Tummy tuck

Other patients may have developed excess skin and fat in this area as a result of normal ageing or following previous surgery. Many patients will have tried dieting or regular exercise to improve this area without success as despite their best efforts their tummy skin doesn’t tighten up. Some patients requesting tummy tucks may have scars from caesarean sections or other surgery on the abdomen and are unhappy with their tummy tissue overhanging the scar. Many patients find that the appearance of their tummies affects their confidence and can impact on their relationships.

Case 2: Before and after photos showing appearances from full tummy tuck (abdominoplasty) and liposuction to the hip/flank region in a patient who was unhappy with her tummy after having children. The scars are quite pink which is completely normal at this stage in recovery. It can take up to 12-18 months after surgery before the scars reach their final appearance (they generally become pale). 

Case 3: Before and after photos showing appearances from full tummy tuck (abdominoplasty) and muscle tightening for this mum. Appearances shown 6 weeks after surgery and the scars are already settling nicely but will ultimately become paler. The muscle tightening has flattened the tummy and brought the waist in. 

Case 4a: Before and after photos showing appearances from Fleur-de-Lys abdominoplasty (tummy tuck) and mons reduction/lift in a massive weight loss patient. This lady in her 20s lost more than 10 stone through dieting and exercise alone leaving her with a  large, hanging tummy. The Fleur-de-Lys abdominoplasty has tightened the tummy in an up and down direction and also from side to side. Internal muscle repair has helped to flatten the tummy.  

Case 4b. Before and after photos following Fleur-de-Lys abdominoplasty (tummy tuck). The after photos were taken 18 months after surgery showing how the scars have become pale and flat (arrow highlights scar around belly button)

Case 5: Before and after photos of a patient who had full abdominoplasty (tummy tuck) with muscle tightening (repair of divarication of rectii muscles) to flatten the tummy.

Case 6. Before and after photos showing the appearance of a patient who had Fleur-de-Lys abdominoplasty (tummy tuck) after massive weight loss. Patients are advised to avoid exposing their scars to strong sunlight for 1 year after surgery to avoid the scars becoming permanently tanned. This lady therefore covered the scars with tape so that they were protected from the sun. 

Case 7. Before and after photos showing the effect of a full tummy tuck for this mum. Having had a number of children, my patient was unhappy with the appearance of her tummy because of the tissue which hung over her caesarean section scar. Full abdominoplasty with internal muscle tightening gave her the flat tummy that she had not been able to achieve despite intense exercising. The scars will become paler over the next 1 year.

Case 8. Before and after photos showing the effects of a corset abdominoplasty (Fleur-de-Lys abdominoplasty). This lady lost 6 stone (38kg) and was left with loose skin and a prominent tummy that would not improve despite intense exercise. A Fleur-de-Lys abdominoplasty (tummy tuck) has tightened the skin. This was combined with internal muscle tightening (internal corset) which has flattened the profile of the tummy.

Case 9. Before and after photos showing the transformation that a full tummy tuck has made to this mum who was unhappy with the saggy skin and tissue hanging over her caesarean section scar. The skin would not tighten up despite an intense exercise regime. A full abdominoplasty (tummy tuck) and muscle tightening (repair of divarication) has flattened the tummy, enhanced the waist and removed the overhang.

 

Case 10. Photos showing appearances before and after tummy tuck (abdominoplasty) and mons reduction (liposuction in a lady in her 50’s. I have also tightened the abdominal muscles in order to help flatten the tummy (internal corset). The scar is pink which is normal at this stage in healing (6 weeks) and will settle to a paler colour over the next 12-18 months.

Case 11. Photos showing the appearances before and 6 weeks after full tummy tuck (abdominoplasty) with muscle tightening. This mum was unhappy with the appearance of her tummy after having children. Her main concerns were the roll of hanging tissue in the lower abdomen, the prominence of her tummy which made her feel like she still looked pregnant, and the fact she couldn’t wear the clothes that she wanted to wear. The composite image were the before and after photos have been overlaid shows how the patient’s waist has narrowed with the tummy tuck. 

Case 12. Before and after photos after tummy tuck surgery – This lady was unhappy with the prominence of her tummy and pubic (mons region) and the overhanging tissue after 10.5 stone weight loss through exercise and diet. She had a fleur-de-lys abdominoplasty with muscle tightening and mons reduction. Appearances are shown 8 weeks after surgery. 

