Orange County, Santa Ana, Newport Beach

A friend of mine once said “Physicians are just nerds trying to be cool.”  The title above is my feeble attempt to sound hip!

But joking aside, when a patient presents to me for improvement of the abdominal area, the question arises which procedure is best: liposuction or tummy tuck (abdominoplasty)?

If a patient has no stretch marks or loose skin and the only issue is excess fat under the skin, the decision is easy:   liposuction will remove excess fat and since the patient has normal skin tone and elasticity, the skin will retract properly.  If on the other hand, the patient has hanging skin over the pubic area and a hanging shelf of skin above the umbilicus (belly button), then a tummy tuck will give the best result.

What about the patient who is borderline though?  There are patients who have borderline skin elasticity, may or may not have some stretch marks and are in that gray area between liposuction and tummy tuck.  This is where patient’s concerns and expectations are important to asses.

First of all, is the patient terrified of having general anesthesia, despite the safety of general anesthesia in healthy individuals?  In a recent article by the American Society of Plastic Surgeons, the risk of death from elective out patient surgery was 1:50,000 versus 1:5,000 from driving.  This means the risk of dying while driving is TEN times more than having elective outpatient surgery!  Are they concerned about the increased incisions and recovery time after a tummy tuck?  Is cost a factor?  What are the patient’s expectations?  Is he/she expecting a flat stomach with little or no stretch marks or is the patient looking for some improvement only?  It is critical the patient is honest with him/herself and with the surgeon, and adequately addresses their concerns and expectations.  Liposuction is a very effective procedure for patients who have borderline skin tone, as long as the above issues are adequately addressed.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

As have been stated in my previous blog, mommy makeover surgery addresses the changes which occur after pregnancy.  These changes primarily affect the breast and the abdomen.

The breast can be enhanced with an implant (breast augmentation) with or without a breast lift.  A breast lift may be required to reposition the nipple and tighten the loose skin.

Although some patients are lucky enough only to require liposuction, most patients will require a tummy tuck (abdominoplasty) to address the loose skin, stretch marks, and the weakened abdominal muscles which occur after pregnancy.

So, can both surgeries be combined together?  The answer, in most cases, is yes!

There are two limiting factors preventing both procedures to be performed at the same time: the patient’s financial situation, and the total time the patient is under anesthesia.

Mommy Makeover surgery is among the more expensive procedures performed by plastic surgeons.  The surgery may take 4-6 hours and the cost of anesthesia/operating room, implant and surgeon’s fee will add up quickly.  Having said this, if the patient can afford the cost, there are many benefits to having the procedures combined.  First, there is one recovery period, both from anesthesia and from the surgery.  For patients who work, one recovery period is financially advantageous.  Second, combining both surgeries will result in a 10-15% reduction in overall cost.  Surgery centers typically charge more the first hour and the price decreases after that.  Therefore, staging the surgeries will result in more added cost to the patient.

The second limiting factor is the anticipated anesthesia time.  The current recommendation by the American Society of Plastic Surgeons is to limit anesthesia time for elective, outpatient surgery to six hours.   Therefore, if the surgeon feels the surgery may take longer, it is best to stage the procedures.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

The question always arises with elective, cosmetic surgery: should you, the patient, spend thousands of dollars for a medically unnecessary procedure which makes you feel and look bad for a few weeks, so that you can look and feel good in the future?

The answer is yes, if and only if you have realistic expectations, are a good candidate for the procedure and are doing the surgery for yourself and no one else.

The ideal candidate for tummy tuck surgery is someone who is healthy or has medical issues which are under control.  The patient can be within 10-15 pounds of their ideal weight and still obtain a good result, if the fat above the umbilicus (belly button) is thin and the skin is loose.  If the fat is thick and the skin “stuck”, there is no way the skin and fat can be moved down to cover the area where the loose skin was removed.  Even if it can be moved down, the thick fat will bulge out and the result will not be ideal.

