Cool Case of the Week

Labia Minora Reduction

Labiaplasty in a patient with extreme anterior hypertrophy

   

This 26 year old patient came to see Dr. Medalie at his Beachwood office. Her chief complaint was labial hypertrophy with extreme irritation in tight clothes and during physical activity. On exam she had a great deal of excess and thick  labial tissue as well as fullness of the clitoral hood. Dr. Medalie performed a labiaplasty under local anesthesia with mild oral sedation in his clinic. The wedge techniques was used and the post appearance is shown at three months. It can be seen that the labia minora are now no longer protruding beyond the labia majora and run in a straight line as opposed to being quite redundant. The clitoral hood was not operated on  but has become more streamlined because of the pull of the labiaplasty. Her overall appearance is much improved and she has much less irritation during all activities. She was extremely pleased with her result.

Below is my Labiaplasty FAQ: Click on each question to see the answer!

Do I need general anesthesia?
No – Labiaplasty can be performed with mild oral sedation and local anesthesia.
How long does it take?
Typical surgery time is around 1-1.5 hours.
What is the chance of infection?
I typically give my patients antibiotics for three days around the surgery. I have NEVER had a post-operative infection. Sometimes patients who take antibiotics get yeast infections and this has happened to several of my patients. The treatment consists of stopping the antibiotics and applying a topical anti-yeast agent. Please be aware that smoking is the number one reason for post-operative infections and healing problems. I thus require my patients to STOP SMOKING at least 6 weeks prior to any labiaplasty procedure.
Are there bleeding risks?
The labia are very vascular and bleed easily. During the surgery local anesthetic is injected into the tissue-this blocks the sensation and also constricts blood vessels. As a result, there is very little bleeding during the surgery. I have NEVER had a patient have a bleeding complication post-op.
What is the recovery?
While it may seem that this is a very bad area to have surgery on, in fact, the labia are very resilient and heal speedily. Pain that may require narcotic pain medicine typically lasts only a few days. After that, ibuprofen (Motrin and Advil) is sufficient. I recommend that patients take a week off from work, but if you have a desk job, you can go back sooner. The post-op care is fairly easy and involves cleansing several times per day and the application of antibiotic ointment for a week. Most of the swelling and all of the external stitches have disappeared by two weeks.
When can I resume my normal activity?
I recommend that patients refrain from intercourse for at least 4 weeks after surgery. This does not mean that other types of sexual activity cannot take place. Even after 4 weeks, the labia incisions may be sensitive and patients need to use caution and plenty of lubrication.
When will I be completely healed?
Some of the deep sutures under the skin can take up to three months to completely dissolve. For this reason, some patients may report sensitivity issue such as itching for up to three months post-op. After that, sensation issues are very uncommon. Damage to the clitoris with resulting changes in the ability to have orgasm has never happened in my patient population.
Can other procedures be performed at the same time as labiaplasty?
Yes – I frequently perform multiple procedures on labaiplasty patients. Sometimes I perform clitoral unhooding. This procedure removes some of the skin overlying the clitoris to allow for greater stimulation during intercourse. The labia majora can also be reduced (this is more typically asked for by my older patients or patients who have lost significant amounts of weight). Vaginoplasty or vaginal rejuvenation is a procedure to tighten the vaginal introitus after child bearing. This is easily performed in conjunction with labiaplasty. Finally, all the other cosmetic procedures that I perform (e.g. breast augmentation, tummy tuck etc.) can be performed at the same time as labiaplasty. These would require a trip to the operating room and general anesthesia.
What does it cost?
Simple labiaplasty under local anesthesia and mild sedation costs around $3800 at Dr. Medalie’s outpatient procedure clinic. Clitoral hood reduction can be added for $500. Labia majora reduction is an additional $1500 (or $3000 as a stand alone procedure). All procedures are less expensive when combined with other procedures such as vaginoplasty or breast augmentation.
What if I am from out of town?
I frequently perform labia reduction and vagina rejuvenation surgery on patients who live out of town and are unable to easily to see me in consultation prior to the procedure. I have several requirements for these patients: I must see pictures of them prior to scheduling surgery. They need to contact my office and have my patient care manager fax or e-mail them a history and physical form to be filled out and sent back. Typically the patient will come in to town 1 day prior to the procedure, and I will see them the day of surgery.  A phone consultation will be performed about 3 weeks prior to surgery. I will then perform the operation and see them back in my clinic in several days to check the surgical site and answer any questions. This means that the patient will spend around 4-7 days in the Cleveland area. Some patients have stayed only for 24 hours and had family doctors check on them. Patients who live far away, but can drive to Cleveland (2-6 hrs.), can go home the next day and drive back to see me for their first post-operative appointment. I will then follow the progress of the patient via e-mailed pictures on a weekly basis. My patient care mananger has information about hotels in the area as well as financing. You may contact her at [email protected]
Where can I get more information?
Please visit Dr. Medalie’s vaginal surgery specific web site at www.LabiaplastySurgery.net. There you can see multiple before and after labiaplasty and vaginoplasty photos as well as watch his live labia and vagina surgery video or call him at 216-393-9924. You can also e-mail his patient care manager at [email protected].
  • Posted on: Mar 26 2019
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FtM Top Surgery Revision

