5 Details That Deliver Superb Tummy Tuck Results

If you look around online or in those secret Facebook tummy tuck groups where others share their post-op photos and ask questions like, am I okay? You'll be able to relate to what we're talking about today. I'm Dr. Bob Basu, and today on Behind the Double Doors, we're sharing five little things that make big, big differences in our tummy tuck outcomes. Sometimes it's the simplest thing that makes the biggest difference, and the belly button is the focal point of the abdomen. So if it's in the wrong place or it doesn't look natural, it can really ruin the aesthetic of the entire result. There are five little things in tummy tuck surgery that I believe make big difference in the aesthetic outcome of abdominal contouring procedures. The first being the belly button, the second being the mons or the pubic area is often forgotten. The third is strategic and targeted use of liposuctioning to enhance contour.

(01:03)
And the fourth is addressing the waist to hip ratio or utilizing your fat and putting it to good use using fat transfer. And last but not least, advanced pain control. Let's talk about belly buttons. So oftentimes a lot of patients, when they come to see me for consultation, they actually tell me that the reason why they chose me as a surgeon is because they love the way that my belly buttons look in my patients on our Instagram, our website. So what are we doing differently? So let's step back for a second. When someone's had kids, everything's stretched out, right? And that's why moms have loose skin and laxity. Or for patients that had a lot of weight and they've lost their weight or when they had that weight, when everything's stretched out because of that weight, guess what? The belly button stretched out. So pregnancy or weight gain can stretch out the belly button.

(01:55)
Well, when you lose that weight or you have post-pregnancy changes, everything shrinks down, you lose the baby weight, for instance, but the loose skin stays behind. Similarly, the belly button, when it gets stretched out, it still stays stretched out. Oftentimes you can't see it because the skin's folding over the belly button, but you've got a pretty large belly button. And so one of the things that I do in all my tummy tuck procedures is I assess the belly button and about 70 to 80% of tummy tucks that I do, we're performing what's called a reduction umbilical plasty fancy words. But what that means is I'm taking it in enlarged belly button and actually reducing it to a more proportionate side, but it's much more important than just reducing the side. It's how we actually inset the belly button and shape your belly button. And without getting too complicated, what I'm really trying to do is to give you a cute innie, but have it have more of an elliptical shape that makes your torso look taller and leaner.

(02:56)
And that's what I believe is part of making a very natural appearing umbilical. So it's not just this big round hole or it's not too small or it doesn't look like a small little slit. It's making it look like a very natural looking innie, probably what you had before you had kids. The other aspect of a valued belly button is that it's quite common for moms to have a belly button hernia. A simple way to think about it is if you have an outie, you might have a belly button hernia, and it's quite common for us to repair a belly button hernia at the time of a tummy tuck so that we can convert your outie into an innie. The second area that I find that has been missed by other surgeons when I see patients for revisional work is the mons or the pubic area.

(03:45)
The mons is a medical term for the pubic area. And when we do a tummy tuck, what are we doing? We're removing exoskeleton and fat, we're tightening up the muscles and we're giving you a nice flat washboard tummy. But oftentimes, if the mons or the pubic area is neglected or hasn't been addressed, what happens is you get a flat tummy, but the mons appears more projected and full and you get a mismatch. And that's really troublesome for a lot of patients because if you're wearing form fitting clothing, you don't want to have an awkward projection in the Mons area. If you're wearing exercise pants or yoga pants, that could be quite awkward and uncomfortable. So in all of my tummy tucks, I actually evaluate the mons or the pubic area, and it's quite common for patients who've had kids or patients who've lost weight that they hold onto excess fat in their mons.

(04:35)
If that's the case, then I often perform what's called a mons or pubic area lift or reduction. And what that means is not only are we pulling the mons up, but we're really de-fatting the pubic area so that the upper tummy, the tummy area, is an alignment with your mons and pubic area. So it's flat in one plane. We don't want the mons projecting out, and that's what a mons lift reduction does, is it helps to keep the mons flat, so it's in the same plane as your tummy. So not everyone needs a mons lift or reduction, but the only way really to know is for me to evaluate you during the physical exam. Oftentimes, if you've lost a significant amount of weight, you're a weight loss patient, or you've had multiple children, or you've had maybe C-sections and you have C-section scarring, that might require a mons or pubic area lift reduction.

(05:27)
But again, it requires an evaluation, but it's a procedure that I do quite commonly with every tummy tuck because again, we want you to have a nice flat washboard tummy, but we also don't want your mons or pubic area to project out and be more prominent. So it all needs to be in an alignment. The third procedure that I perform quite frequently with tummy tucks is liposuctioning, and that's much more than just liposuction the waist. I'm also looking at the upper waist as well as the lower waist. So it can really create a nice hourglass shape. For some patients that have fat extending posteriorly to their back, we'll often perform what's called 360 lipo at the time of the tummy tuck. And what 360 lipo means is that we're liposuctioning the anterior waist, the upper waist, and also the lower back or the posterior flank.