Tummy tuck (abdominoplasty) can be combined with breast augmentation and lift in patients who have had children.  This procedure is now commonly known as Mommy Makeover.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in central Orange County.  If you like to schedule a complimentary consultation, please call 714-834-0101.

As an Orange County mommy makeover surgeon, tummy tuck surgery is one of our most popular procedures.  But what happens after the surgery?

Tummy tuck surgery is an out-patient procedure, meaning the patient will go home after the procedure.  In rare instances, the patient may be kept in the surgery center over-night.

After surgery, the patient will have 2-3 drains placed under the abdominal skin.  The drains will collect any excess fluid which the body produces as the result of surgery.  Typically these drains are removed in 7-9 days, depending on their output.  The patient’s family or provider will be instructed on how to empty and record the outputs separately on a piece of paper.  If the patient has chosen to have a pain pump catheter (which I highly recommend) these catheters will be placed under the abdominal skin as well.  These catheters are removed 3 days after surgery.  The patient will be instructed on removal, there is no need to return to the office for their removal.

After surgery, it is important for the patient to sleep with their knees or hips bent to avoid any tension on the skin closure.  Most of my patients are able to walk fairly straight after the first week of surgery.  However, they must sleep in a slightly flexed position for 2-3 more weeks.

The patient will be seen in the office 24-48 hours after the procedure.  The dressings will be changed and new ones placed.  I instruct the patient and care-giver on how to properly apply and adjust the abdominal binder which was placed at the end of the procedure.  The purpose of the binder is to provide support and minimize swelling.  It must be worn for 4 weeks.  It is important for the binder to fit well and be firm but not too tight.  As a general rule, the binder should be as tight as the patient can comfortably tolerate.

The patient will return 7-9 days after surgery.  Depending on the drain outputs, the drains may or may not be removed.  If the drains are removed too early, the fluid will collect under the skin.  This is called a seroma.  The patient has to return to the clinic at least once a week to have the seroma “sucked out” with a needle and syringe.  This is not fun!  It is also critical for the patient to refrain from too much activity for one week after drain removal.  It is the movement and rubbing of the abdominal skin against the abdominal wall which produces seroma.  If the patient has a “desk job”, they may return to work after the second visit, provided no lifting or bending is permitted.

Minor wound issues, such as small skin sloughs right at the edge of the incision is fairly common after tummy tuck surgery.  I would say 30% of patients will have some minor wound break-down which usually heal with antibiotic ointment and daily dressing changes.

The patient returns for a follow-up one month after surgery.  Although the swelling has improved, it will take 2-4 more months for the swelling to completely resolve.  At this time the patient may chose to remove the binder.  Some patients, however, feel more comfortable wearing the abdominal binder.  The patient may start light exercises such as walking on a flat surface or light weight lifting.  The patient should refrain from sit-ups or abdominal exercises for 6 months. As part of the tummy tuck, the weakness of the abdominal muscles has been corrected with sutures.  It takes approximately six months for the repair to be strong enough to allow abdominal exercises.

The patient returns for their 3 month follow-up.  At this point, most patients have obtained their final shape.  However, in some cases, it may take longer for the swelling to completely resolve.  Depending on the patient’s skin color, the incisions may be darker than the surrounding skin.  It may take up to one year for the incisions to lighten.  Many patients also are concerned about numbness in their skin.  It may take one year or longer for the sensation to return to all areas of the abdominal skin.

The last clinic visit is 6 months after surgery.  At this time, the patient may resume abdominal exercise as tolerated.  The patient should avoid any sun tanning to the abdominal skin for one year after surgery.  The skin is very sensitive and even a sun-burn may cause significant damage to the skin.

This is a typical recovery for a patient undergoing abdominoplasty surgery.  Not every one will have the same experience and, rarely, complications do occur.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

Mommy makeover is the catch phrase for cosmetic surgery involving the breast and abdomen, the two areas most commonly affected by pregnancy.

