FAQ's
TUMMY TUCK
Q. Can exercise tighten up my abdominal skin?
A. Exercise can tighten and thicken muscles and reduce
the fat on your stomach but exercise can never repair muscles
which have been widely separated or stretched apart due to
pregnancy. Also, exercise cannot eliminate stretch marks or
change skin which is loose and overhanging (called a panniculus,
which is Latin for “apron”). A tummy tuck can correct all of
these changes by eliminating loose, damaged skin and
internally tightening lax, stretched out muscles to restore
firmness to all layers of the abdomen.
Q. Is there a way to avoid a scar?
A. No, not with a tummy tuck. You have to trade a
surgical incision for the excess fat, wrinkled skin, abdominal
scars, stretch marks or belly button distortion to get the
changes you want the most. You may require an incision that
goes from hip to hip, but it’s usually an excellent trade for
those who are appropriate candidates for abdominoplasty. Scars
vary from person to person. Sometimes the design can be
customized to keep it low or shape it to fit under a skimpy
French cut and still hide the scar. It’s a good idea to bring
the type of swimwear or undergarments you prefer so that your
request can be kept in mind when the incision design is
planned.
Q. Do I need to lose weight before I have a tummy tuck?
A. If you are in the middle of a successful diet,
sometimes we do suggest that you lose weight to
optimize the planning of the surgery. Often, it’s reasonable to proceed
with the tummy tuck immediately if the weight cannot be reduced or if it
is stable. Occasionally, if there is a large weight loss after a tummy
tuck a touch-up surgery may be beneficial, but these situations are less
common and must be evaluated individually.
Q. My upper abdomen and belly button are fine. All that’s bothering me
is just the skin below that is hanging. Would I need a tummy tuck for
that?
A. Yes, but possibly not a full tummy tuck. There are three
variations of tummy tucks. A mini tuck just tightens loose, separated
muscles, much like an internal corset. These are the least common and are
only appropriate for patients with good skin, little fat and bulging which
is mostly due to loose muscles stretched apart by pregnancy. An extended
mini tummy tuck tightens the muscles and also takes off excess skin and
fat, tightening the entire area below the navel. The incision is shorter
than a full tummy tuck. In another option, the belly button is detached
and “floated” downward, instead of being repositioned and tightened which
is standard with a full tummy tuck. Each tummy tuck, mini, extended mini
or full is specifically designed for the individual torso. We consider
where the original navel is located, how much excess skin needs to be
removed, where the excess skin is located, and the condition of the
underlying muscles in addition to the expectations of the individual.
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LIPOSUCTION
Q. How many sizes will I go down after liposuction?
A. First, it’s important to realize that liposuction is not really
a weight loss surgery. Liposuction will reshape bulges and smooth out
contours. For this reason the fit of clothing always changes, although the
clothing size may not change. In other cases, the clothing size may change
significantly depending on your starting point and what areas are treated.
Interestingly, the scale weight may not change that significantly even
though you may appear to have lost a great deal of weight. Remember that
in order to lose the bulges which are treated with liposuction you would
have to lose quite a bit of overall body weight on a diet. However by
taking those specific pounds away selectively, the body often appears to
have lost quite a bit of weight. A pound of fat is about as big as a
grapefruit, so if you take off two or three pounds, you can imagine what a
nice change it can be in the shape of the thighs, for example, even though
a 2 or 3 pound weight loss might not have made that much difference. Most
people can tell a difference in their size after the first week even
though there is still some swelling. We take photos about six weeks after
surgery but you will continue to see subtle changes for up to six months.
Computer imaging helps to show a person the minimum change that could be
expected after the healing process. This is extremely helpful in helping
patients have a realistic expectation, since we can demonstrate reduction
of bulges without making other changes.
Q. Will the fat come back?
A. Fat cells are unique in that they do not multiply so areas which
have had liposuction will have true removal of the fat cells in that
region and they will not come back. However, if you consume more calories
than you burn, your body will gain weight. The difference is that after
liposuction weight gain is usually more evenly distributed since the fat
cells in those bulges which have been treated are gone for good.