Case 13. Before and after photos following abdominoplasty – This lady was unhappy with the prominence of her tummy and the excess skin/fat in the lower part of the abdomen which would not improve despite regular exercise and a controlled diet. The tummy has been tightened with a full abdominoplasty and internal muscle tightening. Result shown at 6 weeks after surgery. 

Case 14. Before and after photos after full tummy tuck and flank liposuction. This mum of three was unhappy with the overhang of her tummy and the prominence around the hips/flanks. Full tummy tuck and suction assisted liposuction of the hips/flanks with internal muscle tightening has improved her profile. Appearances shown 6 months after surgery. 

Case 15. Photos showing appearances before and after tummy tuck. Amazing transformation for this mum of 3 who had also lost 4 stone in weight through exercise and diet. She was unhappy with the loose skin and felt that her tummy was too prominent in clothing. A fleur de lys abdominoplasty with muscle tightening has improved her contour and confidence.  

Case 16. Photos showing appearances before and after tummy tuck. This mum of 4 was unhappy with the appearance of her tummy despite losing 3 stone in weight. Her main concern was the overhang which prevented her from wearing the clothes that she wanted to wear. The overhang has been removed with a full abdominoplasty. The rectus muscles have been tightened to give a flatter tummy and pulled in waist. Appearances shown 6 weeks after surgery. 

Case 17. Photos showing a lovely outcome from this mum from tummy tuck and muscle repair (repair of divarication). This lady was unhappy with the loose skin and had a wide gap between her six-pack muscles which would not improve despite physiotherapy and exercise. Her belly button was removed at the time of surgery and a new one reconstructed. Appearances are shown 6 weeks after surgery. 

Case 18. Patient selfie photos showing the early appearance following tummy tuck and repair of divarication (separation of rectus muscles). This lady was unhappy with the prominence of her tummy after completing her family. She had a large gap between the rectus abdominis muscles (six pack muscles) and when she sat up a large bulge appeared in the centre of her tummy between the muscles. The muscles were tightened with internal stitches to stop the bulging and improve her core strength.

Case 19. Photos showing appearances before and 6 weeks after a tummy tuck. This lady had completed her family having had 3 children. She was unhappy with the appearance of her tummy primarily because of the tissue which hung over her caesarian section scars. A full abdominoplasty (tummy tuck) with muscle tightening has been performed giving her a flat tummy.  

Case 20. Photos showing the appearances before and 6 weeks after fleur-de-lys abdominoplasty and mons reduction (done with liposuction). Having lost 7.5 stone this lady was unhappy with the appearance of her tummy and also with the prominence/drooping of her mons (pubic area). A modified scar pattern has been used for the vertical scar to avoid the scar extending onto the breast bone as this area is associated with poorer scarring. 

Case 21. Photos showing appearances before and 6 weeks after fleur-de-lys abdominoplasty and mons reduction. This lady had lost 10.5 stone after gastric sleeve surgery (bariatric surgery) but was unhappy with the loose skin and prominence of her tummy. Thanks to my patient for giving permission to show these images. 

Case 22. Photos showing appearances before and 5 weeks after tummy tuck surgery for this mum of 3. The patient has had a full abdominoplasty and muscle tightening. Thanks to my patient for giving permission to show these images. 

Case 23. Photos showing appearances before and 6 weeks after mini abdominoplasty (mini tummy tuck). This lady was unhappy with the prominence of the lower tummy which hung over her c-section scar. A combination of skin excision and liposuction has improved her contour. Thanks to my patient for giving permission to show these images. 

Case 24. Photos showing the appearances before and 6 weeks after Fleur de lys abdominoplasty (FDL tummy tuck). This lady lost 4 stone in weight (getting to BMI 31) but was still unhappy with the appearance of her tummy partially with regards the lower abdominal roll. Thanks to my patient for giving permission to show these images. 

Case 25. Photos before and after tummy tuck, repair of divarication, umbilical hernia repair and liposuction to the flank area for this mum. Thanks to my patient for giving permission to show these images. 

Case 26. Photos before and after tummy tuck, repair of divarication,  and hernia repair. This mum of 2 who exercised regularly was unhappy with the loose skin and prominence of her tummy.  A modified scar pattern has been used here as the distance from her belly button to pubic hairline was longer than average (the alternative would have been a higher than average scar or to have a small vertical scar). In addition to a flatter and tighter tummy, the patient’s waist has also been narrowed from the muscle repair. Thanks to my patient for giving permission to show these images. 

