In its simplest form, an abdominoplasty, or tummy tuck, involves removal of excess skin from the lower abdomen in order to tighten and restore a youthful look to the tissues. Most surgeons, over the last few decades, have found that tightening the muscles of the abdomen is helpful as well. Women, and some men, have this operation after losing weight. Excess skin and loose muscle have persisted as the fat is lost. Most women also find that pregnancy has resulted in even more profound excess of skin and muscle laxity.

In most plastic surgeon’s hands, a tummy tuck is 1 of the top 3 transformative operations to benefit a patient. At Sando and Aker, our 3 surgeons have never been satisfied with the status quo of a procedure if they perceived a need for improvement or found a new technology to apply. Three modifications stand out to us as the most significant improvements in our technique of tummy tuck over the last 3 decades.

First, the incision placement has become more important as women’s clothing styles have demanded a lower waistline. The resulting scar, even though usually well-healed, must be placed down at the junction of the thigh and abdomen. It must be placed at the level of the pubic bone in the middle as well. This placement allows us to tighten the upper thigh and to thin and lift the pubic mound as well. The briefest of clothing and swimsuits may be worn, therefore, without showing the scar.

Second, the emphasis is shifting towards the muscular repair. Certainly, the skin is tightened as much as possible, but we have shrunk by more aggressive tightening of the abdominal muscles. No longer should modest flattening of the abdomen be the greatest expectation of most patients. Many now achieve an athletic contour, especially those patients who are at or near their ideal body weight.

Furthermore, we now have confirmation from our chiropractic colleagues that reconstructing the abdominal musculature unloads overworked back muscles to the extent that chronic back pain is frequently diminished.

Our runners often state that they feel stronger after healing from their tummy tuck. It is unlikely all these effects are from the skin tightening alone.

Third, and finally the biggest advance we have made in our tummy tuck procedure, is the drainless technique. This is a new way of avoiding what is to most patients the most difficult part of healing after the surgery. Namely, 2 silicone rubber tubes exiting their skin and draining excess wound fluids. Not necessarily painful, drains are just “creepy.” They keep our patients thinking of themselves as patients instead of as women or men. It is also an emotional drain during recovery. Dr. Harlan Pollock showed us a way of applying extra internal sutures and distributing the internal forces so that there is no space into which wound fluid can accumulate. There is, therefore, no need for drains. In addition, the tension on the new tight skin is borne upon many sutures internally, thus creating better abdominal muscle definition and taking most of the tension off the main wound. It is tension that is often behind a thick or ugly scar.

Many of our patients who have had multiple facial and body procedures admit that their tummy tuck was the most significant in returning them to a sense of fitness, youth, and normalcy.