An Extended tummy tuck has become a mainstay procedure of post bariatric tummy tuck surgery. This surgery has been modified from the traditional tummy tuck to address specific concerns of post bariatric patients including:

  • Severe skin redundancy and loss of skin elasticity of the abdomen
  • Prominent and sagging pubic region
  • Prominent love handles, flanks, and lower back tissues
  • Extensive stretching out of the abdominal muscles
  • Thinning out of the abdominal muscles (attenuated)

The extended tummy tuck has been developed to improve the appearance of the abdomen as well as prominent lateral flanks and love handles. The extended tummy tuck surgery is designed as an extension of the tummy tuck excision lines that are modified to accommodate the planned excision of the lower back and flank prominence and a sagging pubic region. In order to address the lateral flank and lower back prominence, the traditional tummy tuck incisions are lowered from their traditional position as they extend laterally. In order to address a sagging pubic region, the traditional tummy tuck incisions are lowered centrally to allow for lifting and trimming of a prominent pubic region. When designing excision of skin redundancies, more aggressive resection of skin is designed in order to account for “recurrent skin laxity” syndrome. This name refers to the fact that following excision of redundant skin, the remaining skin loosens or gives because it has lost its ability to recoil due to loss of skin elastin protein. As such, if aggressive skin reduction is not performed, the skin can loosen soon after surgery and be redundant.

In order to allow for more aggressive resection of the redundant skin, patients are flexed beyond the traditional 20 degrees to 30 degrees of flexion. Finally, traditional repair of the abdominal muscles is modified to accommodate both extensive stretching out of the muscles as well as thinning out of the muscles. The repair of stretched out muscles usually requires tightening or placating of the muscles along the midline of the muscle. Typically, 8 to 10 cm of muscle can be tightened in this area which narrows your trunk and waist line like a brassire. In an extended tummy tuck, the muscles may be tightened as much as 14cm. In addition, a second line of thigtening is often required over the lateral aspect of the abdomen, termed oblique muscle plication to accommodate more generous stretching out of the abdominal muscles. Infrequently, the muscles may be thinned out and not be able to be tightened with suture only plication. In these situations, further reinforcement is required to achieve appropriate tightening of the muscles and thus requiring Tri Modality repair. Patients requiring Tri Modality repair will undergo more generous muscle plication as above following release of the lateral muscles, called component separation, followed by placement of a biologic mesh overlay. The Tri modality repair is the gold standard for abdominal muscle tightening in patients with thinned out(termed attenuated) abdominal muscles. During your initial consultation with Dr. Mowlavi, he will examine you and determine whether you are a candidate for the Tri-modality repair and design your extended tummy tuck excision lines. The extended tummy tuck excision lines may be extended to a lower body lift to allow for circumferential reduction of your mid torso in order to maximize waistline reduction.

Procedure: Elimination of redundant skin and abdominal bulge, reduction of lateral flank and love handle prominence, reduction and lift of the pubic region.
Length: 2 to 3 hours depending on the size of the abdomen and flanks.
Anesthesia: General anesthesia.
Place of Treatment: Outpatient surgical suite or hospital operating room.
Side Effects: 1) Due to extent of redundant skin excised, patients may experience temporary tightness surrounding skin incisions; patients are asked to remain semi-flexed in order to minimize tension on the incision line for the first week while the remaining abdominal skin relaxes.

2)Temporary numbness of the abdominal skin which will resolve over the first 3 to 6 months.

Risks: 1) Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following surgery. This complication is avoided by providing intermittent pneumatic compression garments

2) Local skin infection is not uncommon in a patient who has diabetes, iron deficiency anemia (low blood count), and protein deficiency. All of these conditions are corrected well before surgery to avoid this complication.

Recovery: The recovery for extended tummy tuck surgery is as little as 2 to 4 weeks.
Duration of Results: Patients are extremely pleased with extended tummy tuck surgery and return of their hour glass appearance and they enjoy physical and mental confidence of showing off their abdomen and waistline. Patients can expect cosmetic results to last a lifetime as long as they avoid weight gain.

What does extended tummy tuck surgery involve?

Extended tummy tuck surgery involves removal of redundant skin and elimination of abdominal prominence as well as fullness of the lateral flanks and reduction and lifting of the pubic region. The extended tummy tuck was designed as a modification of the traditional tummy tuck procedure.

Am I a good candidate for an extended tummy tuck surgery?

You are a good candidate for extended tummy tuck surgery if you have significant amount of flank prominence that is blunting your waist line and thus eliminating your hour glass appearance. Most post bariatric patients find the prominence of their lower back and flanks as much as if not more than the prominence of their abdomen. The goal of the extended tummy tuck is to narrow your waist line circumferentially when combined with a lower body lift. Finally, an extended tummy tuck will result in lifting of your sagging and prominent pubic region.

How do I plan my extended tummy tuck surgery?

On your initial visit, Dr. Mowlavi will evaluate your health status, determine the amount of skin redundancy and residual fat, and show your customized excision lines; You will have your blood checked to make sure that your blood count is adequate and that you clotting factors are normal. If you are a smoker, then you should quit for 1 month prior to your lateral thigh tuck surgery in order to allow your body adequate time to rid itself of any residual nicotine. Nicotine in your system results in shutting off of small blood vessels which carry nutrients to the skin; this event could be catastrophic in extended tummy tuck surgery resulting in extensive wounds requiring months to heal.

How do I prepare for my extended tummy tuck surgery?

Since your extended tummy tuck surgery will require general anesthesia, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated and contaminate your lungs during induction of anesthesia. Since, you will have anesthetic medications administered throughout the case, you will remain groggy for some time and will require a ride to and from the surgery center. You should choose a caretaker who is conscientious and who can spend the first night with you.

