Getting the best tummy tuck results requires a surgeon at the top of his game. In this two-part video series, Doctor Mowlavi explains how to get your tummy tuck done right. Below each video is a complete transcript for your reading pleasure
Dr. Mowlavi: Hello everybody. This is Dr. Arian Mowlavi with the Ask Dr. Mowlavi series. I want to encourage everybody to send your questions to firstname.lastname@example.org. Today’s topic is optimizing your tummy tuck results and outcomes. And I want to share with you the advances that have been made in the tummy tuck arena. Today’s tummy tucks are quite different than the traditional tummy tucks that everybody’s used to. Today’s tummy tucks are masterpieces, they’re sculptures. We treat the body today as if it is a statue and we sculpt you. And the results are not just de-bulking the abdomen and making it look smaller and close, but it is creating an absolutely stunning abdominal contour that you can be proud of, that you can show off wearing a two-piece bikini. So let’s start off and explain to you what we’re talking about.
Check out These Tummy Tuck Before and After Photos
Advances in tummy tuck and optimizing your results. Today’s tummy tucks are quite different than the old traditional tummy tucks. And there are several factors that we’ve added or we’re cognizant of that allow us to achieve these stunning results. And I want to enumerate them right off the bat, and then we’ll get into some details. First and foremost, the belly button, the belly button is the center of your abdomen. If you create an ugly belly button as a surgeon, then you’ve failed in your attempts at doing a tummy tuck. The belly button should be hidden, should be natural, should not even be apparent. As someone looks at your abdomen, they should not even see a belly button that looks surgically done are operated in look. So what we’re talking about is creating an innie belly button. So when we do tummy tucks, we excise the redundant skin, bring over the tummy skin flap, and then recreate a belly button.
When we recreate that belly button, there’s a ring called the neo-umbilicus. That ring should really be hidden. And that is what an innie belly button is. And I will teach you all how we get that done. The second component of an advanced tummy tuck is a low incision line. You guys low, I do revisions weekly. And the number one deformity or suboptimal result that I see is an incision line that’s apparent above the undergarment. And it’s often very close to the newly created belly button. If you can see the incision line, you failed that your tummy tuck.
The incision lines today should be low in your pubic area within the bottom of your two-piece bikini or an undergarment. That is because we don’t want anybody to know that you’ve had a tummy tuck.
The third problem that I see is leaving lateral flank and love-handled prominences. In the medical profession, we call that dog ears. Those are no longer allowed. When you look at an abdomen is not just to be looked at from the front view, but you got to look nice from the oblique view and the side view, you can’t just pull the abdomen down like a curtain and then pop out the lateral flank and love handle areas called i.e, dog ears. Today’s tummy tuck advances require us to be cognizant of the entire abdomen and torso, and that includes the flanks on the lateral sides of the tummy. So we go to great lengths to make sure that there are no dog ears so that the abdomen looks elegant and harmonious throughout in all angles of view. This is a key part of getting the best tummy tuck results.
The last topic I want to talk to you about is the overall contour. And this is talking about the muscle repair component of the abdomen. When an abdomen is created and contoured on a young lady on a feminine silhouette, the upper abdomen should be concave. The lower abdomen should be slightly convex as it approaches the pubic area. So we have a sleek concave, upper abdomen, and then below the belly button, there’s a gentle, soft convexity. To create this we have to be cognizant of our muscle repairing techniques. And I will cover that today.
And on the side views, we really have to focus today on creating a beautiful curve and contour lines, i.e, described by a numerical symbol called the tilde. So the tilde curve has to be created, and this is created only by narrowing the waist and then having a gentle transition into the lateral flank areas and maxed into the buttock or mid-hip areas to create the hourglass shape.
So there you have it, all of the components to an amazing tummy tuck, and we will get into the details of what is involved with achieving this in my part two series of optimizing tummy tucks.
Optimizing Tummy Tuck Results Part Two
Let’s start today’s series, which is part two of optimizing tummy tuck results and outcomes. And so we’ll get right into it. Last time we covered the five critical advances and factors that create stunning tummy tuck results. They include an innie belly button, that’s a belly button that’s transparent and beautiful, and natural. Two, a low incision line that’s able to be hidden in your two-piece bikini bottoms or your undergarments, so nobody knows you’ve had one done. Avoiding the dog ear, which is coined to refer to the prominences in the lateral flank and love handle area. And this can get more prominent when you do a tummy tuck if you don’t address it.
And the final thing for you is the contour enhancement of not only the front of the belly, where you have to create a concavity over the upper belly, above the belly button, then which transcends and transitions into a slight convexity as we approach the pubic area on the front view. And on the side view, what we’re talking about is waistline narrowing, so that you get your waistline tucked in, and then it comes smoothly and transitions into the peak point of your lateral hips to create that hourglass look that we are all fond of.
So here we go. Let’s talk about the first concept. It’s an innie belly button. The innie belly button is created when you recreate the belly button because remember, in a tummy tuck, we cut out the belly button, we leave the stock attached, and then we get rid of all the extra skin, pull what’s left down, and resew it. And then the belly button’s gone temporarily until we make a little window called the Neo N-E-O umbilicus, and that little ring, the window then gets sewn back to the stock.
Well, I can’t tell you how many patients I see that have an absolutely ugly belly button. One of two things happens. Either the ring is sewn way too big, and it’s outside on the abdominal skin and you can see it like a target, or the surgeons try to hide that belly button and it becomes scarred and it looks even more deformed.
The way that we are able to create innie belly buttons is as follows. The first secret is to sew the belly button stock down onto the muscle. You want to sew it down. That is because once you make the ring on the new abdominal skin flap to sew down to the stock, that ring is going to get pulled down, and it’s going to get pulled down into the shadow of the new belly button that you’ve created. And that’s how you get a transparent neo umbilicus.