The breasts typically “deflate” after pregnancy and breast feeding and almost always will require a breast augmentation to regain the lost volume.  If there is sagging of the nipple and loose skin, a breast lift (mastopexy) may be needed as well.

Some patients (the lucky ones!) have little effect on their stomach area after pregnancy.  However, most patients will develop loose skin, stretch marks and weakness of the abdominal muscles, resulting in a “beer belly” appearance.  Typically a standard or extended abdominoplasty is required, although some patients can achieve an excellent result with a mini-tummy tuck.

In most cases, both breast and abdominal surgery can be performed together, if the anesthesia time can be kept under six hours (this is the recommended time limit for outpatient elective surgery by the American Board of Plastic Surgery).  Performing both surgeries together has the benefit of one recovery term (this is especially critical for patients who work) and lower cost.

Mommy makeover surgery is amongst the most expensive cosmetic surgery procedures performed.   This is due to the prolonged surgery and anesthesia/operating room time required to adequately address and correct the changes discussed previously.  Whether the time and cost is worth it is a personal question only the patient can answer.  However, if you have realistic expectations and are doing the procedure for YOU and YOU ONLY, it is one of the most rewarding surgeries I perform.  Imagine reversing the effects of pregnancy, what a wonderful concept!  Many patients have told me their sex life has improved since the surgery because they feel more confident about themselves.  The smile on the partner’s lips is always a big give-away!

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

Many patients are not aware there are three main types of abdominoplasty available.

Mini-abdominoplasty, as the name implies, is not as involved as a standard tummy tuck.  This procedure is indicated in patients who have loose skin with or without stretch marks in the lower, central, part of the abdomen.  The skin above the umbilicus (belly button) is normal with no loose skin or stretch marks.  The incision is slightly larger than a c-section scar and is placed in the central third of the lower abdomen.  If the patient has excess fat in the upper part, liposuction of the upper abdomen can be performed at the same time.

A standard abdominoplasty is indicated for patients who have loose skin, with or without stretch marks, below and above the umbilicus.  However, the loose skin ends before reaching the flanks (love handles).  The incision is from “hip to hip”, in the lower portion of the abdomen.  With this procedure, the abdominal muscles (if separated by pregnancy or massive weight gain and loss) are also tightened, resulting in a flatter abdomen.  If the flanks have excess fat, liposuction of the love handles can be performed at the same time.

An extended abdominoplasty is needed in patients who have loose skin and stretch marks of the abdomen, with extension of the loose skin up to and even beyond the flanks, extending to the lower back.  In this procedure, the incision has to be extended to remove the excess fat and skin over the flanks. 

The usual surgery time for a mini-abdominoplasty is 1-1 1/2 hours, 3-4 hours for a standard tummy tuck, and 4-5 hours for an extended abdominoplasty.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon and a member of American Society of Plastic Surgeons.  His office is located in central Orange County.  If you like to schedule a complimentary consultation, please call 714-834-0101.

Abdominoplasty (tummy tuck) is one of the most requested surgeries from my Orange County patients.

Seroma is one of the most common problems which may occur after abdominoplasty.  In my practice, approximately 10% of patients develop seroma.

Seroma is a collection of fluid under the skin.  It can develop early (while the drains are in) or late (after the drains have been removed).  If the seroma is small (one ounce or less), it usually absorbs with time.  If the seroma is large, however, it must be removed.  This is done by aspirating the seroma through the abdominal skin with a syringe and needle.  Multiple aspirations, once a week, may be required for several weeks.  In majority of patients, this treatment will alleviate the problem.  Rarely, other steps (even surgery) may be required to treat the seroma.

The main reason seromas occur is due to the abdominal skin rubbing against the underlying surface.  It is this rubbing motion which promotes seroma formation.  It is for this reason I emphasize to my patients to avoid excessive movement of the abdominal area while the drains are in and for one week after the drains have been removed.  In my experience, majority of patients who develop seroma started their activities too fast and did too much.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in central Orange County.  If you like to schedule a complimentary consultation, please call 714-834-0101.

