Traditionally, December is the month when most plastic surgeons are fully booked.  This is not surprising as most people would like to take advantage of the long vacation, allowing them to enjoy enough rest during their recovery instead of taking a leave off work.

Also, cooler weather (December to March) requires people to wear “bulkier” clothes—this is an advantage to patients who want to conceal swelling and bruising, which are symptoms often associated with facelift, brow lift, neck lift, and liposuction.  Another bonus is that sun exposure can be minimized.

It is important to note that exposing the incision site from the sun can result to hyper-pigmentation and more visible scars.  For this reason, the treated area should be covered by clothing; trousers, scarves, jackets, and even wide-rimmed hats can be helpful in protecting the skin.

On the other hand, people who want to undergo plastic surgery to prepare their body for summer (hello tiny bikinis!) are often recommended to have the procedure in spring (April to June); in this way, they will have enough time to recover and wait for the swelling and bruising to subside.

Liposuction, body lift, breast augmentation, buttock enhancement, and tummy tuck are just some of the most popular pre-summer preparations among plastic surgery patients.

And just like in winter, spring (only applicable in Northern states) allows patients to wear bulkier clothing that can conceal their post-surgical swelling, bruising, and other symptoms; they will also enjoy long holidays and spring break.

By contrast, summer is not a great time to have cosmetic plastic surgery unless for those who want to use their vacation time to recuperate.  But if a patient chooses this season to have her procedure, a reasonable option is to stay indoors, making sure that she stays in an air-conditioned room to enjoy a comfortable recovery.

Patients should remember to stay away from the sun and never hang out in the backyard or poolside (even under the shade) as the heat may still exacerbate the swelling and bruising, which in turn leads to longer recovery.  Also, they run the risk of developing hyper-pigmentation which can darken the incision sites.

Laser resurfacing is particularly not ideal during summer because the treated area should not be exposed under the sun for at least six weeks.

Fleur-de-lis tummy tuck is ideal for massive weight loss patients whose pannus may even reach their pubic area, resulting to foul odor, poor hygiene, back pain, limited physical movement, and skin irritation because the flap of tissue is trapping moisture and sweat.

While the traditional tummy tuck’s horizontal incision can narrow the waist, this is not enough for MWL patients who also need a vertical incision in the middle to further contour the midsection.  For this reason, the incision pattern with fleur-de-lis abdominoplasty looks like an inverted T.

The procedure is designed to remove more amounts of excess skin and fats and narrow the midsection.  It can also reduce and lift the outer thighs and to some extent the inner area, abdomen, and buttocks.

Because the technique involves the extensive use of incision, the ideal candidates are patients who already have a vertical scar from a bypass or weight loss surgery.  Meanwhile, women are more likely to be interested with the inverted T-shaped incision pattern more than men because they often need more contouring.

The fleur-de-lis abdominoplasty is only reserved for people who need substantial amounts of hanging skin removed and a lot of lifting and tightening around the waist area.

Plastic surgeons use tummy tuck technique that requires the smallest incision possible so the scars are less noticeable and the healing time is shorter.  However, MWL patients will likely need longer excisions because of the severe body disfigurement.

In many cases, patients with moderate to severe redundant skin will need to have their navels repositioned or their plastic surgeons may even create a new one.

As with any body contouring surgery, all types of tummy tuck can provide a long-lasting result as long as the patients will maintain a stable weight for the rest of their lives.  For this reason, the surgeons also consider a person’s willingness and determination to live a healthy life and engage in regular exercises and moderate diet.

While fleur-de-lis can significantly improve the body shape and help patients fit better into their clothes, it may be difficult to achieve a “near perfect figure” because obesity has already stretched and weaken their skin.  But still, the procedure is worth it especially if the hanging skin and fats cause irritation, back pain, foul odor, and other problems.

Meanwhile, these are the most common incision patterns used in tummy tuck:

• Traditional tummy tuck

This approach involves making a hip-to-hip incision and another one around the navel that will enable plastic surgeons to remove the loose skin, fats, and tissues and also realign or reshape the weakened, stretched muscles.

In some cases, doctors also perform abdominal liposuction several months prior to traditional tummy tuck surgery.

• Extended tummy tuck

This technique, which is ideal for patients with “love handles” or the excess fats hanging from the crest of the hips, uses an incision that extends behind the hips and is kept low so the scars will not be visible even if one is wearing a bikini.

Because men are more prone to develop “love handles” than women, they are the ones who usually ask for this tummy tuck technique.

• Mini tummy tuck or partial abdominoplasty

This tummy tuck technique is ideal for patients who are within 10 percent of their recommended body weight and only have a limited amount of excess skin and fats in their abdomen.

In this procedure, plastic surgeons make a short incision below the navel that will allow them to eliminate the excess skin and fats and reshape the underlying muscles.  Meanwhile, this approach usually do not involve repositioning the navel.

