Rapid Recovery No-Drain Tummy Tuck with 360 Degree Liposuction
Learn what Dr. Gutowski does that is Different from most Tummy Tucks
- Rapid Recovery
- 360 Degree Liposuction
- High Volume Liposuction for Obese Patients
- Muscle Tightening (Rectus Diastasis Repair) with Mesh Support if Needed
- Brazilian Tummy Tuck
- Extended Tummy Tuck or Body Lift
- Pubic (Mons) Lift
- Fat Transfer to Breast or Buttocks
- Awake Mini Tummy Tuck
Not all tummy tucks are the same. Some surgeons just treat the front of the trunk without addressing the sides and back (flanks and “love handles”) which may result in an unnatural appearance and extra skin (called “dog ears”). Also, most surgeons still use drains, plastic tubes which come out of the skin for 1 to 2 weeks, as part of their tummy tuck. Dr, Karol Gutowski however, has evolved his tummy tuck procedure over the last 20 years to give his patients better results with an easier recovery. He has published his techniques and been an invited speaker to teach other plastic surgeons his techniques. You may view his lectures here.
Below are some of Dr. Gutowski’s medical publications on the No-Drain Tummy Tuck and improving tummy tuck results.
Why The No-Drain Tummy Tuck?
Traditionally, plastic tubes called drains, are placed under the skin during a tummy tuck to drain fluid and prevent a seroma (fluid collection under the skin). However, these drains may stay in place for 1 to 2 weeks, causing discomfort, pain, scars, and infection. While the drains are in, most patients have less mobility and difficulty walking due to the pain associated with drains.
In 2006, Dr. Gutowski developed a modification to the drainless tummy tuck by using new sutures which allowed him to do the procedure faster than before. He published his technique in 2009 and has been asked to lecture on his technique to teach other plastic surgeons.
Illustration of Dr. Gutowski’s technique of using internal absorbable barbed sutures to eliminate drains as part of the No-Drain Tummy Tuck
What is a Rapid Recovery & Enhanced Recovery Tummy Tuck?
Fear of pain after surgery is normal. During a tummy tuck, most of the discomfort comes from the muscle tightening, and not from the skin incisions. To reduce the discomfort after a tummy tuck and allow for an earlier return to activity, Dr. Gutowski uses these techniques as part of his procedure:
Abdominal Anesthetic Block: The anesthesiologist will use an ultrasound machine to inject a long-acting local anesthetic around the abdominal nerves to block pain for 24 to 36 hours. This is called a Transverse Abdominus Plane (TAP) block or a Rectus Sheath (RS) Block and is included in all of Dr. Gutowski’s tummy tuck procedures. By blocking the pain before the surgery starts, patients need less anesthetic and narcotic medications during and after the procedure, allowing for a more comfortable, safer, and faster recovery.
Tumescent Analgesia:In addition to the abdominal block, Dr. Gutowski, injects a long-acting dilute local anesthetic into the areas of liposuction which relieves pain and allows for a more comfortable recovery.
Multi-Modality Analgesia:By using a combination of pain-relieving medications that work in different ways to block pain, patients need less, or sometimes no narcotic medications after the procedure.
No Drains:Drains can be painful and prevent early activity after surgery. By preforming a No-Drain Tummy Tuck, Dr. Gutowski’s patients can move around and walk with much less discomfort.
Early Walking:By using these rapid recovery techniques, patients do not stay in bed and are less likely to have problems once they are ready to resume light activity.
Example of ultrasound guided TAP block for long-lasting pain reduction. The anesthetic is placed exactly where the nerves are so pain signals to the brain are blocked.
360 Degree Liposuction with Tummy Tuck
Liposuction should be part of almost every tummy tuck but not all surgeons include it as part of a tummy tuck “package”. Dr. Gutowski believes that including liposuction all the way around the truck (360 degrees) gives a better and more natural result. This procedure takes longer as patients are turned from side to side during surgery, however, the results are worth it. Be sure to keep this in mind when comparing the proposed tummy tuck plans and costs done by other surgeons. Having to come back later for liposuction that should have been done at the same time as the tummy tuck is more expensive and requires a longer recovery.