I have examined many before and after tummy tuck photos to determine what makes a result pleasing.

The most important factor for a tummy tuck is the amount of fat under the skin.  If a patient has too much fat under the skin, the result will not be pleasing.  As the thick skin is pulled down, it will “bow out” and a flat stomach is not obtained.  Therefore, it is critical the patient be at or within 10-15 pounds of ideal body weight and have thin amount of fat under the skin.

The other important factor is the shape of the umbilicus (belly button).  I have seen many nice results being less than ideal due to the distracting shape of the umbilicus.

The third factor is the amount of skin removed and the tightness of the closure.  If too little skin is removed, the abdomen will be loose and “jiggly”.  If too much skin is removed, the recovery time is prolonged.  Eventually, when the patient can stand straight, the skin will curve inwards due to excess tension. Not very attractive!

The flanks (love handles) also need to be addressed.  If the patient has too much fat around the love handles, liposuction is recommended to smooth out the area and give more definition to the waist line.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, CA.  To schedule a complimentary consultation, please call 714-834-0101.

To put most of you at ease, I have had many patients who have had C-sections prior to their tummy tuck surgery.  All of them have told me the pain of tummy tuck surgery is less than C-section.  So if you have had a Caesarian before, you are in luck!

For the rest of us, there is a device which, in my experience, reduces the pain associated with surgery.

This device, called onQ, is a dual (two) pain pump catheter attached to a reservoir.  The reservoir is filled with numbing medication (similar to what is used at a dentist office to numb your teeth).  The two catheters are placed underneath the skin of the abdomen and secured to the thigh/groin skin with special tape.  The catheter slowly releases the numbing medication over a 48-72 hour period.  The entire length of the catheter is coated with silver, which has anti-bacterial properties.  I have not yet seen any wound infection as a result of this catheter.

Although the catheter does not eliminate the need for oral pain medication, I feel, in most patients, this catheter makes the pain more tolerable, with less need for oral medication.  The catheters are very thin and easy to remove.  All my patients remove the catheters themselves, avoiding an extra trip to my office.

I have used this catheter for breast augmentation as well.  However, the result has been mixed.  I, therefore, do not feel the additional cost of the pain pump is justified for breast surgery.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon, practicing in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

One can exercise 24 hours a day, seven days a week, but the loose skin and the weak abdominal muscle will remain.  Only plastic surgery can address these issues.

The abdominoplasty (tummy tuck) procedure involves separating the abdominal skin above the pubic hair line, all the way to the costal margin (the lowest ribs which you can feel).  The skin around the umbilicus (belly button) is cut, so the umbilicus is attached to the abdominal wall.  After elevating the skin, the abdominal muscles (six-pack muscles) are brought together by suturing the fascia (thick) layer on top of the muscles.  This, in effect, gives the same result as when one sucks their stomach in.  The patient is then placed in a semi-sitting position, and the excess skin is removed.  A new hole is made for the umbilicus to come through.  The new abdomen, therefore, will have little or no stretch marks and be flatter, due to improving the abdominal muscle weakness.  Typically, two drains are placed under the skin to remove any leakage after the surgery.  The drains are usually removed at 7-9 days.  The addition of a pain pump catheter (a catheter which drips pain medication slowly over 3 days), has significantly lessened the pain patients experience after surgery.  Patients may resume light exercise after 4 weeks, but it will take 2-3 months or longer before normal routine can be reached.

In addition to abdominoplasty, liposuction of the flanks (love handles) can be performed at the same time.  This will improve the waist-line.

I have attached before and after photos to illustrate the effectiveness of this procedure.

Michael Jazayeri, M.D. is a board certified plastic surgeon with over ten years of experience.  He is certified by the American Board of Plastic Surgery and is a member of American Society of Plastic Surgeons.  To schedule a complimentary consultation with Dr. Jazayeri, please call 714-834-0101.