Tired of your Flabby Abs? Ever considered a Tummy Tuck?
MINI TUMMY TUCK With today’s life being mostly sedentary, is it any wonder that flabby abs are a common problem for so many of us? According to Dr Sanjay Parashar, Specialist Plastic Surgeon and Founder and Director of Cocoona Centre for Aesthetic Transformation, flabby abs are caused by fat accumulation inside the tummy that pushes the muscle forward (Intra abdominal fat.) “It could also be due to fat accumulation under the skin that causes folds that you can pinch (extra abdominal fat), excess skin due to excessive stretching and fluctuation of weight, loss of muscle tone that bulges out and/or large sized organs such as stomach, a megacolon, or a fatty liver due to obesity related issues,” remarks Dr Parashar. Unfortunately, it is common in women, he adds, because of limited physical activity (less outdoor activity and less sports), improper food choice (chocolates, ice creams etc), post marital life style, weight fluctuation, hormonal changes, female hormones, pregnancy, and high incidence of thyroid dysfunction. “It is irrespective of age; if there is childhood obesity then it can cause flabby abs in early adulthood,” he explains and metabolically after age 35 to 40 years, the fat becomes more resistant, skin elasticity reduces and other factors supersedes. A mini tummy tuck, says Dr Parashar, is an outpatient procedure performed in a hospital under local anaesthesia and IV sedation. “An ideal candidate for this procedure is an individual with small to moderate excess fat, mild skin laxity and stretch marks below belly button and muscle laxity,” he says and it is not recommended for an obese patient with a large amount of intra-abdominal fat as they will not get satisfactory result. “Medical problems such as uncontrolled hypertension, cardiac disease and so on, can also be unsafe,” he explains as well as patients with a history of deep vein thrombosis or coagulation diseases as risks are very high. TECHNIQUE Dr Parashar says that this is performed with a short bikini line incision; “The lower abdomen is lifted and extra skin removed,” he says, while in another variant, the whole abdomen is lifted including the belly button and skin is pulled down, muscle is tightened and extra skin removed. “In the latter technique belly button is shifted few centimetres below,” he says. RISKS Risks like any surgery include bleeding, haematoma, infection, hypertrophic scarring, asymmetry, unevenness TIME the procedure takes approx 2 hours PAIN FACTOR Mini TT- Patient can return to work within 4-5 days and start exercise in 2 weeks time. It is more painful if muscle repair is required, hence needs rest and pain medications for 1 week. RESULTS Result is firm and flat well contoured tummy and waistline. EXTENDED TUMMY TUCK This procedure, points out Dr Parashar, is indicated for individuals with large amount of fat, excess skin folds in upper and lower abdomen extending on the sides, and/or very lax muscles. “An extended tummy tuck is performed under general anaesthesia. Regular TT stops at the hip bone, extended goes beyond that and can be used to lift the outer thigh as well. “An extended tummy tuck requires one to two days of hospitalization,” he says. TECHNIQUE The incision extends beyond the hip bone and sometimes to the back, notes Dr Parashar, if there is lot of saggy skin on the sides. “In this surgery muscle is repaired, large amount of skin and fat is removed, belly button is repositioned in a more youthful location,” he says. . The Incision is in the bikini line area and extends ensuring it is very low. The tummy can be contoured with simultaneous liposculpturing to remove excess fat and give 3 dimensional contouring. The skin is lifted off the muscle. Belly button is repositioned. The muscles are tightened, excess skin is removed and the skin is tightened and stitched in the bikini line area. The belly button is stitched in the new location. The stitches are all internal running under the skin that avoids hatch marks on the skin. RISKS- bleeding, haematoma, infection, skin loss, scarring, risk of anaesthesia, deep vein thrombosis etc TIME- approx 4 hours PAIN FACTOR Extended TT- It can take 3-4 weeks before going back to work, exercise after 6- 8 weeks RESULTS Result is firm and flat well contoured tummy and waistline. LIPOLYSIS There are three kinds of lipolysis procedure, Injection lipolysis/ Laser Lipolysis/ & Ultrasonic lipolysis explains Dr Parashar and lipolysis means breaking and liquefying the fat and it has to be removed from the body by liposuction to achieve quick result and long term result. “Laser lipolysis is the technique in which fat is liquefied by laser and removed with a syringe,” he says, pointing out, “It is indicated for small areas (zones) such as chin, neck, arms, love handles, inner thighs, outer thighs, ankles, calves.” It is possible to treat two to three zones in a single session. It may have to be repeated, stresses Dr Parashar, if multiple areas are involved or there is large volume of fat. TECHNIQUE- After anaesthesia laser wire is inserted underneath the skin and laser energy is delivered to melt the fat. The laser energy is of 1440 nm wavelength that is absorbed by water content of the fat which gets heated up and ruptures to liquefy the fat cells. Then a syringe with small (2mm, 3mm) cannulae is inserted under the skin and liquefied fat is aspirated. Local anaesthesia, small holes, lasering to melt the fat and syringe suction. RISKS- infection, laser burns to skin, unevenness, recurrence of fat TIME- 1-2 hours depending upon the zones PAIN FACTOR Pain is minimal recovery is quick, return to work in 48 hours. RESULTS Results in some area are visible in few days such as arms others may take few weeks. Optimum results can take 3-5 months. Ultrasonic Lipolysis is another form of lipolysis and Dr Parashar says in this, fat is liquefied using ultrasonic device and removed by gentle suction. “It is indicated for larger areas, tougher fat with overlying skin irregularities. It is for more dramatic contouring of the body,” he says. The best candidate is an individual of normal weight or an overweight patient in good health that needs reduction in belly, waistline, large thighs, back areas or multiple areas of the body. “It can also be done in selective obese patients who have large hanging tummy or hanging inner thighs that make it difficult to exercise,” he explains. TECHNIQUE-need more please This requires twilight anaesthesia (LA & sedation) for moderate areas or GA for multiple & large areas. It is performed in hospital with overnight stay. Tumescent anaesthesia is injected into the fatty layers for anaesthesia purpose. Then Ultrasonic probe is inserted under the skin. The ultrasound waves causes emulsification of fat due to three important mechanism- cavitation of fat cells, mechanical breakdown due to ultrasound waves and thermal liquification of fat. After complete emulsification with ultrasonic device the fat is removed by a cannula connected to low power vacuum machine (0.1 – 0.2 barr, unlike liposuction where the vacuum is utpo 1 atmospheric pressure). After the end of the suction the part is contoured in a 3 dimensional manner. No sutures are required. The area is bandaged for 24 hours then pressure garment is worn for 3-4 weeks. RISKS- infection, burns, skin loss, scarring, internal tissue damage, anaesthesia risks. TIME1-4 hours depending upon the extent required PAIN FACTOR Pain medications are required for 4-5 days. RESULTS The result is visible in a month time however it can take 4-6 months for complete remodelling.