1) Exposure of the abdominal wall muscles.
2) Tightening of the abdominal wall muscles (rectus muscle plication).
3) Removal of the excess, redundant skin.
By definition, this procedure requires relocation of the umbilicus to a new position. The traditional tummy tuck is an excellent technique for the right candidate.
Certainly, for patients with a large amount of excess skin located below the belly button associated with laxity of the abdominal muscles (diastasis rectus), a traditional full tummy tuck makes sense. However, there is an ever growing subset of patients with a thin body habitus who develop weakness of the abdominal wall muscles following weight loss and/or pregnancy without having a significant amount of redundant skin and subcutaneous tissue. These patients often complain to me that people note that they look pregnant; sometimes even years after their delivery. They may have a very small amount of loose skin just above the pubic area. However, these patients certainly do not have adequate redundant tissue to allow removal of all of the tissue that exists below the belly button. In order to reconcile this problem, the Mini-Tummy Tuck was invented. During this “mini-operation,” the following sequence of events occur:
1) a shorter incision is made in the bikini line.
2) the tissue is elevated up to the level of the belly button.
3) the abdominal wall muscles are tightened below the belly button only.
4) a small amount of skin is removed just above the pubic area.
The problem with this operation is that by definition, the upper half of the abdominal wall muscles do not get tightened…at all. Commonly, these patients will have an awkward bulge of the upper abdomen months and years after the operation which is very difficult to repair. For this reason, I have found that a true “mini-tummy tuck” is rarely indicated. In order to provide excellent results in this subset of tummy tuck patients (very loose muscles, without much excess skin) I modify the tummy tuck operation to design a procedure that combines the best aspects of both of these operations; namely, a shorter scar and a full muscle tightening. This operation is called the Short Scar Mini-Tummy Tuck®. The key aspects of the Short Scar Mini-Tummy Tuck are:
1) A short bikini line incision that is slightly longer (2 cm on each side) than the traditional Los Angeles C-section scar.
2) Complete elevation of the skin and soft tissues off of the muscle.
3) Full muscle tightening (from the rib cage to the pubic area).
4) No scar around the belly button (or sometimes minimal scar).
During this operation, I use an endoscope to help facilitate this minimally invasive approach. Patients have loved the results for several reasons:
1) They get a flat abdomen as a result of complete muscle plication.
2) They are rid of the small amount of residual skin that was troublesome to them.
3) They almost never have a visible scar around the belly button.
4) The incision is much shorter than in a traditional tummy tuck, and located very low in the same location as a C-section incision.