Tummy Tuck in Mexico by Dr. Manuel Gutierrez Romero

The operation described as a tummy tuck in Mexico is designed to eliminate the excess skin located in the lower part of the abdomen, usually from the belly button down to the pubic area.  It reinforces the abdominal wall, and the objective is to eliminate the excess skin, and obtain a more flat and firm abdomen.

Who is a good candidate?

Typically, females who have had multiple pregnancies are good candidates.  The skin stretches during pregnancy.  Women end up with sagginess and redundancy of skin, and fat deposits and stretch marks mostly in the lower part of the abdomen.  There are many other circumstances when patients will need a Tummy tuck: male or female patients who gain and lose a substantial amount of weight, or those who have gone through major weight loss (gastric bypass or lap band). These areas persist even with exercise and appropriate diet, and can give the appearance of disproportion with the rest of the body.

The best way to know if you need a tummy tuck is: remove your clothes, sit down in a chair and pinch the excess skin in the lower part of your stomach.  If you are able to grab a good amount of excess skin, you are a good candidate. Part of the evaluation is to look for previous abdominal operations or hernias.  We also evaluate the different fat deposits, and discuss with the patient all of the advantages and disadvantages.

When is the best time to have a tummy tuck?

The best time to have a tummy tuck if you are female, is after you have had pregnancies.  It is always advisable to wait until you decide not to have more children.

The other type of patient would be those who are in the process of losing weight.  It is very highly recommended to get to your ideal weight before getting your tummy tuck, so you will get the best result.

The operation is technically very simple: usually under epidural anesthesia placed by the anesthesiologist, we begin with an incision in the lower part of the abdomen (it can be designed to the type of underwear you like). We proceed to undermine the skin and fat from the abdominal wall, realign the belly button, and continue with the undermining up to the rib cage. We proceed with tightening muscles.

Vertical abdominal muscles that have been stretched and weakened over time are tightened, restoring the appearance of a firmer, flatter abdomen.

We proceed to tighten the muscles and stretch the excess of skin.  We then remove the excess, and make a small incision to pop up your belly button in the same location.  The wound is closed in 4 different layers. We always leave a small drainage.

There are some technical refinements in a tummy tuck that will make the operation stand more than any average tummy tuck.  In order to eliminate the excess skin in the corners (called the ear dogs or folds of skin), we must extend the incision as far as necessary, as a small incision most likely would leave excess in the corners.

Another important problem is a lot of fat in the pubic area.  Most of the Doctors don’t remove the fat in the pubic area which results in a flat stomach with a large and bulgy pubis. The way to address this problem is at the time we do the incision. From the center we elevate the pubis, trim half of the fat and then we remove the excess skin (all of our patients love this procedure).

The last refinement is a small belly button.  At the time we undermine and realign the belly button, we cut in a triangular shape.  Then, at the time of stretching the skin, we do another incision in an inverted “V” that adapts nicely with the triangular one. The result is a small triangular incision which is less likely to close up or show a large scar.

Tummy tuck procedures can be performed alone, but are often performed with liposuction to further improve body contours. A tummy tuck should not be considered as a treatment for obesity, or a substitute for proper diet and exercise. Individuals considering a tummy tuck should be healthy and relatively fit. Future pregnancies and substantial changes in weight following a tummy tuck, as well as the presence of scars from prior surgeries may decrease the effectiveness and longevity of treatment.

Upon completion of the operation, the patient is transferred to the recovery room with sterile strips in the wound, drainage, and a compression garment. The patient must sleep and rest at 45 degrees. The next morning they must walk and have a daily shower.

Postoperative Instruction

Daily shower (no baths), blow dry the tape that covers the wound, clean your belly with q-tip and hydrogen peroxide once a day.  Take your medication according to instructions (antibiotic 3 times a day, pain relief medication alternate up to every 4 hours), empty the drainage 3 times a day.  Sleep at 45 degrees, you can sleep on your side but not your stomach.  You must walk every 2 hours, and must have a bottle of water every 2 hours with regular bathroom breaks. You can eat anything except hard to digest foods (no red meat).  You must wear a firm compression garment all day and night for 4 weeks with no exercise for 4 to 6 weeks.  During the first week you are allowed small walks inside the house.  Whenever you are resting, keep your legs elevated.  Avoid constipation, if you suffer begin prevention on day one ( papaya, plums, orange juice, fiber), and the most important, avoid dehydration. Avoid walking a lot, going up and down stairs, no walking the dogs, etc.  Never apply any heat on the abdomen. You can begin exercising after 4 to 6 weeks, with abdominal work in 3 months.