These patients’ backside (flanks and “love handles”) were treated with liposuction as part of the 360 Degree Tummy Tuck, resulting in a more feminine and natural appearance.
High Volume Liposuction for Obese Patients
Many surgeons will turn away patient whose body mass index (BMI) is too high for a tummy tuck. While a tummy tuck should not be considered a weight loss procedure, many obese patients can still benefit from this procedure when combined with high volume liposuction to contour the trunk.
This patient traveled from the east coast to see Dr. Gutowski as she was told she is not a candidate for a tummy tuck by her local surgeons due to her weight. Dr. Gutowski performed high volume 360 degree liposuction and a No-Drain Rapid Recovery Tummy Tuck giving her the result she wanted.
Muscle Tightening (Rectus Diastasis Repair) with Mesh Support if Needed
In most cases, pregnancy results in stretching of the abdominal wall and a gap (diastasis) develops between the muscles resulting in a bulge. During a tummy tuck, this gap is repaired with sutures. However, when the diastasis is large, or the connective tissue is weak, additional support may give a better result. For certain patients, Dr. Gutowski may recommend using an absorbable mesh which is replaced by your body’s own collagen resulting in a stronger repair. The mesh is made of the same material as the sutures and is completely gone within a year.
This patient had a large bulge in her abdomen due to a diastasis after a twin pregnancy. Dr. Gutowski reinforced the diastasis repair with an absorbable mesh.
What about the Scar? Short Scar vs Long Scar vs “Brazilian” Tummy Tuck vs Extended Tummy Tuck vs Circumferential Tummy Tuck (Body Lift)
A common concern is the scar that result from a tummy tuck. It is important to understand that in nearly all cases, a short scar results in less loose skin being removed and a less favorable result. A long scar removes more skin and results in a tighter abdomen and less chance of “dog ears” (extra skin on the sides). For this reason, Dr. Gutowski prefers the long scar to achieve a more natural result. After 1 to 2 years, the scar is usually a thin line that is barely noticeable. Dr. Gutowski also places the incision much lower than most surgeons do and this results in a lower scar, also called a “Brazilian” Tummy Tuck. For some patients with loose skin on the sides, an ExtendedTummy Tuck may be recommended. In cases with significant weight loss and loose skin in the back, a Circumferential Tummy Tuck (Body Lift)should be considered.
This patient lost over 100 pounds and needed an extended tummy tuck to remove the loose skin. With a low “Brazilian” incision, the scar is hidden by her undergarments.
Pubic (Mons) Lift
The pubic area is often not addressed during a tummy tuck by most surgeons. However, Dr. Gutowski typically does liposuction and a lift of this area to match the newly reshaped abdomen. This is included in the tummy tuck “package”.
Fat Transfer to Breast or Buttocks as part of Tummy Tuck
During a tummy tuck, the removed fat can be repurposed and placed elsewhere in the body. Common areas for fat transfer at the same time are the breasts and the buttocks, although the face, hands, and other areas may be treated also. Breast fat transfer gives a modest enlargement without the need for breast implants. The results look and feel natural. The buttock can also be rounded out with fat to complement the tummy tuck.
These two patients desired to improve other areas of their body during the tummy tuck. In one case, the removed fat was transferred to her breasts for a 1 cup enlargement, without implants. In the other case, the fat was transferred to her “hip dip” on the side of the buttock to create a more rounded and youthful shape.
Awake Mini Tummy Tuck and Liposuction
For those patients who don’t need a full tummy tuck, a mini tummy tuck may be an option. This can usually be done awake with a local anesthetic for a faster recovery. Liposuction is usually done at the same time and drains are not needed.
This patient desired a mini tummy tuck and breast lift after two pregnancies changed her body. The procedure was done awake, the lower abdominal fullness was eliminated, and the breasts are more perky and youthful.
Since each patient is unique and has their own goals and expectations, Dr. Gutowski tailors a custom treatment plan for his body contouring patients. The techniques and procedures mentioned above may be modified to give the best result based on each patient’s body type.