FtM Top Surgery Revision

I get contacted by many patients who have had top surgery and are now seeking a revision of their chest. If they are my own patients seeking revision, the problems are almost always small and can  be taken care of under local anesthesia in my clinic (touch up liposuction or dog ear revision). Usually when I am contacted by a patient who has had a procedure by another physician the results are quite poor (because otherwise the patient would have gone back to his original surgeon), and the patient needs to go back to the OR for a successful outcome. Below is the before and after photos of a patient who initially had his top surgery by another surgeon. There is obvious loose skin and retained fatty tissue with stretching and distortion of the nipple areolar complex. I completely revised the scars and nipples and was able to give him a much improved chest contour. He is shown two months after the surgery and is very happy with his early result. I would be happy to review any before and after photos a prospective patient wishes to send me, and I will do my best to give an idea of what might be necessary to improve the cosmetic outcome.

  • Posted on: Feb 22 2019
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Gynecomastia Reduction Before and After

   

This pleasant 30 year old man came to see Dr. Medalie at his Beachwood, Ohio office to discuss gynecomastia reduction. He had evidence of breast tissue on his chest since adolescence and even with losing weight had not noticed a big difference. After careful consultation he decided to undergo a male breast reduction surgery (gynecomastia procedure) as an outpatient at the Brainard Surgery center where Dr. Medalie performs most of his operations. The surgery lasted around 1.5 hours and was an outpatient procedure. It involved a combination of liposuction and direct excision of the sub-areolar glandular tissue. The patient is now shown 6 months after his gynecomastia surgery and has an excellent post-operative contour. He is very pleased with his result. Plastic surgery results can vary. Below is information from the American Society of Plastic Surgery concerning gynecomastia and male breast reduction surgery.

What is gynecomastia surgery?

Gynecomastia surgery reduces breast size in men, flattening and enhancing the chest contours.

In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.

Plastic surgery to correct gynecomastia is technically called reduction mammaplasty.

What is gynecomastia?

Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity or the use of certain drugs.

Gynecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.

Gynecomastia is characterized by:

  • Excess localized fat
  • Excess glandular tissue development
  • Sometimes excess breast skin
  • Presence unilaterally (one breast) or bilaterally (both breasts)

    What are the steps of a gynecomastia procedure?

    A gynecomastia procedure includes the following steps:

    Anesthesia

    Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

    Liposuction technique

    male breast reduction

    In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions.

    The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.

    There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.

    Excision technique

    male breast reduction

    Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.

    Combination of liposuction & excision techniques

    male breast reduction

    Sometimes gynecomastia is treated with both liposuction and excision.

