Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation process is rigorous and detailed. The surgeon evaluates the entire torso, not just the front of the abdomen. The patient is examined while standing to assess how gravity affects the skin and fat deposits on the hips and flanks. The “pinch test” is used to estimate the relative amounts of subcutaneous fat and skin laxity.
The surgeon palpates the abdomen to determine the width of the diastasis recti (muscle separation) and checks for any ventral or umbilical hernias. The skin’s elasticity is tested to predict how well it will drape after fat is removed. This hands-on assessment confirms whether an extended tuck is necessary over a standard one.
Safety is paramount in extended procedures due to the larger surface area involved. The surgeon reviews the patient’s complete medical history, looking for red flags such as a history of blood clots (DVT/PE), bleeding disorders, or poor wound healing.
Previous abdominal surgeries, such as C-sections or gallbladder removal, are noted as they produce scars that can alter blood flow to the skin flap. Chronic conditions like diabetes or hypertension must be well-controlled. The surgeon acts as a risk manager, ensuring the patient’s physiology can handle the stress of surgery.
The “ideal” candidate for an extended tummy tuck is at or near their ideal body weight. Surgeons typically require weight stability for at least 6 to 12 months. Fluctuating weight can negatively impact healing and ruin the aesthetic result.
Body Mass Index (BMI) is calculated. While cutoffs vary, a BMI below 30 is preferred to minimize complications such as infection and seroma. Patients with a high BMI may be referred to a bariatric specialist or nutritionist to optimize their weight before being considered for body contouring.
Nicotine is a potent vasoconstrictor, meaning it shrinks blood vessels. In a tummy tuck, the skin flap relies on tiny blood vessels for survival. Smoking can shut these vessels down, causing the skin to die (necrosis) and leaving massive open wounds.
Surgeons enforce a strict zero-tolerance policy. Patients must stop all nicotine products (cigarettes, vapes, patches, gum) for at least 4 to 6 weeks before and after surgery. Urine cotinine tests are often administered to verify compliance; failure to pass results in surgery cancellation.
Nicotine is a potent vasoconstrictor that shuts down the tiny blood vessels required to heal the large skin flaps created during an extended tummy tuck. Smoking increases the risk of tissue necrosis (skin death), infection, and catastrophic wound failure.
A strict zero-tolerance policy is enforced. Patients must stop all nicotine products (cigarettes, vapes, patches, gum) for at least 4 to 6 weeks before and after surgery. Urine cotinine tests are often used to verify compliance. This is a critical safety measure to preserve the tissue.
Body contouring surgery is an emotional journey. The consultation assesses the patient’s psychological readiness. Patients must have realistic expectations and a healthy motivation for surgery. The recovery is physically demanding, and postoperative depression is a known phenomenon.
The surgeon ensures the patient has a strong support system at home. Understanding the timeline of swelling, scarring, and mobility restrictions is vital for mental preparation. Patients are encouraged to view the recovery as an investment in their future self.
A complete medication review is conducted. Patients on anticoagulants (blood thinners) will need a plan to safely bridge or stop them. Hormonal medications, such as birth control or hormone replacement therapy, increase the risk of blood clots and are often paused 2-4 weeks before surgery.
The surgeon provides a list of safe and unsafe medications. Prescriptions for post-op pain, nausea, and antibiotics are often offered at the pre-op visit so they can be filled in advance.
Standard pre-operative clearance tests are ordered. A Complete Blood Count (CBC) checks for anemia and infection. A Metabolic Panel (CMP) checks kidney and liver function. Coagulation profiles ensure that the blood clots normally.
For patients over a certain age (usually 40 or 50) or those with cardiac history, an EKG is mandatory. Clearance from the patient’s primary care physician or cardiologist may be required to certify fitness for general anesthesia.
Preparation extends to the home environment. Patients are instructed to create a “recovery nest.” This includes a recliner or a bed with wedge pillows to maintain a flexed position (bent at the waist), which relieves tension on the incision.
Patients must arrange for 24/7 help for the first few days. Meal preparation, childcare, and pet care must be delegated. Placing essential items on counter-level surfaces prevents the need to reach or bend, which is prohibited early on.
Many surgeons use 3D imaging during consultations. This allows the patient to see a simulation of their potential results. While not a guarantee, it helps align the patient’s and surgeon’s visions.
The surgeon uses this tool to explain the trade-off between the length of the scar and the contour’s flatness. Visualizing the lateral improvement helps patients understand why the extended incision is necessary.
On the day of surgery, the marking process is critical. The surgeon draws the incision lines while the patient is standing, as skin position changes when lying down. The patient may wear their preferred underwear or bikini bottom to ensure the mark is placed within the concealment zone.
The extent of the flank excision is mapped out, and areas for liposuction are topographically marked. This blueprint guides the entire surgery.
The consultation concludes with the informed consent process. The surgeon details the specific risks of extended abdominoplasty, including seroma, hematoma, infection, delayed wound healing, and scarring.
The patient acknowledges these risks and the permanent nature of the scar. This legal and ethical step ensures the patient is making an educated decision to proceed with body contouring.
Send us all your questions or requests, and our expert team will assist you.
You should be within 10 to 15 pounds of your goal weight. The surgery is for shaping, not weight loss. If you lose significant weight after the surgery, the skin may sag again. Stability is more important than a specific number.
You will need standard blood work (CBC, metabolic panel) to check for anemia and organ function. If you are over 40 or have a history of heart issues, an EKG is required. Women of childbearing age will need a pregnancy test.
Smoking constricts blood vessels. In a tummy tuck, the skin is lifted and relies on tiny blood vessels for blood supply. Smoking cuts off this supply, leading to skin death (necrosis), massive open wounds, and terrible scars. You must quit for 6 weeks before and after.
It is rare, but possible. The extended tummy tuck involves a large surface area. Surgeons monitor blood loss carefully. If your iron levels are low before surgery, you will be put on iron supplements to raise your blood count.
It is safe to get pregnant after, but it is strongly advised to wait until you are done having children. Pregnancy will stretch out the muscles and skin you just paid to have tightened, likely requiring a second surgery to fix.
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