Dr. Larry Schlesinger, after many years of frustration with the standard tummy tuck, tried doing liposuction at the same time as the tummy tuck but he found it necessary to limit the amount of liposuction to avoid unwanted complications. He then tried liposuction first, but found it left scar tissue which limited his second stage tummy tucks, and because of the skin retraction, was often unable to get the abdominoplasty incision as low as both he and his patients wanted. He finally settled on the paradigm in which one does the liposuction 90 days after the tummy tuck. These two surgeries in themselves are not unique, but put together in this particular sequence, one is able to do a safe but aggressive tummy tuck followed by an extra safe but aggressive liposuction.
One might say, the Ultimate Silhouettplasty (USP) is The Best Of All Worlds.
The USP has, at its core, the fact that the patients in their mind have an idea of the outcome they want, and the surgeon should be left to determine what surgeries will best attain that outcome. It also gets both the surgeon and patient to buy into the concept of a process and not an event.
Cosmetic plastic surgery is a partnership between the patient and the surgeon requiring total, open communication in both directions to allow the greatest chance of success.
The Ultimate Silhouettplasty™ is a meticulously well done tummy tuck first followed by an equally complete liposuction in 90 days.
Liposuction first in a patient with loose skin, excess fat, and multiple pregnancies can lead to scar tissue throughout the entire abdominal wall which can be very unattractive. If one is unable to follow through with a tummy tuck at a later stage, the ultimate result of the liposuction first situation can decrease one’s self esteem. Secondly, an attempt at aggressive liposuction can interrupt the lymphatics on the rectus abdominus sheath increasing the chance of a seroma as an outcome during the second stage tummy tuck.
Some of the world’s most brilliant plastic surgeons have written extensively on the value of this combined surgery. To some extent, they had to limit the amount of undermining of the upper abdominal skin so as not to stretch it out perfectly in order to keep the blood supply to the skin necessary to support a simultaneous liposuction. Also, the liposuction portion of their combined procedure tended to be limited in order not to injure the skin of the abdominal wall, especially because the blood supply in this area are muscular cutaneous perforators (that means, the blood comes from the muscle straight up to the skin, and if you tear enough of these perforators in the liposuction, you potentially can have injured skin secondary to decreased vascularity).
This 90 day wait allows for the “delay phenomenon” whereby the blood supply to the skin has been altered (from its normal vertical position due to the muscular cutaneous perforators being interrupted) into a horizontal blood supply coming from the uninjured skin at the periphery of the abdomen and from the chest. This new blood supply to the skin is much stronger and allows the plastic surgeon to be more aggressive in the removal of both deep and subcutaneous fat. The 90 day wait time also allows the patient to completely recover from the tummy tuck and the secondary surgery will take only about three days to recover and five days to even get back to exercising.
Tummy tuck alone is not appropriate for even slender females who have excess skin but no obvious excess fat. The problem here is that when you shorten the vertical height of the abdominal wall, you push tissue out to the side condensing the residual skin fat and making even slender females look a little puffier and with a greater propensity towards muffin tops.
Unfortunately, most females do not put on fat after pregnancy just on the lower abdomen, but the upper abdomen as well. When the tummy tuck takes out the skin and subcutaneous tissue of the lower abdomen, the upper abdomen is pulled down leading to fat on the entire abdomen. Therefore tummy tuck alone improves one’s appearance which would be great for the old type tummy tuck which was merely a salvage procedure, but to get a complete modern cosmetic result, the secondary liposuction is absolutely necessary.
The abdominoplasty incision should be as low and thin as possible. The length of the scar is irrelevant as long as the scar is low and thin. Whenever possible, make the abdominoplasty scar in the midline 2 cm above the vaginal cleft. This will hide the abdominoplasty scar and give a broad, flat area to show off the new tummy tuck. I eschew short abdominoplasty scars because, by their nature, they lead to pleated and thicker scars, and also by their nature, they tend to make the belly button narrower and longer, therefore appearing like coin slots. Tension in the area between the neo-umbilicus and the abdominoplasty scar can lead to a vertical scar coming down from the belly button, interrupting the broad, scar-free lower abdomen. There are certain things the surgeon can do to decrease this possibility. The patients should be advised they need to walk bent over for at least 7 days after surgery to decrease the chance of this unattractive scar. The tummy tuck scar should be sutured in layers with several large sutures in the SFS (superficial fascial system) which can keep the abdominoplasty scar thin, and also pull up the skin on the anterior and medial thigh, as well as pulling up the vulva.
I want both patient and surgeon to understand that the Ultimate Result is a Process and not an Event, thereby eliminating concern, both on the side of the patient and the surgeon, as to when minor problems will be eliminated along with the already anticipated liposuction.
Dr. Schlesinger took two well-known procedures and put them together in a unique fashion to get an outstanding outcome for body sculpturing. To learn more about the Ultimate Silhouettplasty and other breakthrough procedures Dr. Schlesinger has championed, please call our Patient Coordinator, Jenna at (808) 597-8835, to set up a consultation with Dr. Schlesinger so he can personally answer all of your cosmetic surgery questions.Learn More...