Tummy Tuck Troubles? How We Keep Patients Happy
At least once a week, I will see a patient who’s had a tummy tuck performed elsewhere and is now seeking a revision.
I never disparage another physician’s work. I know, without a doubt, that everyone does their best to make a patient happy.
The art of tummy tuck is inexact. Different surgeons have different training, styles, and different approaches. Sometimes all it takes is a tiny tweak here and there to make that patient happy. Sometimes, it can be an entire revision of the tummy tuck. For some, all that is needed is an explanation of why they are seeing the result they are seeing.
That said, what follows is, what I consider, my approach to doing my best to keep my patients happy after their surgery.
My consults are very detailed and involve a list of the things I feel can or cannot be accomplished.
Many patients have unrealistic starting goals. A patient with a markedly elevated BMI can be made more streamlined but cannot be made flat. The body is more intelligent than the doctor, and what is inside the body, more so inside the abdomen, will determine how flat that tummy will stay.
If I am not honest and transparent with a patient from the outset, that patient will only be disappointed further down the road.
Making a sound plan
I will always give my patients my best, heartfelt advice.
Many patients arrive with a preconceived notion of what they want, often gleaned from the very dangerous internet. They may not be aware that what they feel they want will not necessarily accomplish their goals.
Most people start out wanting liposuction for their postpartum abdomen. At the right age, for the right patient, liposuction is terrific, but in the postpartum mother with loose skin, liposuction will only make the skin looser.
Many people come in wanting a mini tummy tuck which is an appropriate option for the right patient. However, it will barely accomplish half their goals and perhaps look worse for the wrong patient.
I have seen surgeons take the wrong path, pressured by their patients, only to regret it later. It is better not to operate when you don’t feel you’re doing the right thing.
It is essential to discuss scarring with patients.
All plastic surgeons will do their best to make beautiful scars. But without question, genetics play a role. I always ask my patients if they would have a tummy tuck if the scarring were unaesthetic. It is the safest and most honest way to proceed.
Thankfully, most patients create good scars, but occasionally patients may have thick or hypertrophic scars, which is most common in patients with darker skin tones.
Keloid scars are exceptionally rare, and as of this writing, I have never seen a true keloid in a tummy tuck.
Each plastic surgeon will have different techniques to accomplish their goals. Here are a smattering of mine:
- A smooth and graceful incision – I don’t know why but some surgeons will make a zigzag of the scar, particularly over the pubis. I’ve never liked that. I don’t find it aesthetic, and I think it draws the eye. I favor an incision that looks more like the “wings of a seagull” as it travels over the leg holes in the patient’s underwear or bathing suit.
- Plus or minus HIP liposuction – Not every tummy tuck requires liposuction. I call it as I see it. I might suggest it if bulging is there that draws the eye, but when the curves are already there, I might recommend that the aesthetic curves of the hips are left alone.
- Evening up the pubic area – Many patients have fatty fullness in the pubic area. During almost all my tummy tucks, I will remove some fat from that area to make the area flatter. The lower edge of the tummy tuck is often adjusted so that the two line up as smoothly as possible. There is a limit to what we can safely remove in the pubic area, but this makes a huge difference and one not to be ignored.
- Belly button size – To this day, patients come to me with overly enlarged belly buttons from other practices. Making a large belly button small is not usually gratifying unless that patient can undergo a second tummy tuck. Prevention is the key, and I favor small belly buttons. Small belly buttons can always be made bigger, but I find them less eye-catching and overall better looking.
To me, a tummy tuck requires an aesthetic eye, aesthetic surgical judgment, but perhaps most importantly, clear and common sense communication.
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Dr. Adam G. Tattelbaum, MDPC, is a double-board certified plastic surgeon. He enjoys the process of teaching his patients as much as he loves performing surgeries.
October 14, 2022 8:21 am