Tummy Tuck in Southlake, TX | Dr. Scott Kasden
Today I will be performing an abdominoplasty, which is commonly referred to as a tummy tuck. The operation has already commenced, and the skin incision was made. The incision is carried down through the skin and fat until the abdominal fascia or strength layer is reached. This is the white layer at the bottom of the screen.
Although the navel serves no purpose after birth, it is an important cosmetic landmark, which should be preserved wherever possible. The umbilicus is circumscribed from the surrounding skin, much like coring an apple. The blood supply, which originates from the fascia below, is protected. The flap is then bisected. This allows for easier dissection of the umbilicus and for better exposure of the upper abdominal dissection. The surgical assistant is holding the umbilicus and the instrument.
The flap is usually dissected up to the breastbone or xiphoid process. This allows for a visualization and repair of the fascia and layer for the redundant flap to be removed. The midline of the fascia is first marked with surgical ink, and then the laxity of the abdominal fascia is estimated. The proposed suture lines are marked in surgical ink, and the first suture is placed to ensure proper tension is applied to the abdominal wall.
Using the ruler as a guide, the abdominal wall has been tightened by about three inches. Fascial tightening has been completed from the pubic bone to the breastbone. The umbilicus remains in its original position, attached to the fascia.
In this patient, additional fascial tightening was required in the vertical or axial dimension. This was accomplished by a belt line suture, so named, because it approximates a belt line. Any other areas of fascial weakness are addressed before the flap is trimmed. The flap is temporarily approximated with surgical instruments to ensure proper tension. The right side of the abdominal wound is closed. The left side of the abdominal flap is evaluated prior to trimming. Comparison is made to the completed side.
The flap is trimmed by first making a skin incision with a scalpel. The dissection is completed with electrocautery. This technique optimizes final scar and minimizes blood loss. An incision is made in the abdominal wall skin, so that the umbilicus can be retrieved. A small amount of fat is removed from the area to create a funnel or cup-shape appearance to the umbilicus. This is associated with a youthful look. The umbilicus is then sutured in place, and the repair is completed.