You should also realize that great results in liposuction involve a
partnership between the surgeon and the patient. If surgery is performed
and bulges are improved and the patient begins to eat more, exercise less
and generally gain weight, the return visit will not be satisfying for the
physician or the patient. Both will be disappointed and this is unfair to
you and your doctor. The best results are those which use liposuction as a
starting point for a better lifestyle, a lower fat diet, healthier
exercise and eating habits, and an overall commitment to self-improvement.
It’s very difficult to evaluate the result of liposuction surgery if you
have gained weight between the liposuction and your final visit.
Nonetheless, when bulges are treated the results tend to be permanent. The
best areas are stubborn areas which seem to persist even when you are
close to ideal weight. These include the hips, thighs and abdomen for
women and the abdomen, breast region and love handles for men.
Q. I’ve been considering liposuction and have heard about a new
technology called ultrasonic. What makes it unique and is it safe?
A. Ultrasonic (UAL) involves the use of high-energy sound waves to
soften and liquefy fat before it is removed. We use the Mentor system
which allows smaller incisions due to more advanced technology to cool the
probe without requiring the insertion of a plastic skin protector. The
probe is advanced through tiny incisions into the site and is especially
effective in areas where fat is firmer and more difficult to remove with
traditional liposuction. The best areas for ultrasonic liposuction include
the upper abdomen, back rolls, waist and enlarged male breasts.
Q. Should I lose weight before I have liposuction?
A. Liposuction can never accomplish what exercise can and often
exercise can’t do what liposuction can. If you lose weight with diet and
exercise, you will be a smaller version of the shape you are now. Often
troublesome bulges still persist and these are the areas best treated with
liposuction, areas which really don’t fit the rest of your body. The ideal
situation is to be at your perfect height and weight for liposuction and
just have sculpting of smaller bulges. However, this is not very realistic
for most people. If you are actively losing weight it’s probably best to
complete your diet before liposuction if that’s realistic. However we
perform liposuction on people of all sizes and shapes and expectations
have to be adjusted, depending on your starting weight. If you are
significantly overweight you can look like you’ve lost significant weight
by treating the bulges, however other areas of excess body fat will
persist in areas that aren’t treated so the outcome is different than if
you lost the weight first. Most of our patients feel so good about the way
they look after the surgery that they have the incentive to pay closer
attention to a lifestyle that promotes better health and lower body fat.
This is the ideal situation.
Q. I had a baby and lost all my weight but my lower stomach has a pooch
that will not go away. Will liposuction help?
A. Sometimes the lower abdominal pooch can be caused by muscle and
not abdominal fat. Muscles can be stretched out by pregnancy and may need
to be tightened up in order to flatten the abdomen. In some cases there is
extra fat and muscle weakness contributing equally to the bulge.
Liposuction can take off the fat on the top layer outside the muscle (the
fat that you can pinch and grab hold of). A tummy tuck is necessary if the
muscles are loose and bulging to tighten the stretched out muscles and
flatten the abdomen from the inside. There is not a procedure that can
safely take fat from under the muscle on the inside of the abdomen around
the organs. An examination can help determine which of these contributing
factors need to be treated to give you your best result.
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BREAST AUGMENTATION
Q. Will I have a noticeable incision?
A. Visibility of scars is a concern for most patients. Several of
our staff have had breast augmentation by Dr. Stagnone and can demonstrate
their incisions. They are initially pink and over the course of six to
twelve weeks the color fades and eventually becomes a pale light color
which usually blends in with the adjacent skin. There are three incision
sites available. The axilla (armpit), periareolar (lower edge of the
nipple) and inframammary (in the breast fold). We offer all three
incisions, however most surgeons prefer the inframammary fold approach. We
like to sit our patients up after the implants are placed, and through the
inframammary incision fine-tuning and sculpting can be performed along the
lower border where the shaping is most critical. It is very difficult to
perform this fine-tuning through the axillary approach and there is a
higher incidence of slightly irregular breast implant position or slightly
irregular shape of the inframammary fold. The nipple incision may have a
slightly higher risk of nipple numbness. Regardless of your incision site,
healing takes time.
