Dr. Bailey has been a practicing plastic surgeon for over 24 years (since 1988). In addition to practicing plastic surgery for nearly 25 years, he has experience as an academic surgeon at the University of Toronto, lecturing about plastic surgery. He now has an office in Newport Beach, CA where he specializes in the following surgeries:
- Breast surgeries (implants, lift, reduction, etc.)
- Facial Reconstructive Surgeries (rhinoplasty, face lift, brow lift, eyelid surgery, etc.)
- Tummy Tuck
Dr. Bailey is board certified by the American Board of Plastic Surgery, as well as being an active participant of the American Society of Plastic Surgeons and the American Society of Maxillofacial Surgeons. He has published roughly 20 scientific papers and given 50 scientific presentations to various plastic surgery groups.
Without further Ado, here is our interview with Dr. Bailey about Tummy Tuck Surgery:
1. Please talk a little bit about tummy tuck recovery time. What can patients expect after surgery? How does the recovery progress from the first week after surgery, weeks 2-4, and 5+? Consider bruising, swelling, time needed off work, time before the patient resume working out, etc. What tips/advice do you have to help the healing process?
I almost always do a major tightening of the abdominal muscles, and use a pump after tummy tuck surgery, that pumps local anesthetic into the tummy muscles and cuts down on the pain, so my patients’ experience may not be typical. I also have patients stay overnight in hospital (I use Hoag Hospital in Newport Beach), so that they can get IV pain meds and/or anti-nausea meds if they need them.
The patients go home with the pain catheters in place, and drainage tubes, connected to squeeze bulbs. Because the skin is pulled tight, patients typically sleep propped up for 1 – 2 weeks, and cannot stand up completely straight for 2 weeks. During the first week, they have to move slowly and carefully to get out of bed, take a walk, climb stairs, etc. Patients typically are off prescription pain meds at 2 weeks, and able to drive. The pain catheters come out at about 4 days post surgery, and the drains at 1-2 weeks. Bruising and swelling are generally very mild.
Weeks 2-4 bring increased mobility and decreased pain. Patients often use over the counter pain killers like Advil™ or Aleve™ during this period. Swelling is usually mild, and when the drains come out, patients “graduate” from a wrap-type abdominal binder to a panty girdle. Most patients go back to office type work at about two weeks.
At 4 weeks, patients can start aerobic exercise, but I recommend no heavy lifting (greater than about 15 lbs) for 6 weeks. Long term, I recommend patients avoid abdominal “crunches”, because of the risk of tearing the muscle repair and of spinal disk injury. (Straight leg raises are a good, low impact substitute to tone the abdominal muscles.)
Patients help the healing process by preparing for surgery:
- No smoking or drugs
- Stabilize weight at a level that can be maintained long term, no severe dieting before surgery
- Avoid things that cause bleeding – aspirin, NSAIDS such as Advil™ and Aleve™, but also high dose vitamins and herbal products
Following instructions after surgery (e.g. icing the area, proper use of the binder, taking medication as instructed, proper positioning and activity restriction)
- Letting the surgeon know about any problems promptly
- Not forcing the pace of recovery (patients who try to do too much too soon usually end up recovering more slowly)
- Protecting incisions from the sun, to avoid scar discoloration
2. One of the main downsides of having a tummy tuck are the fairly large scars the surgery can leave behind. What are some of the latest techniques plastic surgeons use to minimize the appearance of scars? How long do they take to fade, and how well to they typically fade? What can patients do to minimize their appearance?
- Proper scar placement in relation to the natural skin lines and the patient’s clothing choices. (I mark the incisions with the patient’s input on the day of surgery. Often they will bring in a favorite swimsuit or panty to help pick the right scar position for them
- Closure with internal stitches only, using a synthetic absorbable suture material that lasts for 4 to 6 months, to minimize scar widening.
- Keeping the incisions taped with elastic wound strips (the older, non-elastic strips many surgeons use are prone to cause skin blistering)
- Frequent follow up visits, to identify any scar problems early, and use of silicone scar sheeting to smooth any scar that is less than perfect
- Use of SPF 50+ sunblock on the scars if the patient is wearing lighter clothing, to avoid scar darkening (a white T-shirt for example is only about SPF 5)
3. What is the main complaint by women who are less than fully satisfied with their tummy tuck, and how can patients avoid this disappointment?
The main complaint I hear in patients who come for a second opinion is improper scar placement, sometimes combined with thickened scars. Obviously, pick a board certified plastic surgeon who does tummy tucks frequently, look at their photographs of previous patients, and make sure your incision is customized according to your wishes.
The complaint I hear most often in my own patients is prolonged, mild swelling in the lower abdomen. This is due to the lymphatic drainage of the abdominal skin flap being interrupted by the incision. It can take up to a year to resolve. Until it does, it can be managed by wearing a panty girdle, avoiding things that cause fluid retention such as salt and MSG, and avoiding excessive work-outs and prolonged standing.
4. For patients with lots of extra fat around the mid section, when is a tummy tuck a better option than liposuction, and vice-versa?
Liposuction removed fat, but causes minor or no skin tightening, and does not tighten the muscles. So tummy tuck is a better option when there is loose skin or borderline skin tone, or when the “abs” (rectus abdominis muscles) have been spread apart by pregnancy or major weight gain in the past. (This is called a diastasis recti, and cannot be corrected by exercise) In the rare patient who has good skin tone, but needs a muscle repair, the fat can be removed by liposuction and the muscle repaired through a scope. (Endoscopic abdominoplasty).
5. What if you get pregnant again after having a tummy tuck? What are some of the complications that can result from this – will this reverse all the cosmetic improvements from the surgery?
I never do a tummy tuck on a patient who is still considering further pregnancies. I have never had this happen to a patient of mine, and there are few reports in the medical literature. They do report successful completion of pregnancy.
I would expect it to have the same effect as massive weight gain after tummy tuck – The muscle repair stretches out, often with more stretching in the upper abdomen and waist area, and there is some re-stretching of the skin also. Because the shape of the tummy, it is often difficult to keep pants up at the waist, when this happens. Unless the initial tummy tuck was done for massive skin looseness, the appearance is likely to be worse than before surgery. A second tummy tuck could be done, but the results are not going to be as good as the first.