  • Posted on: Jan 24 2019
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Labiaplasty Before and After

 

Labiaplasty  Before                                                                                 Labiaplasty  3 Months After

 

These are the results of one of Dr. Medalie’s recent patients. She came in complaining of excess tissue that rubbed during exercise and sexual activity and asked for vaginal rejuvenation (in this case labia minora reduction). She was also unhappy with the appearance of her labia. Dr. Medalie performed a wedge resection of the excess labia minora tissue under local anesthesia in his office. He uses an an anesthetic called exparel which can have a duration of up to three days, and the patient stated that all she had taken for discomfort was Motrin. She was very pleased with her outcome and is shown three months after the surgical procedure.  *Plastic surgery results can vary

What is a labiaplasty?

The term labiaplasty refers to a procedure that reduces the length of the labia minora. It is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia.

Reasons patients want a labiaplasty

Women opt for surgery for a variety of reasons, including pain from twisting and tugging of the labia when riding a bike or during intercourse, itching, irritation and self-consciousness.

What does a labiaplasty do?

The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora. A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia no longer twist, tug or fall out of a bathing suit.

Anesthesia for a labiapasty

Labiaplasty is a procedure that can be done under either local anesthesia with oral sedation or under general anesthesia.

Labiaplasty procedure

The most common type of labiaplasty performed by Dr. Medalie is the wedge procedure, which maintains a natural border after a pie-shaped piece of tissue has been removed. Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures.

What are the risks of a labiaplasty?

The risks associated with labiaplasty include those of most surgical procedures, including bleeding, hematoma and infection. Sometimes a stitch may break resulting in a small hole or notch that can be revised electively. Over-resection can be a complication of the trim procedure so that is why Dr. Medalie prefers the wedge method.

Recovering from a labiaplasty

Most patients take a week off from work, during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underpants and an elastic garment, like Spanx. This can be done “twenty minutes on, twenty minutes off.” The patient can also lie with her bottom elevated to reduce swelling.

Patients can resume wearing tampons or having intercourse after four to six weeks.

While the most distorting swelling is gone by 6 weeks, residual swelling may take 4-6 months to disappear.

What are the results of a labiaplasty?

Labiaplasty typically results in shorter labia that no longer hang down below the level of the hair-bearing labia majora. Most patients who experienced symptoms from twisting and tugging of their labia generally find relief after surgery. According to multiple studies, labiaplasty surgery is associated with a high satisfaction rate of over 90 percent.

  • Posted on: Dec 6 2018
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Breast augmentation with silicone implants and full breast lift

 

   

This 36 year old mother of three came to see Dr. Medalie in his Beachwood office. She was interested in a breast augmentation and  breast lift to tighten her loose skin and increase the superior fullness of her breasts. After careful consultation she decided to proceed with 330 cc silicone breast implants at the same time as a full mastopexy (breast lift). The surgery was performed as an outpatient and took approximately 2.5 hours. She is shown 6 months after the procedure and is very happy with her higher and fuller breasts. *Plastic Surgery results may vary

Below is information from the American Society of Plastic Surgery regarding breast lift surgery:

Your breast lift procedure can be achieved through a variety of incision patterns and techniques.

The appropriate technique for you will be determined based on:

  • Breast size and shape
  • The size and position of your areolas
  • The degree of breast sagging
  • Skin quality and elasticity as well as the amount of extra skin

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The Incision

There are three common incision patterns:

Around The Areola

Breast lift incision around areola

Around The Areola And Vertically Down From The Areola To The Breast Crease

Breast lift incision vertical

Around The Areola, Vertically Down From The Breast Crease And Horizontally Along The Breast Crease

Breast lift incision horizontal

Step 3 – Reshaping Your Breasts

After your doctor makes the incisions:

  • The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.
  • The nipple and areola are repositioned to a natural, more youthful height.
  • If necessary, enlarged areolas are reduced by excising skin at the perimeter.
  • Excess breast skin is removed to compensate for a loss of elasticity.
  • Breast augmentation may also be performed to add more volume and provide superior fullness (this was done in the patient case presented above)

Step 4 – Closing The Incisions

After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed.

Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.

Many women desire the smallest scar possible. However, your plastic surgeon will recommend the incisions which best suit your anatomy.