Q. Can I tan after surgery?
A. You will be hard pressed to find a bathing suit that doesn’t
look good after this surgery. Although we discourage tanning since it
prematurely ages the skin, we recognize that most of our patients can’t
wait to get out in the sun with their new look in a bathing suit! It is
very important to protect your incision during the red or pink phase of
scar fading. If the incision itself is tanned during this red phase it
often gains additional pigment, resulting in a scar which is a little
darker than the adjacent skin. For this reason it is best to protect the
scar thoroughly during the red phase. A thin piece of black electricians
tape works extremely well for this and can be placed discreetly over the
incision during tanning. Remember, some sun even penetrates the fabric of
a swimsuit so it is important to protect the incision even through your
bathing suit is covering the area until the scar has faded to the color of
the surrounding skin.
Q. I saw someone at the pool that had a big space in between her
breasts. How can someone with implants have that kind of cleavage or a
lack of cleavage?
A. It’s important to realize that you can’t necessarily bring in a
picture of the exact breast you would like. Your starting nipple position
will determine the position of the final breast mound. If the nipple
position is widely spaced towards the side of the chest wall, the implants
must be placed under the nipple so that each breast mound looks
appropriately positioned. In most cases, there would be a wider separation
between the breasts because of such a starting nipple position. In most
cases, however, an implant can be selected which is centered under the
nipple and extends toward the cleavage area to create an aesthetically
pleasing cleavage. We choose an implant diameter to try to create the best
cleavage and the best outer silhouette. However, always remember you can
only be a bigger version of your original starting place. You may be
blessed or somewhat limited by your own starting anatomy.
Q. Can you guarantee me that I will not have two grapefruits sitting on
my chest?
A. Round shiny breasts with visible edges of the implant along the
upper border are usually due to very aggressive selection of implants. If
the starting skin is very tight, it will be difficult to place a very
large implant without stretching the skin and creating that round
spherical look. It is often better to select an implant which is a little
less aggressive in order to have breasts which are more beautiful when
they are exposed. If your goal is to have breasts as large as possible so
that you can turn more heads with your clothing on, sometimes you must
compromise and accept a less natural looking breast when you are
unclothed. In general, the more an implant is filled the rounder it
becomes and the fuller it becomes on top. We can adjust the fullness on
the operating table and we like to sit our patients up and adjust the
shape by adding or subtracting volume as the last step in the procedure.
For this reason you will be carefully interviewed about the style of
breast which you most desire. It does help to bring photos showing what
you like or dislike and you can also look through our many, many before
and after photos demonstrating different results. The best results come
with a moderate amount of breast tissue to begin with and skin which is
slightly lax to better drape over the implant. The less breast tissue you
have to begin with and the tighter the skin envelope, the more
conservative one should often be in implant size in order to get a more
natural, soft and realistic appearing breast.
Q. I’ve heard that a lot of people regret that they didn’t go bigger
after their breast augmentation. Do you find this to be true?
A. Yes, this is common. Probably about 20% of our patients would go
a little bit bigger if they could after everything is healed, but most are
actually really happy. The implants are chosen by careful measurement and
we’ll usually recommend a size that fills the breast area without creating
distortion or too tight a look. After we’ve measured we like to place
sizers in a sizing bra so that you can get a preview of the approximate
size you will get. If you are a little hesitant but not totally against
the larger size range we offer, it’s often best to go with that since it’s
very rare after breast augmentation to wish that they were smaller. Also
it’s important to try not to focus too much on final cup size, as a goal
because bras are all cut differently and there is no international
standard defining exact bra cup sizes. Also there are too many variables,
such as compression of the implant by your muscle and compression of the
breast tissue by the implant which varies from one person to the next,
based on different tissue characteristics. Thus it is impossible to
accurately predict or guarantee final cup size. Also, it’s important not
to focus on the size implant chosen by your friends because, like shoes,
each individual has a size that is best for them. Again, it’s a great idea
to look at our before and after book to get an idea of how different women
look with different size implants based on completely different starting
anatomy. If you come to our office for sizing try to remember to bring a
tight shirt and a loose shirt so that you can get an idea of how things
will look with different outfits. Please understand too that the
appearance of the breast with a sizing bra and the implant outside your
body is not going to be identical to the appearance when they’re inside
and under your muscle. However, at least this gives you an idea of the
general size range you’ll be and can help guide you in your final choice.
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