Tummy Tuck

The ideal candidate for usually has the following characteristics:

• Extra skin and fat in the lower abdomen
• Bulging of the central abdomen
• Love handles
• Enough extra skin to be able to put the scar in a low enough position to be reasonably concealable
• No hernias on physical exam – although we can repair them in some cases
• General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions, and would be able to be medically cleared for general anesthesia by an internal medicine physician if you are over a certain age
• Not pregnant or immediately planning to become pregnant – in very selected cases, we will consider performing a tummy tuck to follow delivery of a pregnancy
• Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
• A body mass index below 35 and ideally below 30 for optimal results, with rare exceptions
• Available support system of friends, family, caregivers or others, who can help you to keep your appointments, complete your preop and postop tasks.
• Reasonable expectations of your outcome

Diastasis recti is a condition that develops when the abdominal muscles fail to return to their former position post-pregnancy. Diastasis recti contributes to the appearance of a bulgy, protruding belly. This condition is resistant to diet and exercise, making it impossible for women to achieve a flat belly regardless of what they eat and how often they work out. A tummy tuck can tighten these muscles by pulling the muscles down and suturing them closer together, allowing for a flat and toned stomach once again.

Treatment will leave you with a gently curving horizontal scar that lies slightly above the pubic bone. Depending on the specific technique used, it might span from hip to hip or be somewhat shorter.

Most of our see an immediate improvement after their surgery, but all patients experience swelling for some time after their procedure. A majority of the swelling ends after 2-3 weeks, but residual swelling can occur for up to 6 months. For some patients, it might take a full year before your tissues fully settle and your final results are present.

You will be put under anesthesia during your tummy tuck, so you won’t feel a thing or even remember the procedure.

As for the recovery, tummy tuck techniques have evolved so much in recent years that the recoveries have become much more comfortable. We’ve heard many of our patients report that their recovery was easier than they expected, and many patients quickly transition to over-the-counter pain medicine rather than continuing their more powerful prescription medicine. An Enhanced Recovery Program can include the addition of Exparel, a local anesthetic numbing medication that can provide additional internal pain relief for up to a few days after surgery. Ask us about this upgrade!

Many of our patients are eager to find out if they qualify for this procedure, which is an alternative treatment with a shorter scar and a faster recovery. This is one of the most common questions we receive in our office. Who wouldn’t want a “mini” operation instead of a “full” one if given the choice, right?

However, things are not that simple when evaluating a patient for a mini-abdominoplasty vs. a traditional, full abdominoplasty. The major difference between the two approaches is that the mini-abdominoplasty does not usually include an incision around the belly button, and is typically a somewhat shorter scar. This operation is appropriate for only select patients who have minimal upper abdominal looseness and excess fat, and whose main problem is some loose skin in the lower abdomen. The mini tummy tuck does not usually include full correction of looseness of the muscle since the belly button is not freed up to allow access to the upper abdomen. In our experience, the best candidate is a thin, athletic bodied woman with a small amount of extra skin above the pubic area after pregnancy or weight loss. Patients with more medium or heavyset builds are much better candidates for a full abdominoplasty, especially if they have had multiple children.

Many surgeons try to limit the length of the surgical scar by gathering it in from each end, but in our experience, this can lead to a “pleating” or wrinkled look to the scar, which we do not think is as aesthetic as a nice, smooth scar. The decision on how long to make the incision and whether to include liposuction and muscle tightening is made after a careful examination on consultation with Dr. Sayed.

Since the procedure involves removing excess skin below the belly-button, it can help remove the stretch marks that often result from a growing belly. Because of the nature of the surgery, it can only target a certain area with stretch marks – the area from the belly button down to the pubic region. Removing stretch marks is a beneficial byproduct of the procedure; stretch marks above the belly button and some below might not be fully corrected by the tummy tuck. Dr. Sayed can draw on a photo or your own body which areas of stretch marks would be expected to improve with the procedure.

Most abdominoplasty procedures are two to three hours in duration, but they may take longer if you are also having liposuction. Dr. Sayed has performed abdominoplasty on a slender patient in less than 90 minutes, but it has also taken nearly 4 hours on heavier patients or those requiring extension of the incision along the sides due to being overweight. There are a number of combinations of the tummy tuck with liposuction that we can perform—and safety and operative time are always our primary consideration. Treatment can also be combined with breast augmentation and/or breast lifts in select patients (often called a “Mommy Makeover”), which can take about four to 6 hours.

