#1. Conventional tummy tuck
A traditional abdominoplasty involves removing an oval- or ellipse-shaped wedge of loose skin underneath the belly button to smooth and flatten the area. This technique commonly results in an incision line that runs from hip to hip about an inch or so below the navel. The scar can generally be hidden beneath most underwear or a swimsuit.
In addition to removing excess skin, a plastic surgeon also may tighten the abdominal muscles during a conventional tummy tuck procedure. These muscles may have become stretched out during pregnancy to accommodate a growing baby, or may have become weakened over time due to weight gain. While performing a tummy tuck, many plastic surgeons will tighten these muscles, much like an internal corset, to further enhance the cosmetic result.
One disadvantage of a conventional tummy tuck is the belly button itself is often left with a scar around it. This scar can appear wide and have an ostomy-type look, which of course is a telltale sign that a patient has had surgery and is not aesthetically ideal. An experienced plastic surgeon who is skilled in other tummy tuck techniques will know how to conceal or minimize these scars by using more advanced methods whenever possible.
#2. Mini tummy tuck
Some patients are candidates for a mini tummy tuck procedure to remove excess skin and smooth the abdomen. The advantage to this approach is the incision line can be shorter and lower, resulting in what we call a “lingerie scar” that can be more easily hidden — even under a string bikini. However, a mini tummy tuck typically does not address muscle weakness, especially higher up on the abdominal wall. In addition, most patients are not candidates for this procedure, because the excess skin to be removed must be localized under the belly button only.
#3. Hybrid abdominoplasty
The most commonly performed abdominoplasty technique at our practice is known as a “hybrid abdominoplasty”. With this technique, Dr. Maercks is able to combine the benefits of the conventional and mini tummy tuck to achieve optimal results and give patients the best of both worlds: a low, short incision line with full muscle tightening.
Instead of making an elliptical incision, Dr. Maercks makes a pentagon-shaped incision. This approach ensures the scar is low and enables him to do some lateral tightening while minimizing the width of the incision. The resulting lingerie scar is easily hidden underneath even the tiniest bikinis and undergarments, and will fade beautifully over time.
By creating a “central tunnel” via the pentagonal incision, Dr. Maercks can expose the musculature and tighten up the abdomen all the way up to the rib cage or the xiphoid process (the lower end of the sternum or breastbone). Dr. Maercks approaches this step in a manner that preserves as much vascularity as possible, which means patients heal faster, have better-looking scars, and have a much lower risk of complications. Additionally, his technique makes it possible for him to perform liposuction for some patients who will benefit from additional body sculpting.
Patients often ask what will happen to their belly button. While performing his hybrid abdominoplasty procedure, Dr. Maercks actually anchors the new belly button (umbilicus) to the abdominal wall tightly. This approach creates some hooding on the top of the belly button and a flap below so that the scar is hidden. Once healed, the belly button is an innie instead of an outie, which most patients prefer.
While Dr. Maercks is able to achieve the lingerie scar for most patients who opt for his hybrid abdominoplasty, the extent of the scar is very dependent on the individual patient and their goals. If a patient wants to address excess skin or fat laterally, for example, Dr. Maercks can customize the procedure and extend the incision slightly to achieve even more smoothing and full abdominal tightening. Because the hybrid abdominoplasty is such a flexible approach and can be fully customized for patients while helping them achieve the most aesthetically pleasing outcomes, this option is well suited for most tummy tuck candidates.
For patients who have a great deal of horizontal excess skin that extends around the abdomen to the back, flanks, and buttocks, the fleur-de-lis technique may be the best approach. Neither a conventional nor a hybrid abdominoplasty addresses horizontal skin laxity, so for patients who have extensive abdominal wall laxity in the horizontal dimension, other procedures would shrink down their core but leave them tremendous horizontal excess. The fleur-de-lis adds in the vertical component, allowing Dr. Maercks to tighten the sides and back, creating an hourglass shape. The vertical incision line heals well, and patients find it worth the tradeoff to be able to achieve a significantly tightened, tailored waistline. This option is particularly appropriate for many patients who have experienced massive weight loss.