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Tummy Tuck Guide Miami

Hi guys. Dr. Karlinsky here. I’m continuing my series for preoperative videos since a lot of you have given me very positive feedback and a lot of my patients find it very helpful. I’m trying to create multiple videos that will encompass most common procedures that I perform. And if you happen to be out of town, out of state, out of country, or even local here in Miami, this will give you some information, good information to prepare for your surgery. Or if you’re still contemplating surgery, perhaps this will help you make your decision.This particular video is about abdominoplasty. Sometimes we say extended tummy tuck, regular tummy tuck. There’s really, for me in particular, there’s no distinction. My tummy tucks are always extended because I extend the incision to wherever it needs to go to achieve proper results. Now, if you are already scheduled for a tummy tuck or you’re contemplating a tummy tuck, what I will talk about now is going to be exactly what you will hear me tell you before the surgery, when I meet you for your preoperative visit or even on the day of surgery, which is the same information that I repeat to make sure that my patients understand everything.

Now, if you’re scheduled for a tummy tuck, it means that you have significant amount of muscle separation and your stomach is no longer flat. Maybe because you’ve lost a lot of weight or you’ve had children and you feel like no matter what you do, it always pooches out. Chances are you have an apron of excess skin that’s hanging down and you probably have some excess fat that you would like to get rid of. Remember the idea of having a tummy tuck, the very idea of a tummy tuck is to ensure that we can make your stomach tighter and flatter.

And to do that, there’s always a muscle repair. At least for me, if I do a tummy tuck, it means that I am doing a muscle repair. Every once in a while, somebody will have a hernia, what’s called a ventral hernia or an umbilical hernia, and of course, I will always fix it if I see it. The only thing I always let my patients know is that when I encounter a hernia during a tummy tuck, I repair it what’s called primarily. Primarily means that I repair it with sutures. Now, we know statistically that approximately 25% of primary hernia repairs will recur, meaning they will come back. And I just let my patients know about that because there’s always a potential that in the future, for example, if somebody has a big umbilical hernia and I repair it primarily without a mesh or a plug, which is the standard of repair for a hernia, they may have to seek help from a general surgeon later on to really definitively repair it.

The reason why I never do a mesh and a plug, number one, because the risk for umbilical necrosis goes up or death of the belly button skin. And number two, because this is an elective operation and it’s completely outside the scope of really repairing a hernia with a mesh or a plug. So these are just kind of distinctions that I want my patients to be aware of, and I want you to know that if I do encounter a hernia, I can tell you for sure that it’ll be fixed. It just has a higher chance of coming back. Now, in terms of requirements for preoperative tests, you can find the video for that, and that video talks about all the things that you need to do in order to prepare for your surgery from the medical standpoint.

Now, on the day of your operation, when you come in for your tummy tuck, I always ask my patients to come in wearing comfortable clothing, no makeup, no jewelry, no creams. Because sometimes patients moisturize their skin and it’s impossible to draw with a marker. And you want to wear flip-flops, I always ask my patients to bring in warm socks so you can put them over your compression stockings that you’ll be given at the clinic because it does get very cold in the operating room, even though we try to bundle you and keep you warm, socks help.

When you’re in the operating room, your surgery will be done and then we’re going to put a binder. Remember, you’re going to have two drains, one on each side. The drains will stay in for approximately 10 days. Everybody’s different. Usually patients with a higher BMI will keep the drains in a little bit longer.

Patients with a lower BMI, typically the fluid buildup slows down faster. It really depends on the person, and as I mentioned in prior videos, you will have my cell phone number. You’ll have direct communication with me and my team, which means that on day seven you’ll send me a text message and you’ll say, “It’s been seven days since my tummy tuck. This is how much fluid I’ve been getting from my right drain per 24 hours. This is how much fluid I’ve been getting from my left drain per 24 hours.” And then we will let you know if it’s okay to remove one of the drains.

Now, one of the peculiar things is of course, that a lot of my patients come from out of town. Ideally, I always ask my patients to stay next to me for a minimum of seven days. Because at least you are here for a week so if God forbid there’s any questions, any issues, I’m here to take care of you. And usually on day seven, I’m able to remove at least one drain for my patients. The left drain typically stays in longer because the left drain goes low right across the lower part of your abdomen, and the right drain comes up all the way high to your xiphoid process.

So that means that by gravity, the left drain will always catch more fluid than the right, and that’s why the right one typically will come out first. Now, as strange as it sounds, and it took me a little bit of time to get used to it, but my patients sometimes remove the drains by themselves or they simply go to their doctor back at home and their doctor there helps them to remove the drain when I or my team says that it’s okay to remove it. I always remind my patients, “Please remember, do not remove the drain unless you got the go-ahead from me, my nurse, Amanda or my fellow.”

Now all the incisions are closed with absorbable sutures. There’s nothing that needs to be removed. There will be sticky tape covering those incisions, and I ask that you keep the tape in for approximately seven days or so, seven to eight days. After that, you can remove it just like a sticker. And the only two sutures that you would have to cut are the ones that are holding the drain in place. You see them outside. There’re typically a black nylon suture that’s very easy to just simply snip off, and you would need to do that before a drain is removed. Of course, there are plenty of videos on YouTube that you can watch to remove the drain. I always prefer that I or my team takes out your drains or you go to see a doctor back at home so that your doctor can do it for you.