In the long run, patients can have a permanent numbness in the lower part of the abdomen.  The scar is permanent and the best result of the scar is after one year.  If you want to have the best result, you must wear the tape for the first month, and after you must wear the silicone sheets.  This is a self-adhesive sticker made of silicone that will create pressure on the wound.  It will control the production of collagen and minimize scarring.  You must wear it for 4 to 6 months nonstop.

Liposuction in Mexico

Liposuction in Mexico is the most common procedure perform by any plastic surgeon, the concept of liposuction is “to remove the number of fat cells from a specific area to correct a deformity and improve the shape”. Under no circumstances liposuction should be use as a weight lost method, if a patient is over weight they must be transfer to :
nutritionist and physical trainer or general surgeon for one of the bar iatric procedures like: lap band, gastric by pas, or gastric sleeve, according to the type and amount of overweight.

Genetically we all are born with a different body fat distribution, this will depend were our body swill store the fat if we gain weight, or simply we have a deposit in an specific area that has to much in one area. What ever is the case liposuction can re shape our body and eliminate the number of fat cells from that specific area.

There are several methods available to eliminate the fat from a specific area, some of the manufactures of the new machines have a tendency to proclaim “ this machine is the ultimate, better results, faster recovery, minimal bruising, excellent results, no down time”, and in 1 to 2 years later they have another machine they promises the same thing (they need to sale more new machines) traditional liposuction, ultrasonic, liposuction, smart liposuction, laser liposuction are all reliable methods that depending on the ability and experience of the surgeon will provide optimal results At the end the most important this is the hand of the surgeon, the expertise, and the method that has been able to get you more persistent good results with the less amount of complication.

Problem number one “fat in” solution “fat out” all of the machines eventually will do the same thing, but the expertise of the surgeon will have the final out come.
There are different density of fat in our body typically the fat of the front is smother than in the back depending on the density some methods are more ideal (more power full machines)

THE PROCEDURE:

Most of our liposuction are with epidural or general anesthesia, we don’t belie in local anesthesia an lees a very small area, it is almost impossible to numb a large area with local, and there’s a point were the patient can not stand the discomfort, and the procedure must be stop, “no local”.
We always combines the tumescent method, we inject the area with a prepared solution (bicarbonate, adrenaline, and bupibacaina) this will help with post operative numbing, minimize the bleeding, if we uses ultrasonic, sound travels faster in liquid so is better to inject more liquid.

The procedure is done thru small incisions, ¼ inc or less, we infiltrate the solution and begin extracting the fat. It is very important to levee a small cushion (¼ to ½ inc of fat) to prevent irregularities, also is important also to utilize small diameter canulas, 3 to 4 mm in diameter, also avoid superficial liposuction very close to the skin to prevent irregularities, ones the procedure is finish, we place a compression bandage, it is expected to drain water fluid or blood thru the small incisions for 1 or 2 days, most of our patients are discharge the same day.

The most common complications after liposuction are:

Irregularities, this usually happens, because the Dr. did liposuction to close to the skin, or uses canulas tat are to thick, so the use of smaller canulas is mandatory.
The second most common complication is the collection of liquid, blood or serum, call seroma, this collection of fluid usually happens by 2
reasons: not enough compression, to much physical activity. After liposuction the skin is detach from the muscles, it take up to 7 days for your body to build bridges of collagen that will attaché the skin to the deep layers, so it is very important that for the first week you keep your compression tight and minimal physical activity, this will prevent the creation of a seroma. Scars rarely offered a problem; usually we try to place the scars, in a lees visible area

Post operative care:

You must have a daily shower starting the next day of the operation, you must wear compression garments all the time 24/7 (only take it of for your shower), for the next 4 weeks, you must avoid stannous walking, no walking the dogs, no up and down the stair, no exercise for the next 4 weeks, the only this you must move is inside the house, kitchen, bedroom, bath room, take your medication as prescribe, never apply heat in the area. In order to accelerate the healing process it is advisable to begin lymphatic drainage massages usually after 10 days and it is recommended 3 to 5 times a week, for up to 2 months.

This will help improve the blood flow, the lymphatic drainage, and remove the scaring tissue. The actual result of liposuction is not before 2 to 3 months un till the swelling is down. The patient must never have corrective liposuction before this time, must weight at least 6 months up to 1 year to have normal tissues.