Now to achieve that, you have to have two things happen. Number one, you’ve got to so that umbilical stock down to the fascia, but more importantly, and more technically challenging is that when you make that window called the neo umbilicus to sew it down to that stock, you have to accurately identify the stock position. Because if you’re off by a couple of millimeters, when you make that little window, it’s not going to reach that stock anymore because that stock has been sewn down.
In order to achieve that, we have patented a special tool called the Umbilicator. And this was published about 10 years ago by myself. And it involves this a little apparatus, this little tool, that I actually sew down to the stock before I bring over and redrape the abdominal skin. And what it really does is it allows me then to palpate or feel where that umbilical stock is when I’m going to make that little window. So I never miss it. And that’s the secret. You have to be able to identify where the stock is and using our Umbilicator, we’re able to do that every single time.
What does that mean for you all? It means that you can go on vacation next time and not have to wear a swimming suit. Rather wear a two-piece bikini, and you can show off that belly and be proud. You can be proud that the center of your abdomen is not operated in its look, and it’s not deformed.
The second factor I want to talk to you guys about is a low incision line. What we’re talking about is when we excise the extra skin and we redrape the rest of the abdominal skin flap, we call it, in doctor terminology, down, we want that new flap incision line to be down low. And I can’t tell you how many tummy tucks I see in my clinic where the incision line has been sewn way too high. In fact, even close to the belly button, and so there’s no way you can hide it.
The secret to getting a low incision line is to being aggressive with your skin excision and redraping and putting the patient in inflection so that it’s taught. When you are done with your tummy tuck surgery, if the skin isn’t super tight, you’ve missed the boat. You’ve totally missed the boat because what’s going to happen is that skin is going to recoil and relax. So if it ain’t super tight, at even one week following surgery, it will be way too loose.
So the secret to low incision line placements is to make your skin flaps tight. Be aggressive in your excisions. Flex the patient in the OR, and make sure that you get that skin flap tight and bring it down so it’s low on the incision line so that you can, again, wear that bottom piece of your two-piece bikini and know that your incision is not going to be visible.
The third thing I want to talk to you about is avoiding i.e. dog ears, those prominences in the lateral flank area. This has to come with just being comprehensive, thorough. I know a tummy tuck can be difficult and can take a couple of hours, but once you’re done with the tummy tuck, don’t just quit there. Make sure you look at the sides of your flank and the love handle area as surgeons and make sure you eliminate those. All it takes is either just a little bit of liposuction can get rid of that. And sometimes once in a while, you just have to extend your incision line and cut out if there’s any extra skin there. In today’s day, there are absolutely no excuses for leaving dog ears behind because it ruins the entire sculpture that you’ve created. Now that belly can’t be looked at from the sides and the oblique views, what we call the three-quarter views. So make sure that what you create is elegant and beautiful.
The final thing I want to talk to you about is creating appropriate contour lines. And these contour lines have to be created beautifully, not just from the front, but also on the sides. So what we’re talking about is the front view first, and what we’re talking about is not appropriately repairing the muscles. Let me get into this a little bit.
So one of the things that we do in tummy tucks is to tighten the muscles. These muscles often stretch out when you have babies because the intra-abdominal pocket is filled so much that it stretches your muscles thin. And then they become what we call diastatic or loose or thinned out. Integral to a tummy tuck is repairing these muscles.
Now, what happens is the belly button is a stationary pillar and it actually divides the belly abdominal muscles into two, the upper abdominal muscle and the lower abdominal muscle. And each one of these has to be independently tightened. The secret here is to know that you should tighten the upper muscles a little bit tighter than the lower muscles because the inside of the belly is one balloon. So if you’re tying them the same amount, the upper and the lower, then they’re going to be pushed out the same amount. What you have to do to get a concave upper abdomen and a convex lower pubic area is to make sure that you tighten the upper muscles just slightly more than the lower muscles.
And that’s a secret. I’m giving away all my secrets today to you all. And I hope that you all are more demanding of your surgeons and are able to get these superior outcomes. That is the only way you’re going to get a superior female silhouette that is proportioned and harmonious.
The last thing involving contour lines is the waistline. And this is an error that I see all the time. When you take out the extra skin and then you undermine the skin so that you can redrape the skin, automatically you’re tenting the outside flank area of your abdomen. The waistline will actually get tented. Think of a tent. If you pull the tent taught, like we’re pulling your skin, you’re actually going to eliminate your waistline. And I can’t tell you how many females I see with a square waistline after a tummy tuck.
Now, how do we avoid this? The way you avoid this, it’s called differential undermining. What you do is, and it’s not intuitive, you guys. What you want to do is when you’re undermining the skin, meaning lifting it up to redrape it and pull it down, you don’t want to undermine it over the upper lateral areas of the torso. You want to keep the skin attached to the muscle.
Why is this so important? It’s important because when you’re tightening the muscles in the upper abdomen as we’ve discussed already, those muscles are going to pull in. And when they pull in, if you keep them attached to the skin, overlying them, they’re going pull the skin in. And that is one of the biggest secrets of tummy tucks. In order to waistline narrow your torso, you need to actually minimize your undermining in the upper lateral abdominal area, so that when you pull the muscles in, they pull the overlying skin over the lateral flank area in as well. And that’s how you get waistline narrowing and eliminate tenting.
So in summary, guys, I’ve taught you how to get optimized tummy tuck results. Today’s age demands perfection and stunning silhouettes, contour lines, and the factors that we’ve discussed above, which include an innie belly button, a low incision line, avoiding dog ears, and optimizing your control lines, are critical in being able to achieve these results.
PS: See Doctor Mowlavi’s YouTube Playlist on Tummy Tuck