Listen to your surgeon and do not diminish your result by demanding an incision that will not be appropriate for you.

Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.

  • Posted on: Oct 30 2018
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Liposuction of Flanks with Body Contouring

This pleasant 36 year old patient came to see me at my Beachwood practice. She desired full tummy tuck with revision of a previous breast reduction and lift as well as liposuction of the flanks. This post only shows the results of the flank liposuction and a later post will show the rest. The suction was performed with the tumescent technique and power assisted cannulas. It is easy to see the excellent loss of volume with enhanced contour in the flank and hip regions. Instead of a square buttock and hip region , she now has a curvier and more slender appearance. The body contouring has dramatically improved her waist line. Please remember that plastic surgery can have variable results. Below is information from the American Society of Plastic Surgery:

 

What are the steps of a liposuction procedure?

The liposuction procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include local anesthesia, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Liposuction is performed through small, inconspicuous incisions.

First, diluted local anesthesia is infused to reduce bleeding and trauma. Then a thin hollow tube, or cannula, is inserted through the incisions to loosen excess fat using a controlled back and forth motion. The dislodged fat is then suctioned out of the body using a surgical vacuum or syringe attached to the cannula.

Problem areas that can be addressed with liposuction

Liposuction problem areas

Liposuction problem areas

Step 3 – See the results

Your improved body contour will be apparent once the swelling and fluid retention commonly experienced following liposuction subside. Get more information about liposuction results.

Liposuction rear and side after

Liposuction front and face after

https://www.plasticsurgery.org/cosmetic-procedures/liposuction

  • Posted on: Oct 9 2018
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Male Breast Reduction after Weight Loss

 

Male Breast Reduction to treat Severe Gynecomastia-Before and 1 year After Photos

    

    

This patient came to see Dr. Medalie complaining of  severe gynecomastia and lateral excess skin and fatty tissue. He had lost up to 150 lbs and was concerned about the displaced nipple/areolar complex, excess breast tissue and lateral excess skin and fatty tissue. His male breast reduction surgery was performed on an outpatient basis.He had a complete double mastectomy with nipple areolar reconstruction by grafting and side and chest liposuction. His incisions were extended quite far on his sides in order to remove the excess lateral skin as well. The patient is shown 1 year after his procedure. His chest contour is much improved and his nipples are smaller and in a better position. He is extremely pleased with his outcome. *Plastic Surgery results are not guaranteed

Below is information provided by the American Society of Plastic Surgery:

What is gynecomastia surgery?

Gynecomastia surgery reduces breast size in men, flattening and enhancing the chest contours.

In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.

Plastic surgery to correct gynecomastia is technically called reduction mammaplasty.

What is gynecomastia?

Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity or the use of certain drugs.

Gynecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.

Gynecomastia is characterized by:

  • Excess localized fat
  • Excess glandular tissue development
  • Sometimes excess breast skin
  • Presence unilaterally (one breast) or bilaterally (both breasts)
  • What are the steps of a gynecomastia procedure?

    A male breast reduction procedure includes the following steps:

    Anesthesia

    Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

    Liposuction technique

    male breast reduction

    In cases where the chest tissue is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions.

    The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.

    There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.

     

    Excision technique

    male breast reduction

    Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference. I find that almost always a patient will need a small incision to remove glandular tissue under the nipple. I try to make the incision at the areolar skin junction on the lateral border of the areola from 6-12 o’clock.

    Combination of liposuction & excision techniques

    male breast reduction

    Sometimes gynecomastia is treated with both liposuction and excision. This is the case in the example above when there is both excess fatty tissue and glandular tissue present.