Case 27. Photos before and 6 months after FDL tummy tuck (fleur de lys abdominoplasty) and mons reduction. Having lost significant weight after a gastric band procedure my patients weight stabilised at a BMI of 32. Thanks to my patient for giving permission to show these images.  

Case 28. Photos before and after a tummy tuck with umbilical hernia repair and muscle tightening (repair of divarication). This lady in her early 60s was unhappy with the contour of her tummy as it was too prominent despite undertaking regular exercise. This was a challenging case as she did not have a large amount of excess skin. Liposuction would not have significantly improved the contour as there were only limited amounts of subcutaneous fat. Furthermore, her skin had lost elasticity so would have been made crinkly with liposuction. A modified full abdominoplasty (belly button float) was performed allowing full access to tighten the muscle separation (divarication of recti muscles). The red lines show how much her waist has come in with the muscle tightening. This type of abdominoplasty avoids a scar around the belly button but does have the effect of lowering the belly button so is best for patients with high belly buttons or long torsos. Case 29. Photos before and 6 months after FDL (fleur de lys) tummy tuck surgery. This lady in her 60s was unhappy with the prominence of her tummy after having children and hysterectomy surgery. The tummy was tightening using a combination of skin/fat excision (tummy tuck) and abdominal muscle tightening. Thanks to my kind patient for giving permission to show this outcome. 

Case 29. Photos before and 6 months after FDL (fleur de lys) tummy tuck surgery. This lady in her 60s was unhappy with the prominence of her tummy after having children and hysterectomy surgery. The tummy was tightening using a combination of skin/fat excision (tummy tuck) and abdominal muscle tightening. Thanks to my kind patient for giving permission to show this outcome. 

The risks of surgery are higher in those who have multiple medical problems or take multiple prescribed medications.  Steroid medication increases the risk of wound healing problems with a tummy tuck. Anticoagulant medications (blood thinners) also significantly increase the risk of bleeding from the surgery. People who plan to have more children would be advised to delay an abdominoplasty until they have completed their family. Strong coughing/sneezing can trigger bleeding following abdominoplasty and patients with bad coughs are therefore advised to delay their surgery until they are no longer coughing. The risk of chronic (permanent) fluid collections (seroma) after tummy tucks is higher in older patients.

Mr Morritt gained expertise in the ‘Mummy makeover’ during his training in Toronto. The ‘Mummy makeover’ is typically performed in women following childbirth. Many of these ladies will have stubborn areas of excess skin and fat in the abdominal wall which is resistant to dieting and exercise. They may also be unhappy about the size and shape of their breasts. Some patients will have liked the increased size of the breast which occurred during pregnancy, while others may feel that their breasts are less firm and more droopy after pregnancy. The ‘Mummy makeover’ combines an abdominoplasty with a breast augmentation or uplift in suitable patients. In other patients, flank liposuction may be combined with abdominoplasty in order to improve the contour of the waist or to remove ‘love handles’.

Full abdominoplasty

The full abdominoplasty is used for patients who have a lot of excess skin and fat in the abdominal region. Many of these patients will have separation of the muscles (divarication). The tissue below the belly button (between belly button and bikini line) is removed, the skin and fat above the belly button are then raised off the underlying muscles. The muscles are brought back together and tightened (this is also called the ‘internal corset’) and the belly button is brought out in a new position. The scar typically goes from one hip to the other.

The full abdominoplasty procedure is performed under general anaesthetic and typically involves a two night stay in hospital. Mr Morritt inserts drains at the time of surgery which usually are removed before discharge from hospital. Drain free surgery tummy tuck surgery is available for suitable candidates. Following the surgery you will be able to eat and drink as soon as the effects from the anaesthetic wear off. You will be encouraged to mobilise. It is normal to have some abdominal discomfort and Mr Morritt will prescribe you some regular painkillers.

You will be seen in clinic 1 week following the surgery by the nursing team to check that the wounds are healing properly. The dressings are changed to showerproof tape (micropore) at this stage. Patients must wear an abdominal support garment for 6 weeks following the surgery in order to support the wounds while they are healing and should avoid any straining or strenuous exercise for 6 weeks following surgery. Mr Morritt recommends scar massage and silicone scar gel e.g. Dermatix once the wounds have healed. Patients are reviewed by Mr Morritt at 6 weeks after surgery.