Now, in terms of restrictions for a tummy tuck. Again, I always ask my patients, try to get back to normal life as quickly as you can. There’s no need to dwell in bed, sit around and sort of moan and groan and be uncomfortable. It’s uncomfortable. Of course, it’s uncomfortable. Your muscles are tight, your skin is tight, but the faster you’re able to get back to your normal life, the better off you will be. Certainly immediately after surgery, I do not want you staying in bed. It is incredibly important that you get your pain under control and you get out and you move around even immediately after surgery. I ask that you move your feet kind of up and down if you are laying in bed and you’re awake, and I always ask my patients to take deep breath in and out. If you’ve ever seen what an incentive spirometer looks like, it’s this plastic toy with a bowl and you take a deep breath in and you hold it and you exhale and you see the bowl rise and go down.

As silly as it sounds, it’s very important because it helps to reopen up your lungs and decreases the risk for pneumonia. So I ask my patients to do that 10 times every hour after surgery. As long as they’re awake, I ask them to do that exercise. Same thing with your feet up and down as you’re laying down so that there’s circulation going through your legs and decreases the risk for blood clots. But remember, that does not substitute walking around. Now, just like any other surgery that I do, I ask my patients to take a shower the day after surgery. You must be there in the shower with assistance. Somebody who’s taking care of you has to stand by because my worry is that you may get dizzy and God forbid, fall in the shower and hit your head and potentially cause bleeding or any kind of wound separations.

So please be very, very careful. The binder is there only for you to be comfortable. Remember, it doesn’t do anything for your results. It’s there to give you support. That means that you can open it up, you can close it, you can make it tighter, you can make it looser. You can do whatever feels comfortable, as long as it’s comfortable. As time goes by and both drains get removed, I allow my patients to wear any compression garment that they feel comfortable wearing. Whatever you wear has to be giving you support and should not be hurting. If it’s hurting you, you should not be wearing it. It’s a very simple rule.

There is, of course, all kinds of fajas and compression garments and the stages. For my patients as long as you’re comfortable, you can wear anything you like. It’s a very, very important point. I can tell you that I’ve seen so many skin infection, fungal infections, irritations, indentations, scarring from patients trying to wear super tight garments, and it’s absolutely unnecessary.

It doesn’t do anything for the results. Now, as far as physical activity, you can get back to normal life. The only thing I ask when it comes to the muscle repair is that you don’t do any super heavy lifting, certainly no crunches for about six to eight weeks after surgery. Because remember, we’re going to treat it as if we repaired a hernia. Same idea when somebody gets a hernia repair, in general surgery, we always ask that there’s no heavy lifting and no strenuous activity for six to eight weeks, and I do the same thing for my tummy tuck patients. Other than that, listen to your body. If it feels comfortable, it’s perfectly okay to do it.

Now, risks and complications. As I remind my patients in every video and in every procedure that we do, there’s always potential for risks and complications. One of the things that I haven’t mentioned before, but I will mention now especially for tummy tuck, is that if your BMI is 30 or above, you automatically fall into the higher risk group for potential issues. We know that statistically. That doesn’t mean that a patient who has a BMI of 30 or above cannot have surgery. That simply means that you have to be aware of the fact that the risk for complications is higher. And I can discuss the BMI issue as a separate video because there is a lot that patients need to know. But regardless of your BMI remember that there’s always potential for infection, bleeding, poor scarring, potential for wound separations requiring wound care, potential for umbilical necrosis or death of the belly button, just by virtue of the fact that we have to cut around it in order to free it up. We have to rely on the blood supply that comes from the muscle to feed that skin.

And if for one reason or another that is not enough, then there’s always a potential for that skin to have vascular compromise and not survive. Now, what does that mean? A belly button is an aesthetic unit, and if somebody necroses the skin of their belly button, it means that you end up with a little open wound that eventually needs to be treated as such. And then after everything is healed, we can always go back and do what’s called an umbilical plasty and address the problem to make it look like a belly button. But essentially, remember that a belly button is really a scar from our embryology. And so most always, if somebody does have umbilical necrosis after everything is healed, it’s not a huge issue, but it is something that I want my patients to be aware of. Now, certainly potential for any kind of poor scarring is always there.

Everybody heals differently even though we close the skin in the same manner for all our patients. We use non-absorbable sutures. We use a lot of times quill sutures, which are sutures that don’t even require knots to be made because it’s like a barbed wire that goes in opposite directions, which is wonderful. But still, over the last 15 years in my career, I’ve seen patients heal in different ways.

Even though the incisions are closed the same, everybody heals differently. And so you always have to keep in mind that there’s a potential for poor scarring.

Now, scars, of course, can always be revised, but one of the most common misconceptions that I hear from my patients is that the scar will go away.

Remember, scars do not go away. They do fade. They become better over time, but they never go away. It’s just a very important aspect. Now, things like