Our tummy tucks are performed on an outpatient basis in a local, San Diego or Newport Beach AAAASF-certified operating room, meaning the facility operates on the highest levels of safety (hospital-level or higher). Patients usually spend up to a couple hours in the postoperative suite before being discharged into the care of a companion, family member, or friend. Some patients may be advised to spend the night in a 24-hour observation facility here in San Diego, or even the hospital, although most patients are good candidates for ambulatory surgery. Dr. Sayed gives a phone number to all patients that’s available 24/7 so that they can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.

Early in their post-operation recovery, patients experience abdominal pain, muscle cramping, mild nausea, back discomfort from walking in a semi-bent position, bruising and swelling, numbness or diminished sensation in the skin, and some mental adjustment to the process of healing—although this is common for patients of any surgery. Most patients are advised to take up to 3 weeks out of social circulation and we’d prefer that you not drive yourself in the first 14 days or as long as you are taking any prescription pain medication. Most sutures are dissolvable, but there may be a few that need to be removed at around 14 to 21 days after. To help reduce fluid collection, you will probably have drains in place that are usually removed in at our San Diego office at 10-14 days.

We ask that you abstain from exercise for 4 weeks and then return to light fitness routines after that for the best outcome. It is very important that you get up and walk even the first night following your procedure. You may have to walk doubled-over for the first week or so as your body adapts to the tightened muscles. To help with swelling, you will be asked to wear a surgical garment for about 3 months. In the first three weeks of your recovery, it’s highly recommended that you stick to tops that button from the front. Dr. Sayed and his team provide close postop care in the office but also try to reach you with our remote engagement tools. You will be asked to take some supplement medications to aid in your tummy tuck recovery that may include medications for pain, bruising, swelling, constipation, and dietary optimization.

While Dr. Sayed has occasionally performed abdominoplasty without drains, he has never seen evidence that shows that removing drains results in consistently better outcomes. Like many plastic surgeons, Dr. Sayed feels he can better avoid some of the issues associated with the fluid collection and other complications by using drains, as they are “tried and true.”

The final scar from a tummy tuck may not mature until after a year. However, the new, contoured silhouette of the abdomen and the loss of excess skin are immediately noticeable for most patients—and our patients are usually “wowed” by the amazing transformation. Some minor asymmetries might linger and heavier patients might experience some bulging, but residual results like these can be fixed with occasional touch-up revisions like scar improvement or removing small areas of excess tissue. Remember, this is not a weight loss procedure and is not a substitute for diet and exercise.

For the most part, the results may last indefinitely if the patient maintains a reasonable goal weight through diet and exercise. Certainly, if a patient becomes pregnant after their procedure, the result may change, but it is possible to do a revision in most such patients. Changes associated with aging will continue, of course, but the overwhelming majority of patients are highly pleased with having had their tummy tucks years before.

Before you undergo treatment, there are many ways you can prepare for the procedure:

• Have a reasonable expectation of what surgery can accomplish – understand that this is not a surgery for weight loss
• Look at before-and-after photos and understand what kinds of techniques you are interested in
• Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
• Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
• If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk.
• Designate a caretaker who can help you through the first 7-14 days after your abdominoplasty
• Identify whether you think you might have a hernia bulge in your belly button or abdomen
• Lose weight to get to a target which we can set together based on your body mass index (BMI) – ideally, we’d like to help you get it below 30, but there is a reasonable range depending on other factors

It’s highly recommended that you wait at least a month before engaging in any strenuous activity—and sticking to only a light workout at that. Dr. Sayed will let you know when it’s the right time to ramp up your workouts.

A cost schedule is available at our San Diego office. The cost of your surgery will partly depend on where you have it, and whether you combine it with liposuction, breast surgery, or other procedures. Further, because costs are dependent on matters outside our control such as anesthesiologist fees, we prefer to provide you with a cost schedule during your consultation at our office.  Conversely, review our Pricing page to build a “wishlist” and get estimated pricing on a tummy tuck or a combination of procedures. We also have a fee schedule available in the office after your consultation. Feel free to contact us for a pre-consultation and we are happy to provide more information on costs. One thing to keep in mind for patients considering combining BBL (Brazilian Butt Lift) and tummy tuck: Dr. Sayed most likely will recommend that you stage these operations for your safety and to optimize the results; although in selected patients it may be reasonable to combine them.

In addition to his tummy tuck expertise, Dr. Sayed has mastered other body contouring procedures such as Brazilian butt lift, liposuction, hi-def liposculpture, body lift, mommy makeover, and more. Dr. Sayed also maintains the highest levels of expertise in face and breast procedures.