Mini-abdominoplasty

A ‘mini-abdominoplasty’ as the name suggests is a smaller version of an abdominoplasty. It is used to target excess skin and fat between the patients’ belly button and the top of their bikini line. It is a smaller procedure than full abdominoplasty so results in less scarring and the recovery following surgery is quicker. Some patients may be unhappy with the appearances of their caesarian section scars and the bulging which sometimes occurs above these scars and this can be often be improved with mini-abdominoplasty. The belly button is generally not touched with this procedure and the muscles are generally not tightened. The mini abdominoplasty is often combined with liposuction.

Fleur-de-Lys abdominoplasty

This procedure is the most extensive type of tummy tuck and is generally performed most frequently in patients who have lost large amounts of weight e.g. after gastric banding. In contrast to the full abdominoplasty which generally mainly tightens the tummy in a head to toe direction, the fleur-de-lys abdominoplasty also tightens the tummy in a side to side direction. This results in an additional vertical scar that runs up the middle of the tummy.

Poor scarring – despite intensive research around the World towards producing scarless wound healing, it is impossible at the moment to produce invisible scars from surgery. Plastic surgeons therefore take care to place scars in areas where they are less likely to be seen. Most patients do ultimately get good scars (pale, flat, thin) once the scars have matured but this may take up to a year.  Rarely, some patients get thick, red, painful or stretched scars which is often related to their genetics and therefore difficult to prevent. These patients may have other scars on the body which have healed in the same way. Treatments are available to improve these thickened scars. It is quite common following the surgery for the scarring to be asymmetrical (wonky) and for the scars to move. Scars can generally be hidden in regular underwear but this may not be the case when patients have a lot of tissue in the flank region as the scars will need to be longer to address these bulges.

Bruising and swelling – surgery is effectively an ‘injury’ to the body and the body therefore reacts in the same as it would to an injury by producing bruising and swelling. This will settle as the wounds heal.

Bleeding – this is usually minor but may in some cases require a return to theatre. Bleeding is more common is patients with high blood pressure or those on blood thinners. Strong coughing after surgery or lifting heavy things may trigger bleeding.

Wound infection – The wound of skin of the tummy may become red and warm and the patient may feel unwell and sometimes have a raised temperature. This may require treatment with antibiotics. This is more common in patients with diabetes.

Numbness – this may take a number of months to improve. Permanent numbness can frequently occur in the area between the pubic hair and belly button.

Asymmetry – It is very common for there to be slight differences between the left and right sides of the abdomen following the surgery which is called asymmetry (and many of these differences are actually present before the surgery). These difference may be more visible after surgery as the skin is pulled tight.

Wound healing problems – this includes delayed healing and skin loss. Wound healing problems following tummy tuck surgery are much commoner in smokers. Mr Morritt therefore recommends that patients having abdominoplasty stop smoking completely for 4 weeks before and 4 weeks after surgery. A rare complication is necrosis of the belly button (more common when tummy tuck is combined with an umbilical hernia repair).

Seroma formation – it is common for the body to produce ‘seroma’ following any operation like this. A seroma is a collection of serous fluid which is a naturally occurring fluid in the body and looks like the fluid in a blister. In some cases, it may be necessary to drain this fluid with a needle following the surgery.  Very rarely the serous can continue to accumulate months after the surgery and further surgery may be necessary to stop this happening (chronic seroma). Chronic seroma is more common in patient who overdo things following surgery or in the elderly.

Chest infections – can occur following general anaesthesia and are more common in those who smoke or those who have chest problems such as asthma.

Permanence of the result – the results from abdominoplasty can be affected by fluctuations in weight and Mr Morritt therefore advises patients considering abdominoplasty to only proceed with the procedure once they are at a stable weight that they can maintain comfortably.

Chronic pain – a very rare complication of tummy tuck surgery.

Sensation of internal tightness – A tummy tuck tightens the tummy and some patients rarely struggle with the sensation of internal tightness.

Change in stream of urination – A tummy tuck most frequently tightens in an ‘up and down’ direction. This also has an effect of pulling the ‘mons’ area up and in doing so can change the direction of stream of urination.

Deep vein thrombosis (DVT) and Pulmonary embolism (PE) – Mr Morritt and his team take multiple precautions both during and after the surgery to minimise the risk of this rare but potentially life threatening complication.  DVT would present as a painful, swollen leg after surgery. PE presents as shortness of breath and chest pain after surgery. Both situations are emergencies and patients are advised to arrange urgent checkup if they have concerns.

Death – an exceptionally rare risk following any tummy tuck.

Read more about tummy tuck (abdominoplasty) (BAPRAS procedure guide)

Read more about tummy tuck (abdominoplasty) (BAAPS procedure guide)