  • Posted on: Aug 28 2018
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Breast Augmentation with Silicone Breast Implants-Cleveland Plastic Surgery Cool Case of the Week

This 28 year old woman from Columbus, Ohio came to see Dr. Daniel A. Medalie at his Beachwood, Ohio office to discuss breast enhancement with silicone versus saline filled breast implants. After a careful discussion where she examined many before and after photos of Dr. Medalie’s breast augmentation patients, she elected to have 350 cc silicone breast implants placed in the sub-muscular place. She is 5’5″ tall and 120 lbs.  The surgery was performed in about an hour at an outpatient setting at University Suburban Health surgery center. She is shown 6 months after her breast implantation procedure and is very happy with her new contour and breast size. Plastic surgery results may vary

 

What are the steps of a breast augmentation procedure?

A breast augmentation procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. Dr. Medalie typically uses light general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). A belly-button approach is associated with a higher complication rate. Dr. Medalie typically uses an inframammary fold approach.

breast augmentation incisions

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either:

submuscular and subglandular breast implant placement

A. Under the pectoral muscle (a submuscular placement)

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations. Dr. Medalie typically uses a plane partially underneath the pectoralis major muscle.

Step 4 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin.

breast augmentation incision locations

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Step 5 – See the results

The results of breast augmentation are immediately visible.

  • Posted on: Mar 20 2018
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Mommy Makeover with tummy tuck, liposuction and breast augmentation- Cleveland Plastic Surgery Case of the Week

This 43 year old mother of two also lost one hundred pounds from diet and exercise. She came to Dr. Daniel A.  Medalie of Cleveland Plastic Surgery complaining of loose skin and muscle of the abdomen as well as deflated breasts. Dr. Medalie recommended a full mommy makeover with tummy tuck and liposuction as well as a full breast lift with moderate sized breast implants. She chose Natrelle silicone 375 cc smooth round breast implants for her breast augmentation. On the day of surgery she went to University Suburban Health Surgery Center and underwent the tummy tuck and breast augmentation procedure as an outpatient. The surgery took around 4 hours and then the patient went home after recovery. She is shown 3 months after her procedure. She is very happy with her new breast and  body contour. Her scars will begin to fade in another several months. *Plastic Surgery Results are not guaranteed

What Is A Mommy Makeover?

The goal of a mommy makeover is to restore the shape and appearance of a woman’s body after childbearing. Many women notice changes in their bodies post-pregnancy. There are many areas of the body that can be addressed, most commonly the breasts, abdomen, waist, genitalia, and buttocks. A mommy makeover is typically performed as a single stage procedure. There are many techniques used to perform a mommy makeover, and many factors should be taken into consideration when choosing which techniques are best:

  • Desired amount of restoration
  • Placement of the incisions
  • Type of implant used

Possible Procedures In A Mommy Makeover

Abdominoplasty

Liposuction

Breast Augmentation

Breast Lift

Vaginoplasty

Labiaplasty

Thigh Lift

Arm Lift

  • Posted on: Sep 28 2017
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Tummy tuck with liposuction and muscle tightening-Cleveland Plastic Surgery Case of the Week

This 36 year old patient from Cleveland, Ohio came to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to discuss tummy tuck surgery and liposuction. On exam she has a great deal of loose skin and muscle as well as some extra fatty tissue. Dr. Medalie proposed an abdominoplasty procedure with muscle plication (tightening) and side and flank liposuction as an outpatient. She agreed and is shown 6 months after her body contouring surgery. She has excellent reduction of loose skin and stretch marks as well as good tightening of the abdominal wall and is very happy with her results.

Plastic Surgery results can vary and are not guaranteed

Abdominoplasty with liposuction and muscle tightening Before and After (side view)

Abdominoplasty Surgery is well explained at the American Society of Plastic Surgery web site. (see text below). I encourage you to visit the site at this link to obtain more information

Tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.

A flat and well-toned abdomen is something many of us strive for through exercise and weight control. Sometimes these methods cannot achieve our goals.

Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes of this include:

  • Aging
  • Heredity
  • Pregnancy
  • Prior surgery
  • Significant fluctuations in weight

What tummy tuck surgery can’t do

A tummy tuck is not a substitute for weight loss or an appropriate exercise program.

Although the results of a tummy tuck are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies would be advised to postpone a tummy tuck.

A tummy tuck cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised.

  • Posted on: Sep 13 2017
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