
Q: What is a drainless tummy tuck?
A: My tummy tucks are what we call “drainless” tummy tucks. There is no drain, and that’s very attractive because not many doctors are doing it. A lot of patients love the idea of a no-drain tummy tuck.
If you don’t drain or quilt stitch the skin during a tummy tuck, there’s fluid buildup. As the fluid is building up, it separates the skin from the muscle underneath and can actually compromise the patient’s circulation. It’s also very uncomfortable! Imagine walking with jiggling fluid in your belly. It’s very uncomfortable and it’s painful.
So the old technique was the drained tummy tuck with a catheter, to deal with that fluid buildup. The new technique – which more and more people are doing – is the drainless tummy tuck, often referred to as the stiches quilting tummy tuck.
Q: Is there anything a patient can do to ensure they get the best results from this procedure?
A: Well, losing weight is important, because then I can tighten the abdomen optimally. If the patient is overweight and there is a lot of fat inside the belly, then I cannot tighten them as much as I would like to.
Here’s what happens if you tighten too much: the fat gets pushed up into the diaphragm and into the lungs, and the patient can’t breathe.
The way I determine how much to tighten is with the anesthesia machine. I take a look at the anesthesia machine and look at the pressure the machine has to exert to push air into the lungs. When it reaches a certain level, I don’t tighten anymore. Usually the way I do it is 25 centimeters of water pressure. When that pressure is reached, I don’t tighten the patient anymore and that’s the endpoint.
Q: How do you know if you’re a good candidate for a tummy tuck?
A: The best candidates for tummy tuck surgery are people in good health, who are at or at least near their desired weight. Keep in mind that tummy tucks are not meant as major weight loss surgeries like bypass. Tummy tucks are meant to help tone and shape the midsection. Here are a few signs you may be a good candidate for a tummy tuck:
- Excessive skin around the bellybutton
- Weakened abdominal wall muscles
- Sagging or loose skin on the abdomen
- BMI below 35
The most common reasons I see people coming in for tummy tucks are wanting to tone the tummy after significant weight loss or childbearing. Those are the most common reasons people do it.
Q: So tummy tucks are more for toning than weight loss?
A: Exactly. A tummy tuck is not really a weight reduction surgery. A weight reduction surgery is more things like bypass surgery, lap band, things of that nature. Tummy tucks are mainly to improve the patient’s appearance, self-esteem, confidence, and attractiveness. As a side benefit, they can also lose weight. Now, obviously, they have to pay attention to what they eat. I always tell them, “Pay attention to your body.” So if the patient feel there is too much in their stomach, they should stop eating. If they continue to eat, they will gain weight. So if they pay attention to the pressure in the stomach and they stop eating when they feel full, they will lose weight.
Obviously, there are some people who are obsessed with eating, and they will gain weight. However, even though they gain weight, their results are still phenomenal.
There was a patient I’d done surgery on about 3-4 years ago. I removed about 20 pounds of skin and fat from her body – can you imagine? Twenty pounds! And she looks fantastic. If you see the pictures, you won’t believe your eyes. She’s still flat. But she gained weight and so she came to me and we are now planning to do liposuction. But the stomach is still phenomenal – flat, totally flat.
Q: How do your patients tend to feel after a tummy tuck?
It’s amazing. I’m telling you, it’s just like a miracle what happens to these people. They look fantastic and their confidence soars. In French, we call it “joie de vivre.” You know what this means? A joy of living. Yes, they definitely know how to enjoy life; they have the joie de vivre.
Q: Do men get tummy tucks?
A: Absolutely! While most of my tummy tuck patients are women, we do have men come in from time to time. Because, you know, men want to look good, too! So it’s just as helpful to them.
I’ve seen a lot of men who do excessive heavy lifting come in for tummy tucks. Sometimes when men do a lot of heavy lifting without protective gear – like a protective leather belt – there is separation of the muscle, like in pregnancy. I recently had a male patient come in for a tummy tuck for that exact reason. Obviously, he didn’t have children or a history of significant weight loss. When I asked him if he did heavy lifting in his youth, he said yes. And that was the reason he had a need for the surgery.
Q: Other than improved appearance, what are the benefits of a tummy tuck?
A: There are quite a few benefits. For example, the posture improves. They stand up straight. Plus, it takes off pressure from the lower back. So think about your lower back; by standing up straight, that reduces the strain on your lower back. Also, by tightening the abdominal muscles, it helps to stabilize the back. So it’s very helpful for the back overall.
I had one patient who spent thousands and thousands of dollars on a chiropractor and CAT scans because of her lower back pain. Once she had the tummy tuck, she didn’t need to see the chiropractor anymore; the pain disappeared. It was incredible.
Another benefit is weight loss. When you tighten those muscles, you can’t eat too much food, because it fills you up excessively. Eat too much and you’ll feel sluggish and uncomfortable. That’s what happens after a tummy tuck: patients don’t eat as much and they don’t feel as hungry.
We get hungry in two ways: one is chemical, the sugar level. Your sugar levels drop in the bloodstream, making you feel hungry. The other way we get hungry is mechanical, meaning the pressure in the stomach. In the stomach we have special nerve cells called baroreceptors. These baroreceptors measure pressure. When the pressure is high, they tell the brain, “Stop filling me up! I’m full.” When the pressure is low, they tell the brain, “Fill me up. I’m hungry!” The brain is not sophisticated enough to tell the difference between pressure from food or pressure from muscle tightening. So we basically fool the brain when we tighten the muscle; the brain simply thinks we get full faster. Then the patient doesn’t eat as much anymore and they lose weight.
