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Surgical Techniques for Abdominoplasty

There are many techniques available for the Tummy Tuck based upon your needs and goal.





John Q. Cook, M.D.

Chicago 312-751-2112
Winnetka 847-446-7562

Tummy Tuck Techniques – Learn more about the High Lateral Tension Abdominoplasty

Three Layers of Support

The high lateral tension abdominoplasty involves a three layer restoration of abdominal support. The deepest layer involves the sutures that bring the rectus muscles together. Next is a firm layer of tissue known as the superficial fascial system, which forms a layer of support between the skin and the muscles. This layer is extremely important for the quality of the result in that it helps to tighten all of the outer layers of the abdomen. The final layer is the skin.

In the classical form of this operation, Dr. Cook designs the scar so that it sits low in the bikini area then curves up toward the hip bones. There is no set pattern to the length of the scar; it is determined during the consultation, when Dr. Cook notes the degree of looseness in various zones of the abdomen. In most cases Dr. Cook can design the pattern of incision so that the scar will sit within the pattern of the patient’s preferred swimsuit or underwear.

Surgical Technique

During the surgery Dr. Cook will make incisions according to the pattern that he and the patient have mapped out. Next he will undermine the skin and underlying fat in the zone that he plans to excise.

He will then undermine a much narrower section in the center of the abdomen that surrounds the umbilicus and continues up to where the abdomen ends at the ribs. He then frees the umbilicus from its attachment to the skin but leaves it attached internally. This provides a good view of the gap that has developed between the rectus muscles, so that Dr. Cook can restore the muscles to their proper position with precision and security.

A complete repair of the muscles is performed, both in the upper and in the lower abdomen. This complete repair is very important, since it prevents the unfortunate bulge that develops in the upper abdomen when only the lower muscles are repaired.

Dr. Cook will now determine the optimum amount of skin and fat that he will remove from the lower abdomen. This may involve just a portion of the lower abdominal skin or when there is significant looseness the resection may extend to the old level of the umbilicus or even above that. Once the excess skin and fat is removed, the upper and lower borders are brought together so that the scar lies along its planned path along the swimsuit line.

At the time of closure two important steps are carried out. The new location of the umbilicus is marked on the skin and the umbilicus is reattached to the skin at that point. Liposuction is carried out in portions of the abdomen as well as in the flanks. The opportunity to carry out liposuction at the time of the abdominoplasty is an important advantage of the high lateral tension technique.

The Extended High Lateral Tension Abdominoplasty

For patients who have extensive looseness that involves not just the front of the abdomen but the waist and flanks as well, the extended version of the procedure can be very helpful. The scar starts low in the abdomen, then curves up toward the hip bone, and then extends toward the back. Recovery is similar to the classical operation.

The Low Scar Variant of The High Lateral Tension Abdominoplasty

Current fashion emphasizes a relatively low cut to swim suits and other clothing. Dr. Cook has modified the classical operation to meet the needs of patients who wear their clothes at this level. The incisions are designed so that the scar sits at a lower level than it would with the classical high lateral tension abdominoplasty.

The Superficial High Lateral Tension Abdominoplasty

Some patients have lost tone at the level of the skin, but not at the level of the deep fascia and muscles. For these patients Dr. Cook follows the pattern of the high lateral tension technique for the skin excision, but he does not need to put stitches at the deepest level of the muscles. This results in a much easier recovery for the patient. Just as in the full technique a precise tightening is accomplished in the outer layers, the superficial href=”/breast system and the skin. Liposuction can be combined with this technique as in the full operation. For most patients Dr. Cook will reposition the umbilicus, but when he removes only as small amount of skin, the umbilicus maintains its original position.

Liposuction (Lipoplasty) With Lower Superficial Abdominoplasty

This operation is ideal for the patient who desires liposuction to correct areas of resistant fat in the abdomen and the waist, but who has moderately diminished skin tone in the lower abdomen. Liposuction alone by any technique in a patient such as this will further destabilize the skin tone and potentially result in unattractive wrinkles or folds. Fortunately there is a good solution to this dilemma. Dr. Cook will carry out a liposuction procedure using the Vaser® or other advanced technology and adjust the skin tone with a limited removal of skin in the lower abdomen. The scar sits low and in many cases can be kept relatively short.

Posterior Body Lift and Outer Thigh Lift

For some patients there is significant looseness of the body that extends all the way around to the midline of the back. Usually these patients have lost significant weight. For motivated patients a beautiful shape can be obtained around the entire mid body (front, sides, and back) with a two stage procedure.

In the first operation Dr. Cook carries out a high lateral tension abdominoplasty. After the patient has recovered from the first procedure Dr. Cook carries out a posterior body lift, which begins where the abdominoplasty left off and ends at the midline in the upper buttock region.

Dr. Cook has found that the recovery from this two stage procedure is much easier that when the front and back of the body lift are carried out in a single massive operation.