(06:16)
So basically liposuctioning 360 degrees around your waist to really accentuate your contour. In addition, we use liposuctioning very strategically to actually give you a more of a three dimensional improvement to your abdominal wall. Now, we know with a tummy tuck, we're trying to give you a nice flat washboard belly, but the next step up in terms of really getting beautiful results is actually accentuating your natural shadow lines of your obliques and your six pack muscles in a very graceful way. Now, I know online and on Instagram, I've seen these exaggerated six pack looks, and they look great on table with nice shiny oil on the patient. But do you ever see long-term one-year follow-up on those patients? And the answer is no. It's pretty rare. And so I don't overdo this ab etching phenomenon right now. I really like to accentuate natural curves so that you do get a three dimensional effect to your tummy tuck, and it gives you more of an athletic look for those that are seeking that.

(07:19)
And the fourth smaller procedure that I use as a nice adjunct to some tummy tucks is also fat transfer. So we're talking about desirable curves that more of the athletic look that fit. Look, sometimes for moms, they get what's called hip depressions, also known as hip dips. And why does that occur? When you think about pregnancy, what happens? I believe the pelvis actually stretches out, and we know that anatomically this happens, right? So when the pelvis stretches out, it can actually exacerbate some depressions in your hips and you lose that hourglass shape that maybe you had before you had kids. And so one of the things that we could do is to restore a desirable waste to hip ratio, think hourglass shape. So what we can do is when we're doing the liposuction of the waist or the posterior flanks or other areas, we can actually put that fat to good use and do fat transfer to the hip depressions to really give you a much nicer, smoother contour.

(08:19)
And that fat transfer can also help to accentuate your hourglass curves. That doesn't mean you're getting this exaggerated look that we've all seen in Hollywood on reality TV shows. No, it's really just giving you more of that athletic look. And every patient has an endpoint of what they want. And some patients don't care about this, but a lot of patients do. And so this is part of the conversation in a consult is what are the patient's goals? What are their aspirations? And oftentimes fat transfer can be a really great tool to accentuate or restore your curves. And last but not least, is pain control. And probably the number one reason why moms are scared to do a tummy tuck as they've heard, it's a really painful procedure. And I want to bring you fast forward to 2023, and I can tell you with our advanced pain control techniques, almost one in three of my tummy tuck patients do not take any narcotic pain pills whatsoever.

(09:15)
Now, we're not withholding narcotic pain pills. We'll give them a short-term supply because I don't want my patients to be in pain. But the reality is, up to one in three of my tummy tuck patients do not take a single narcotic pain pill. They either take Tylenol or they take non-narcotic pain medicines that we provide them. And I think the number one reason for that in addition to our surgical technique, is our use of advanced pain control techniques. I love using long-acting numbing medicine in all my tummy tuck procedures. All my body lift procedures, and it's a medication that I didn't invent. I wish I invented it, but it's a product that is F D A approved called exparel. Exparel, the medical term is it's liposomal slow release marking. Fast forward, it's numbing medicine that lasts for about three to four days, and it's F D A approved, very safe if it's used effectively.

(10:06)
But what I do in all my tummy tuck as I inject that numbing medicine all throughout the tummy tuck incision, but what really hurts out the tummy, like it ain't the incision, it's the muscle tightening that I do to give you that flat wash board belly. Remember, with pregnancies, muscles stretch out, and that's why a lot of moms get a lot of bulging. And so what we do in every tummy tuck is we tighten up those muscles, bring them back to the midline, to not only give you the flat washboard belly, but to help accentuate your hourglass contour. And so when you do that muscle tightening, well, that muscle tiding can really hurt. So what we do is we put that numbing medicine also into the muscles so that you don't feel the pain of the muscle tightening. And the numbing effects last at least 72 hours.

(10:47)
And it's been a huge game changer in all my tummy tucks, all my mommy makeovers, all my body lifts. And it's really exciting to see that up to 30% of my patients don't take any narcotic pain pills from these surgeries that are ambulating or walking immediately after surgery on their own, so they're not bedridden. And this is also another advantage is if you're not having the pain and you're walking and medial after surgery, that helps to diminish the risk for blood clot risk after elective surgery. Advanced pain control techniques are a really important part of our care plan for all our tummy tuck patients. Are details like this standard and always included a tummy tuck? And the answer is no, but it's what we do. It's standard for us. We've done thousands of tummy tucks. We listen to our patients, we hone our techniques, we adopt state-of-the-art techniques to keep improving our craft. And if you're interested in seeing more of our results, follow us on Instagram at Basu Plastic Surgery or visit our photo galleries on our website at www.basu, B A S U, plasticsurgery.com.

Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basu plastic surgery.com/podcast on Instagram. Follow Dr. Basu and the team at Basu Plastic Surgery. That's B A S U Plastic Surgery. Behind the Double Doors is a production of the Axis, T H E A X I S.io.