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Cosmetic Surgery: Promises and Pitfalls™
No-Drain Abdominoplasty (Tummy Tucks) for Abdominal Contouring in Dallas: A New Technique Eliminates Drains, Bent Posture and Makes Convalescence Easier
PROMISES
Abdominal deformities, such as abdominal fullness, excess skin,
excess fat, etc., most of which are related to pregnancy or genetics,
can be corrected with liposuction and/or abdominoplasty (tummy tuck). Most patients
are pleased with the end results of this surgery, when it is appropriate,
well implemented, and successful.
PITFALLS
- An accurate diagnosis by a surgeon trained to do ALL types
of body contouring surgery is important (see Promises and Pitfalls: Credentials). Partially trained physicians are offering liposuction
in general practice, gynecology, dermatology and other medical
practices. The doctors may offer liposuction, but most are not
trained or interested in the more complex abdominoplasty (tummy tuck). Results following liposuction in a patient who is actually an abdominoplasty (tummy tuck) candidate are usually disappointing.
- There are many variations in techniques of performing abdominoplasty (tummy tuck) and there is considerable variation in results, rate of complications and length of severity of convalescence. To assume all techniques
are the same would be a mistake. Before having surgery understand the
basics of the technique, average length of convalescence (especially
restrictions after surgery) and the surgeon's rate of complications.
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OUR APPROACH IN DALLAS, TEXAS 
- During the initial consultation, an individualized evaluation and
treatment plan to address patients' specific needs, is carried out by
one of our surgeons. During this visit the surgeon will explain the details
of our technique, expected convalescence, and anticipated results.
- Since this surgery can usually be done safely and comfortably under
twilight sleep with local anesthesia, anesthesia risk is minimized.
- Comfort and privacy is promoted by the use of our American Association
for Accreditation of Ambulatory Surgery Facilities (AAAASF) accredited
office or surgical suite. This surgery is often done as an outpatient,
with no hospitalization required.
- The surgical technique that we use is the progressive
tension suture technique, which was originated and published
by our surgeons, Drs. Harlan and Todd Pollock. Our experience
of over 20 years using this technique in Dallas and Allen, TX, has produced a high percentage
of excellent results and the following advantages:
- NO DRAINS required, which minimizes post-operative care.
- EARLY RESUMPTION OF UPRIGHT POSTURE AND PHYSICAL ACTIVITY is an
improvement over traditional methods that require a severe limitation
of activity and ambulation in a bent posture for several weeks.
- Complications are dramatically reduced by the use of Progressive
Tension Sutures (PTS).
The Progressive Tension
Suture Abdominoplasty (Tummy Tuck)
We originated the Progressive Tension Suture (PTS) procedure that
greatly simplifies our abdominoplasties (tummy tucks), significantly reduces
surgical complications, improves our patients' results, and shortens
our patients' convalescence. We have been using this technique over
the past 25 years and have found it to be reliable
and long-lasting.
Above: Illustration of PTS placement under the skin to advance and anchor the
skin flap
Following
the appropriate management of the deeper tissues of the abdomen including
muscle repair, the skin redraping and tightening is
accomplished by the use of PTS. These
are sutures that advance and anchor the skin to the underlying tissues.
This is a very simple, yet effective technique that has the advantage
of:
- The distribution of pull over the entire skin surface (instead
of only at the skin closure!) improving the skin redraping
- No tension on the skin closure -- resulting in less scarring
- Direct suture of the bellybutton from the underneath
surface of the flap -- enhancing the appearance
of the bellybutton
- Elimination of the space under the skin flap and secure
anchoring of the skin flap to the underlying tissues -- eliminates
the most common complication of the procedure seroma formation
(fluid collection)
- Secure anchoring of the flap permits early return
to the upright posture and improves and speeds the convalescence
- No drains or pressure dressings are necessary
Comments from a Peer
Dr. Richard Moss is a plastic surgeon in Massachusetts. Unrelated to our practice, he has success with his patients using this progressive tension suturing (PTS) technique. This is how Dr. Moss describes applying this technique for tummy tucks on his own website:
"Dr. Moss has recently incorporated in his abdominoplasty procedures a new technique referred to as the 'progressive tension suturing technique.' This technique allows a surgeon to more closely suture the multiple layers of tissue together, thereby preventing the formation of large amounts of drainage. In the past, this drainage required surgical drains that had to be left in place for weeks. Most patients find surgical drains painful and a nuisance. Since Dr. Moss has implemented this new technique, he has been able to eliminate the use of surgical drains. This means that Dr. Moss' patients have been more comfortable when they leave the hospital. The 'progressive tension suturing technique' also reduces the risk of certain complications associated with abdominoplasty. Dr. Moss and his patients have been very pleased with the results of the 'progressive tension suturing technique.'"
