Aesthetic Plastic Surgery Blog

I am often asked how do I determine what patient is a candidate for Mini Tummy Tuck as opposed to a Full Tummy Tuck or Abdominoplasty. In examining a patient several factors are assessed to make this choice.

What is the laxity of the abdominal muscles and where is it located? If it occurs primarily in the lower abdomen below the umbilicus, then a Mini Tummy Tuck may be considered. If muscle tone is poor for the entire abdomen then a Full Tummy Tuck is usually indicated.

Where are the areas of fat and loose skin located? If these are just in the lower abdomen, then again the mini tummy tuck might be chosen. A Full Tummy Tuck requires repositioning of the umbilicus but allows tightening of the skin in the upper abdomen. In the typical Full Tummy Tuck most or all of the skin between the pubic area and the umbilicus is removed. Because of this the scar will be longer than in a Mini Tummy Tuck. However with proper planning, I am able to locate the scar within a typical two piece bathing line.

Liposuction is usually done with both procedures where indicated to define the waist and remove upper abdominal and anterior hip roll fat.

Frequently I will see patients who are unhappy with shape and contour of their breasts but do not wish augmentation of their size. When adequate breast volume is present a mastopexy or breast lift is indicated. Mastopexies attempt to lift the breast while preserving volume and reducing the skin envelope. Over the years I had become dissatisfied with the long-term results of primary mastopexies without implant placement. In my search for a better procedure, I met Dr. Ruth Graf of Brazil who developed an innovative technique of mastopexy which provides excellent long term results and in my opinion is better than other described procedures.

The Brazilian Mastopexy that I learned from her corrects breast ptosis for those patients who have adequate volume and do not require or desire the addition of a breast implant. In this procedure the nipple is moved to its new location while maintaining an attachment to the breast tissue. A portion of breast tissue in the inferior portion is then moved to the superior breast to correct ptosis and provide superior fullness. This tissue is maintained in its new position by a loop of chest wall muscle that acts as an anchor to provide a permanent long-term fullness

Recently a new buzzword has been making the rounds in the plastic surgery news--- A Mommy Makeover. Simply stated this is catch phrase for treatment of a particular group of women who are seeking plastic surgery to address the changes of age and pregnancy. Many women desire figure rejuvenation after multiple pregnancies. These include improvement in breast size and shape, removal of excess skin and stretch marks of the abdomen and fatty deposits of the hips and thighs.
Mothers who desire a return of their more youthful figures are wonderful candidates for combined procedures such as minitummy tuck and breast augmentation with selected liposuction of small areas. Frequently this transformation can be accomplished as an outpatient.

Breasts are, like faces, very dynamic. They start to grow when a girl enters puberty, which is variable and dependent on genetics and nutrition, and for some women, breasts don't complete their growth until the women are in their thirties.

For other women, especially those with large breasts, some sagging is already evident by this age. These women should take care, wear supportive garments, and consider a breast reduction or breast lift.

In addition, breasts are very susceptible to life events. Pregnancy and nursing can cause breasts to swell and shrink, leaving them sagging. The most significant cause of sagging other than weight and gravity, is smoking. Women who smoke tend to lose elasticity in their skin, and this in turn contributes to the sagging of breasts. These women might profit from a lift combined with a breast augmentation, since the implant can provide structural support for the breasts. Women are advised to quit smoking before having their surgery as smoking can not only diminish the effectiveness of the operation, but slow healing and increase the risk of complications.

Dr. Linderman has decades of experience working with the effects of aging and can give personalized recommendations to you based on the effects age has had specifically on your body. Contact us today to set up your initial consultation

I am often asked how do I determine who is a candidate for liposuction as opposed to tummy tuck or abdominoplasty. This is a decision that takes experience and technical expertise. First a potential patient should seek out a board-certified plastic surgeon who has the ability and training to perform both procedures. If a doctor only knows how to perform liposuction, he is not equipped to recognize and select out those patients who would achieve a better result with tummy tuck surgery. Factors to consider in choosing liposuction or tummy tuck include the quality of the skin, the amount of fat to be removed and estimated skin elasticity. If the skin is of poor quality with many stretch marks, there is a significant risk that treatment with liposuction alone will result in excess skin or contour irregularities. The more fat removed, the more the skin must contract in the abdomen with the chance of a poor result. Tummy tucks address skin excess and quality problems with removal and tightening of the remaining skin. Frequently liposuction is combined with tummy tuck surgery to achieve an optimal result. A tummy tuck can be tailored to a patient’s contour problem. Depending on the examination a mini tummy tuck or a full tummy tuck may be recommended. More on this choice at another time.

Incisions will vary depending upon the type of tummy tuck being performed i.e. mini tummy or full tummy tuck. These differences will be addressed at another time. My personal philosophy is that the location of the scar should be optimized for all patients. The idea is to hide the scar and keep it as low as possible so it does not show in a small two piece bathing suits. Ideally the final scar should be located no more than a little over two inches above the top of the vagina. The initial incision is marked pre operatively to take into account the tension on the final closure and allow for the final scar to rise higher. Occasionally a small vertical component may be added to the transverse scar in order to maintain the longer scar in the bikini line. Pre operative surgical marking can be done in the desired bathing suit to determine the final location of the scar. Although the scar will extend from hip to hip in a full tummy tuck, this part usually heals quite well and can be covered by the lateral band of most swimsuits. It is a geometric fact that the more skin taken out, the longer the scar. However scar extension can remove additional skin and fat. In some cases a circumferential or belt lipectomy can achieve a dramatic result. More on body lifts at another time.

Over the past ten with the explosive growth of cosmetic surgery procedures, it has become increasingly difficult to tell who is qualified to perform what procedure. As a consumer, the choices have become more difficult and blurred. There has been a dramatic increase in the competition for elective cosmetic surgery fueled by the declining reimbursements for insured procedures. This has led to a huge influx of unqualified practitioners from other medical specialties and also non-medical personnel to compete for the cosmetic surgery patient. How is a consumer to choose?



I would suggest the potential patient seek out the answers to two questions.

1. Is the doctor board certified in plastic surgery? There are many certifying boards but only the American Board of Medical Specialties defines a specialty and certifies the type and length of training of a doctor to achieve certification but one the boards that it recognizes. The American Board of Plastic Surgery is the only recognized board for training is all aspects of plastic and cosmetic surgery.

2. Does the physician has privileges to perform the procedure you are interested in by your local hospital? This is important as many unqualified physicians may perform a procedure in their office or surgery center but are not deemed qualified by their training to be granted privileges in your hospital. Most hospitals will meticulously review a physician’s training and require board certification before granting privileges to perform various procedures.