Vertical abdominoplasty

Vertical abdominoplasty (Fleur-de-lis) is the operation in which a large excess of skin and subcutaneous fat is removed from the anterior surface of the torso, in order to create a more youthful and slimmer torso contour. (The classical abdominoplasty operation has been analyzed in the Aesthetic operations of plastic surgery of the trunk). Candidates for Fleur-de-lis abdominoplasty are patients with a pre-existing median incision above the navel, who after significant weight loss have excess skin throughout their anterior abdominal wall.

Like the classic (horizontal) abdominoplasty, the vertical abdominoplasty can, in addition to skin laxity, correct the dissection of the rectus abdominis muscles and be combined with small-scale liposuction. However, it cannot be combined with other operations. The aim of the surgery is to sculpt a slimmer and firmer torso, remove excess skin with stretch marks and restore rectus abdominis distension - when and where it exists.

WHAT CAN BE DONE?

Vertical abdominoplasty is usually aimed at patients who have lost a lot of weight and who have horizontal excess skin above the belly button and vertical excess skin below it. During the surgery, the skin inside the outline of the figure below is removed and points ABC' approach point C.

The navel protrudes to a new higher position and the rectus abdominis muscles are sutured. As a result of the operation there is a horizontal incision (at the level of the caesarean section) that extends to the iliac bones and a vertical one in the midline, which passes from the navel and starts from the xiphoid process to meet the horizontal, just above the pubic (point C). The issue of postoperative scars should be discussed extensively with the patient before surgery, while the choice of vertical abdominoplasty is easier when there is a previous midline abdominal incision from previous surgery.

WHO IS VERTICAL ABDOMINOPLASTY FOR?

Candidates for vertical abdominoplasty are patients with the aforementioned characteristics, who have stabilized their body weight, have obtained a normal BMI (body mass index) and have no other serious health problems. Female patients should ideally have completed their family planning. In case there is an umbilical hernia or abdominal hernia, it is corrected by a General Surgeon during the abdominoplasty, without additional incisions.

WHAT IS THE TYPE OF ANESTHESIA?

Tummy tucks are performed under general anesthesia in an organized clinic. The duration of the surgery is from 3 to 4 hours. After the surgery, it is advisable to stay in the clinic for 2 days and to mobilize the patients immediately.

WHAT WILL THE SCARS BE LIKE AFTER VERTICAL ABDOMINOPLASTY?

There will be a horizontal low incision over the adolescent to the iliac crests and one perpendicular to it, passing through the level of the umbilicus. The length of the vertical incision depends on the excess skin observed above the umbilicus, on the horizontal axis. There will also be an incision around the navel. The vertical scar is not covered by underwear. For the majority of patients, however, the scars are negligible in the face of the relief they feel from the improvement in contour and strength of their torso. To avoid misshapen or hypertrophic scars you will be given instructions immediately after the stitches are removed, and you will be put on a follow-up program if you have a history of keloids.

HOW LONG WILL THE RESULTS LAST?

The results are permanent and will remain stable as long as patients do not gain weight or women do not become pregnant. Scars will be visible for the first 8 months, after which they fade and sag.

WHAT ARE THE LIMITATIONS?

In a vertical abdominoplasty, the skin above and below the navel is removed, along with old stretch marks and scars. Surgery will not correct the quality of the skin and patients should be aware that stretch marks and thinning of the skin will remain after surgery but will be less noticeable because the skin that is preserved is stretched. It also slightly improves the relaxation of the spine.

Among the most serious limitations of the abdominoplasty surgery are large hernias and the possibility of future pregnancy. Also, patients with serious health problems, who cannot receive general anesthesia or those with dysmorphic syndrome should be prevented from cosmetic surgeries.

WHAT ARE THE RISKS OF ABDOMINOPLASTY?

The doctor will evaluate your general condition and your history and if he/she decides that you are suitable for the surgery, he/she will inform you about the possible complications and what needs to be done to reduce the possibility of their occurrence. You will also be asked to stop smoking and refrain from using supplements that affect blood clotting. The anesthesiologist will then talk to you about the type of anesthesia you will receive and the possible complications.

WHAT YOU SHOULD DO BEFORE SURGERY?

Depending on your age, you will be given instructions on the medications you may be taking and should be stopped or replaced, as well as on the additional testing you may need to do to investigate hernias. Your weight should remain stable at the lowest levels, because possible fluctuations may postpone the surgery.

The doctor will explain the value of smoking cessation and proper nutrition in wound healing. One week before the surgery, measurements will be taken to order a special pressure garment, you will be photographed and the consent form will be signed.

WHAT SHOULD YOU DO AFTER THE OPERATION?

You stay in the clinic for the first two 24 hours, but your time away from work must have been calculated at 3 weeks. This doesn't mean you won't be able to do light work much sooner, but you'll generally feel overwhelmed. It is also recommended to refrain from sports for 1 month.

When you leave the surgery, you will wear a special pressure garment which you will keep for 6 weeks. You will likely have a drain that will be removed in the first 24 hours, and you will need to be mobilized as soon as possible. You will be given antibiotics for a few days. Pain and effusions, when present, are easily treated. Because the sutures are intradermal, no stitches need to be removed.

WHAT IS THE COST OF THE OPERATION?

The cost of vertical abdominoplasty is calculated by adding the cost of the clinic, in which the patient is operated and treated, the fee of the Plastic Surgeon and the Anesthetist. If there is a hernia (umbilical hernia or abdominal hernia), the General Surgeon's fee is also calculated. The purchase of the special pressure garment must be added to the costs.