I had one patient who lost 55 pounds after her tummy tuck procedure. She came in and we didn’t recognize her! We thought she had come in for another surgery, but she had just come in for a follow-up. The results were truly amazing.
Q: How long does tummy tuck surgery take?
A: Tummy tucks are outpatient procedures. The surgery itself varies from patient to patient, according to the amount of skin and fat, and the amount of muscle laxity. It typically ranges from 3.5 hours to 4 hours, although the longest one I’ve ever done took about 6 hours. It’s not a very long surgery, and it’s very safe. But again, it does vary from one patient to another.
Q: What is recovery like after a tummy tuck?
A: Tummy tuck recovery differs from person to person and really depends on what that specific patient is doing. If you have a desk job, you can usually return to work after one week. If it’s something more taxing, it takes 6-8 weeks to return to work.
For example, let’s say you’re a cook. At work, you have to lift up bowls, boxes, and containers of food and supplies. I would simply tell you, “Have someone else do it for you during your recovery.” Because that’s the most important thing: recovering well. It’s a big investment in yourself and you don’t want to mess it up by stretching the muscle and then losing the flatness.
Q: What are the typical restrictions during tummy tuck recovery?
A: Restrictions tend to all relate to movement. For example, typical restrictions include no sex for 6 weeks and no working out at the gym for 6-8 weeks. However, you can go to work, but going to work also varies according to your personal threshold for pain tolerance. I had patients who went back to work after 3 to 4 days, and I also had patients who went back to work after 2-3 weeks. However, the majority – the average – is about a week.
I have also noticed that patients who own their own business tend to return to work sooner than patients who do not.
Q: Is this a procedure that requires maintenance?
A: No, once the tummy tuck is done, you don’t need maintenance or any other surgeries to keep it looking good. The only exception is if you get pregnant again – then you might have to redo a tummy tuck.
I had a patient who got a tummy tuck and looked so good, and she didn’t opt for tubal ligation and got pregnant, so I had to redo her tummy tuck. Obviously it was a while later, but that’s one of the possibilities of maintenance.
The other one is a need for liposuction. Now, only 10 percent of my patients who have tummy tucks request liposuction, because many of them lose weight and they’re very happy with the way they look. If they want additional help and thinning of the skin, then you can do the liposuction. I usually wait 2-3 months for their weight to stabilize and then I will do liposuction and a redo tummy tuck for them.
Q: Are there any medical conditions that might disqualify someone for a tummy tuck?
A: Well, one of the criteria for doing the surgery or accepting the patient for surgery is their BMI, which is Body Mass Index. My limit is 35, so if the patient’s BMI is over 35, I recommend to them to lose weight. BMI is just a recommendation because if most of the fat is in the stomach, then I don’t recommend the surgery.
I always check the patient’s stomach before making a final recommendation. If the stomach is flat, they’re an excellent candidate for the surgery. If the stomach is bulging, that means they have too much fat inside the stomach, and I won’t be able to tighten them optimally.
If you have any medical issues, you must be cleared by your family doctor or your specialist, whether that’s a cardiologist, neurologist, endocrinologist, or whatever you may need. Safety is our No. 1 priority here, so we take this very seriously.
The home page of our website says “Quality is our niche, beauty is our forte, and safety is our priority.” Safety really is our #1 consideration. We have to make sure that the patient will be safe.
If they have any risk – diabetes, asthma – they must be cleared for surgery by their doctors.
Also, every patient over the age of 45 must be cleared by their internist. As you get older, the risk of complications does increase, and you don’t want to take the risk of having any complications.
Cosmetic surgery, you want to have it; you don’t need to have it. It’s not like you have appendicitis and need surgery immediately. Surgeries like that, you have to have. On the other hand, cosmetic surgery is something you want to have, so you want to reduce the risk and complication rate to a minimum.
That’s why, for example, I won’t do a tummy tuck with breast augmentation. Some doctors do it, but I will not do it. Why? Because they are painful operations and the patient lies in bed and doesn’t wanna move. They don’t drink because they’re afraid to go to the bathroom – and then they get blood clots.
There were also studies showing that if you do tummy tuck with other procedures, especially liposuction – it can be dangerous. There are some doctors that do tummy tuck and liposuction at the same time. I don’t, because there was a recent study in the Plastic Surgery Journal about this exact thing. The data was obtained from insurance companies that only cover cosmetic surgery cases. They revealed that combining tummy tuck and liposuction increased the severe complication rate 10 times higher than tummy tuck alone.
In Florida it’s illegal to do tummy tuck and liposuction over 1000 CCs. Under 1000 CCs, it’s okay, but beyond 1000 CCs it’s forbidden by law. The reason is that there were too many complications and deaths from that combination.
If you do tummy tuck with another procedure, the risk increases as well, though not as much – about 2-3 times higher. So that’s the reason I won’t do tummy tuck with breast augmentation.
Now, if you do tummy tuck and breast lift, that’s okay, because breast lift is not painful. If you do tummy tuck and eyelid surgery, that’s okay because that’s not painful.
The additional limiting factor in my practice is the surgery time, so I don’t do anything over 6 hours. Why? Because by the anesthesia society recommendation, surgery over 6 hours increases the complication rate significantly. Again, safety is our #1 priority and I’m committed to keeping all of our patients safe.
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What is a tummy tuck? | Widder Cosmetic & Plastic Surgery Center – Vienna, VA