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PROCEDURES
Modified Abdominoplasty (Tummy Tuck): Liposuction can be utilized in both the upper
and lower abdomen. The surgery then consists of making a relatively short
transverse incision, elevating the skin and fat of the lower abdomen (called
a flap) and repairing the muscle separation or diastasis rectus. The incision
is then closed after removing excess skin. This procedure is usually done
as an outpatient.
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This is an illustration of a full abdominoplasty (tummy tuck);
modified abdominoplasty is only below the belly button. |
Full abdominoplasty (tummy tuck), illustrated above, is similar but more extensive as it involves
elevating the skin flap over the entire abdomen and repairing the muscle
separation. This procedure may be done as an outpatient,
but an overnight stay may be required.
Important techniques we utilize in our practice for Abdominoplasties (Tummy Tucks):
- Power-Assisted Liposuction (PAL) is a relatively
new adjunct to traditional liposuction. It is a device that reciprocates
or moves the cannula in and out at a very high rate of speed. This vibrating
effect cuts through the fatty tissues, facilitating the fat removal.
The device is particularly helpful for fibrous areas, can be done through
small incisions and adds no increase in risk or expense. PAL is surpassing
ultrasonic-assisted liposuction (UAL) in use among plastic surgeons,
with safety concerns and expense being the major considerations. We
use PAL exclusively in our practice.
- Tumescent Liposuction or Super-Wet Fluid Infiltration
refers to injection of the area to be suctioned with saline (salt water
solution), local anesthetic, and epinephrine. This solution plumps up
the tissues, making fat removal easier, constricts blood vessels, which
reduces bleeding, and block nerves, providing painless surgery. The
super-wet technique uses less volume of fluid than the tumescent technique.
- Progressive Tension Sutures (PTS)
is a surgical technique used in abdominoplasty (tummy tuck) that our practice has
developed and reported in the Journal of Plastic and Reconstructive
Surgery, June 2000. The basic concept is that of a controlled redraping
and advancement of the abdominal skin flap by the placement of multiple
sutures from the skin flap to the deep tissue. Read more
about PTS above on this page.
The progressive tension sutures are placed from the skin flap to the
deep fascia as the abdominal flap is advanced. This downward advancement
is maintained as each suture is placed and tied, hence the name, "progressive
tension sutures." In this manner, tension is redistributed over a
broad area of the abdominal flap, as opposed to the conventional procedure
in which all the tension is concentrated on the incision. The PTS technique
allows closure of the incision with virtually no tension. This improves
the quality of resulting scars and prevents healing problems.
However, THE MOST IMPORTANT BENEFIT OF PTS IS THE SECURE ANCHORING
OF THE SKIN FLAP TO THE UNDERLYING TISSUES. The attachment of
these tissues allows the entire abdominal wall to immediately move as
a unit, which PREVENTS DISRUPTION OF EARLY HEALING. It is our opinion
that this is the primary reason that this TECHNIQUE PREVENTS SEROMA formation
(fluid collection) – the most frequent complication of abdominoplasty (tummy tuck).
Complications, such as excess scarring, healing delay and fluid accumulation
are usually prevented by this technique. As with any surgery, have seen
complications after abdominoplasty (tummy tuck), but these have been rare. THIS
TECHIQUE IS AS SIMPLE AND LOGICAL AS IT SEEMS.
As one can see, there are many considerations and alternatives for body
contouring. The best way to find out meaningful information that is specific
to one's individual needs is in a personal consultation with a surgeon
certified by the American Board of Plastic Surgery.
See Other Related Websites:
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Offices of Drs. Harlan Pollock and Todd Pollock
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8305 Walnut Hill Lane, Suite 210
Dallas, TX 75231
(214) 363-2575 |
1105 North Central Expressway,
Suite 2310
Medical Offices 2, Allen, TX 75013
(214) 509-0270 |
Dallas
Map:
Across from
Presbyterian Hospital of Dallas |
Allen
Map:
In the
Presbyterian Hospital of Allen complex |
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Plastic Surgery. All rights reserved.
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