What results can I expect after extended tummy tuck surgery?

By providing you a final skin reduction procedure for the abdomen, flanks, and pubica region, we are able to obtain for you a narrower waist line that you have dreamed of. Patients are extremely satisfied with their surgery and their ability to wear pants and jeans comfortably. By providing a thorough preoperative workup, safe intraoperative course, and frequent postoperative visits, patients should expect a speedy recovery and return to a more aesthetically pleasing torso region and enjoy more freedom with their choice in clothes.

Where will my extended tummy tuck surgery be performed?

Since your extended tummy tuck surgery will require general anesthesia, it must be performed in an operating room that is part of an outpatient surgery center or in an in-house office based operating room, but it is of utmost importance for patients to make sure that the office facility has been accredited by a surgical accreditation body such as AAAASF.

What type of anesthesia will be used for my extended tummy tuck surgery?

Since your extended tummy tuck surgery requires removal of moderate amounts of skin over the lateral flanks in addition to your abdomen, as well as more extensive abdominal muscle repair, there will be more tenderness and thus general anesthesia is required. This is because muscle possesses a large number of sensory nerves (pain fibers) that would be triggered during muscle tightening; general anesthesia ensures that these pain fibers are shut down during the operation.

What should I expect after extended tummy tuck surgery?

You should expect to feel most soreness throughout the abdomen where muscle tightening and biologic allograft material has been placed especially in the early postoperative period. The soreness can be minimized by continuous wearing of the compression garments. In general, the compression garments should be worn for at least 2 weeks in order to prevent development of any contour abnormalities. In addition, Exparel, a long acting numbing medication placed into slow release microspheres, is injected into the abdominal muscles. Injection of Exparel during surgery allows for a tolerable postoperative recovery period during the first 3 to 4 days since patients are provided numbness of their surgical sites.

When will I be able to return to work following extended tummy tuck surgery?

Patients can expect to return to work within 2 to 4 weeks following extended tummy tuck surgery. When patients combine the extended tummy tuck with a lower body lift, they can expect up to 6 weeks to recover. Patients are advised to gauge their return to work by their overall soreness which dictates the tasks which they may perform.

Do patients undergoing extended tummy tuck surgery require lower body lift?

Patients who undergo extended tummy tuck will find their abdomen tightened and their flanks trimmed; they will also find their lateral thighs tightened and their private parts lifted; however, patients may require removal of lower back prominence and lifting of their posterior lateral thigh and buttocks. If circumferential tightening is desired, then an extended tummy tuck can be combined with a lower body lift.

Where is the incision for an extended tummy tuck?

The redundancy of skin and fullness of the lateral flanks can be corrected with an extended tummy tuck incision line. This modification of traditional tummy tuck excision lines requires placement of the excision lines lower than traditional excision lines. By positioning traditional excision lines lower, it is possible to not only get lifting and trimming of the pubic region but also improvement in the flanks and lateral thigh contour. During you initial consultation with Dr. Mowlavi, you will have the opportunity to visualize exactly where your incision will fall; the incision is customize to your favored bikini bottoms and undergarment wear.

What steps can be taken to minimize scarring of the extended tummy tuck incision lines?

We utilize an aggressive scar prevention protocol to ensure optimal incision line healing. This starts with minimizing tension of the incision line with a multi, 3 layered closure of the incision line. In addition, specialized tapes, called Steri-Strips, are applied to the incision lines which act as an external stitch without the risk of railroad tracking. Steri-strips are maintained for one month, after which, topical silicone tape and/or gel is recommended for another two months. During this recovery period, Intense Pulse Light therapy and steroid injections will be implemented when necessary.

How our patients feel about us:

Made me feel comfortable from the very beginning... Dr. Mowlavi and his entire staff are the best. My reconstruction surgery was a year long journey and I could not be happier with the results. Dr Mowlavi is a compassionate and caring surgeon. He and his staff have become like an extension of our family. I had a bilateral mastectomy with reconstruction in a single surgery. Dr Mowlavi answered all my questions and made me feel comfortable from the very beginning.

Anonymous Laguna Beach, CA

The procedure brought back years of confidence in myself... From the moment I stepped into the office I was pleasantly surprised by the friendly disposition of all the staff... After the procedure I was floored! I was surprised that such a great result could be achieved without the use of an implant which I did not want to get. As I admired myself in the mirror 2 weeks post op, Dr. Mowlavi smiled and said modestly, "Its all you!" I nearly cried as I had not perceived of my natural body looking truly beautiful in over 20 years. This procedure brought back years of confidence in myself that I had lost 90 lbs, 20 years and 2 children ago. For anyone considering plastic surgery but has fears and feelings such as I did you owe it to yourself to consult with Dr. Mowlavi and his staff. They are truly the best at what they do.

Lorene B.

Dr. Mowlavi is the best choice in Orange County... My highest recommendations go out to Dr Mowlavi for the skilled and fantastic work he performed on me... Being post bariatric surgery and not being the easiest of cases, Dr Mowlavi made sure we addressed the areas that I would gain the best results, made me fully aware of what to expect from the surgery, recovery and results. From my consultation to my post-surgical appointments... the entire Mowlavi staff treated me with special care, always making me feel like I was family, greeting me with hugs, smiles and ensuring I am doing well from the many follow up calls to all of the post-operative visits. I can not say enough to express how thankful I am to Dr. Mowlavi and his staff, and to let people know that if you are post cancer, bariatric or just need to have work performed to improve your appearance and quality of life, Cosmetic Plastic Surgery Institute with Dr. Mowlavi is the best choice in Orange County. You are all the BEST!

Jenifer D. Irvine, CA

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