Abdominoplasty: (Tummy Tuck)

Dr. Neurohr performs abdominoplasty, or tummy tuck, operations for patients who have lost the shape of their abdominal region, usually after childbirth or massive weight loss, and cannot restore their abdominal shape through proper nutrition and exercise. They have actually changed the structural support components of their abdominal skin, subcutaneous tissues and the abdominal wall, and they can only be restored with surgical reconstruction. There are several levels of abdominoplasty depending on the patients presenting problems.

A simple fat accumulation of the abdomen, especially below the belly button (umbilicus) can be very effectively treated with lipoosuction (SAL), but if the skin is stretched and has lost its structural elasticity, a mini-abdominoplasty is in order. Dr. Neurohr removes an ellipse of lower abdominal skin and reduces the fat layer, contouring either by suctioning fat, or by direct surgical sculpting. In these cases, the umbilicus is not altered, but sometimes the abdominal wall is tightened under the skin, with sutures, from the umbilicus to the pubis. Then, Dr. Neurohr performs a meticulous multi-layered closure of the skin, finishing with a fine line of dissolvable stitches beneath the skin surface which don’t ever need to be removed!

The resulting scar from abdominoplasty is the quality sign of the operation. Dr. Neurohr learned from the Brazilian surgeons, during his training years, how to design the skin incisions so the resulting scar would lay in the natural pelvic contours of the bikini lines. By careful analysis of each patient, studious measurements and markings before the operation, precise placement of incisions, and disciplined control of tension and closure, Dr. Neurohr consistently achieves results of top quality.

In the case of the patient in whom the entire front of the abdomen has been distorted and stretched beyond the body’s ability to spring back, a formal abdominoplasty is most appropriate. Here, Dr. Neurohr seeks to restore anterior abdominal shape by separating the layers of the abdomen from the abdominal wall, including the skin around the umbilicus. He tightens the stretched out abdominal muscles with specially placed sutures, and then re-contours the fat and skin, by removing the excess and repositioning everything back into place. He directly sculpts the fat, particularly around the umbilicus. which he reconstructs using a unique flap he designs to look natural. The internal closure of the skin onto the abdominal wall often precludes the need for drains after surgery. Again, a meticulous skin closure using fine absorbable, buried sutures completes the procedure resulting in a curved scar that hides in the bikini line.

The most severe cases of abdominal distortion occur after massive weight loss, but sometimes, genetically programed aging changes take place which cause a similar pattern of circumferential drooping of the skin and fat around the entire lower abdomen and hips. In these cases, Dr. Neurohr achieves very dramatic improvements in body shape with a 360 degree abdominoplasty. He actually designs a pattern of skin and fat removal all the way around the lower torso to restore the body’s structural shape, leaving a thin scar beneath the bikini line in front, extending and curving just beneath the hip lines to the sides, and connecting just beneath the belt line in the back.

Dr. Neurohr performs his abdominoplasty operations under intravenous sedation anesthesia with local tumescent anesthetic infusions. Avoiding general anesthesia reduces the risk of the abdominoplasty procedure because it precludes the use of muscle relaxants which can increase the possibility of deep vein thrombosis. Dr. Neurohr always employs sequential compression devices to pump the venous blood in the legs back to the heart during and after the operation. After surgery, the patients are encouraged to sit up and get out of bed as soon as possible to speed the recovery process, and to prevent blood clot formation. Pain pumps and long acting Marcaine local anesthetics are used to minimize postoperative discomfort and to expedite ambulation.

Patients are watched overnight in the recovery facility. They go home the next day with a competent caregiver, and follow detailed postoperative instructions about positioning, diet, activity, and pain control. The pain pumps really help during the first 2-3 days, and patients are usually sore, but they are “up and around” after that. Walking endurance progresses after the first week, and typically, patients are safely able to drive and return to work in 2-3 weeks. Exercise may be resumed after 3-4 weeks, however, deep abdominal muscle tenderness often persists to some degree for about 6 weeks depending on the extent of the operation. Healing takes time, and persons considering a full abdominoplasty need to schedule ample time for their recovery. Otherwise, they may become frustrated and disillusioned by the process, and that would be counterproductive to the entire purpose of surgical self improvement. Dr. Neurohr emphasizes that the best results come from a team effort, and proper preparation is the key to success.

Liposuction: Suction Assisted Lipectomy (SAL)

Suction Assisted Lipectomy (SAL) is one of the most revolutionary technical advancements in the field of plastic surgery. The procedure permits the removal of large volumes of fat from under the skin, subcutaneous fat, through a tiny incision by the use of a long cylindrical tube called a cannula that is attached to a suction device. The cannula is passed under the skin repeatedly, creating tunnels, from which the soft fat tissues are removed through a hole in the cannula by a vacuuming effect. The fine, fibrous framework (stroma) of the subcutaneous space collapses and the skin retracts taking the improved shape minus the bulge of fat. Liposuction (SAL) works particularly well in the lower abdomen, the hip/flank area, the outer thighs, and the knees. It is also very effective but has more limitations in the inner thighs, the arms, and in the chin/neck areas.

Liposuction only works as well as the overlying skin retraction enables. If the skin has no elasticity, it will sag and look worse than it did before fat reduction. The inner thighs and back are notorious for this. Superficial suction techniques, just beneath the skin, enhances skin retraction, but must be done with great care and with very small cannulas, passed from multiple directions, to avoid surface contour irregularities. Energy based technologies using lasers, ultrasound, radio frequencies and cold temperatures have been designed to ablate fat and tighten the skin. They are moderately effective and fairly expensive for the results they afford. However, they may provide a non surgical alternative to individuals who have very localized fat contour problems that desire some “fine tuning” of these areas.

Dr. Neurohr thinks of body contouring with SAL as liposculpture because he looks at the total body shape, and sees where to, not only remove, but also where to add. He learned this methodology early in his practice when surgeons were using large bore cannulas, which often left ruts and depressions from removing too much fat! Since he was adept with injectable fat grafting, Dr. Neurohr was able to revise the patients contour problems using small cannula, deep, and superficial SAL to smooth and mobilize the fibrous reticulum, and performing injectable fat grafts to fill the defects which were previously created. He also developed a manual molding technique, where he uses his hands to finalize the surface shape in dense or scarred areas resistant to the passage of the cannula.

Liposuction seems like such a simple minded procedure that it is often not taken seriously, and that approach can lead to unnecessary complications. Patients should be aware of their surgeon’s mindset. Are they detail oriented and thorough, or do they rush through the exam and planning without real interest? Dr. Neurohr knows the surgeon’s skill and effort really makes the difference between a gratified, happy result, and a remorseful, problematic one. By taking time to listen carefully to his patients concerns, and by exercising good judgement in choosing the best set of procedures, understanding the limitations of each, and clearly communicate with each patient, Dr. Neurohr always strives to formulate the optimal plan for their concerns. Then, he performs the operation with finesse and great care, never taking anything for granted, in order to achieve the highest quality result every time.