Problematic Tummy Tuck Patients and Problems That Cannot Be Overcome
By: Dr. Kenneth Hughes
Weight loss patients and postpartum patients constitute the two major groups who seek out tummy tuck for improvement. Many tummy tuck patients have had weight loss surgery. Any placement of a port that connects to an intra-abdominal device needs to be located prior to tummy tuck. Frequently, these ports are placed near the midline and prevent any meaningful plication or tightening of the abdominal fascia. Thus, if these patients are going to retain that device, these patients are going to have a suboptimal tummy tuck result despite optimal surgical execution.
Patients who have a very large open cholecystectomy or any large horizontal scar above the level of the belly button will retain that scar. Furthermore, the risks for partial flap necrosis will be higher. Finally, in an effort to prevent flap necrosis or death, the dissection must not undermine the older horizontal scars. Thus, the relative level of flap recruitment will be suboptimal as well.
Certain patients will have such weak fascia that fascia tightening of any kind will be extremely difficult. Even if the plication can be performed in an unconventional way the healing and integrity of this fascia will always be an issue. This is an important point to consider with all major hernia and diastasis cases. Recurrence is common.
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Dr. Kenneth Hughes, Hughes Plastic Surgery
Kenneth Hughes, MD, Los Angeles