• Endoscopic tummy tuck

This involves even a shorter incision than the mini tummy tuck since doctors use an endoscope, a fiber-optic camera attached to a large monitor that will enable them to see the underlying muscles.

Endoscopic tummy tuck is highly ideal for patients who do not have a noticeable loose skin around the abdomen and have little fats and weakened, stretched muscles.  However, some doctors also use this for individuals who suffer from rectus diastasis, a condition in which the abdominal muscles along the midline of the belly are separated.

• Circumferential tummy tuck

Because of the extensiveness of circumferential tummy tuck, this is only performed on massive weight loss patients who are suffering from loose, hanging skin and fats around their entire lower trunk.

This is performed by making a belt-like incision that reaches the hips and back for the removal of loose skin from the thighs, hips, buttocks, and central abdominal area.

Because the surgery is typically performed with general anesthesia, patients will feel groggy, tired, and nauseated during the first day of recovery as the drug slowly wears off.  Meanwhile, some patients are advised to spend a day or two at a hospital, although most can return home a few hours after the procedure.

To encourage faster recovery, plastic surgeons typically place surgical drains in the incision site before the abdomen is covered with a dressing and compression garment.  This technique will also minimize swelling and prevent excess fluids and blood from accumulating beneath the skin.

While pain and discomfort are the most pronounced during the first few days of recovery, the symptoms can be controlled with prescribed or over-the-counter pain relievers, which are often complemented with antibiotics to prevent infection.

Most of the swelling, bruising, and tenderness in the abdominal area will subside about one to three weeks after surgery as the incisions heal and the body adjusts to its new shape.  However, some residual symptoms may last for several months, although they are supposed to improve as days go by.

Temporary swelling is the most common side effect of tummy tuck surgery.  If the symptom can be controlled, it will likely result to faster recovery and immediate result.

Meanwhile, this is a list of postoperative care proven to reduce swelling after tummy tuck:

• stay hydrated by drinking plenty of fluids during recovery
• resort to a low-sodium, high-protein diet
• get plenty of rest and sleep
• use cold compress according to the surgeon’s instruction
• gently massage the abdominal area to improve blood circulation
• wear compression garment; this will not only encourage the body fluids to drain out immediately but also make the skin heal closer to the body, resulting to a flatter appearance
• avoid medications such as antidepressants and steroids which are known to worsen the swelling

Wearing compression garment as directed has been found to significantly reduce the risk of sagging appearance.

Because getting plenty of rest is crucial during recovery, most plastic surgeons advise their patients to take about two weeks off from work, gradually resuming their normal activities so their body can slowly adjust.

Unfortunately, even the most rigorous exercise is sometimes not enough to address the sagging appearance especially if the weakened and stretched muscles are the primary cause.  In this case, perhaps tummy tuck or abdominoplasty surgery is the only effective way to aesthetically improve the abdominal area.

Because every woman has a varying degree of sagging, there are many types of tummy tuck which are primarily based on the length and location of the incision sites.  But regardless of which technique is used, plastic surgeons usually place the excisions hidden in the underwear so the scars are unnoticeable, although this may not always be the case especially for patients who need the most correction.

For women who are suffering from severe sagging in the mid-section, the complete tummy tuck is the most recommended approach in which doctors make a horizontal incision that runs across the hipbones, with its middle touching the pubic line while its two sides are curving upward, thus creating a U shape.

Through this incision, plastic surgeons can repair the weakened muscles through deep internal sutures and eliminate the excess fats, skin, and tissue.  And if necessary, they create another excision around the navel in case that there is a significant amount of loose skin in the upper abdomen.

Meanwhile, women with a less noticeable sagging can benefit with a shorter incision which usually leads to faster recovery and minimal scars.  Called as the mini tummy tuck, this also uses the same procedures found in the complete abdominoplasty, although the excision is significantly smaller.

To enjoy the full benefits of mini tummy tuck, patients should have a minimal amount of skin, fats, and tissue which are mainly located below their navel while their upper abdomen should have no obvious sagging appearance.

In case the patients have extra fats in their upper abdomen, mini tummy tuck may be complemented with liposuction surgery to create a smoother appearance.

For patients whose only problem is the weakened muscles and minimal fats, abdominoplasty surgery is usually performed using an endoscope, a fiber-optic camera attached to large screen.  In this way, plastic surgeons can see the underlying muscles through a very small incision which can reduce or even eliminate scars.

The excess skin in the abdominal area may be caused by weight loss and natural effects of aging.  However, this aesthetic problem commonly occurs after several pregnancies which may weaken and stretch the muscle, tissue, and skin.  And for women who have C-section, the loose skin may be further aggravated by the pockets of fats which usually accumulate in the upper area of the incision.

While the excess fats in the abdomen may respond to a rigorous exercise, this may not be enough to improve the weakened muscle and stretched skin.  In this case, plastic surgeons believe that tummy tuck may be the only option to improve this aesthetic problem, and which may be combined with liposuction to remove the fatty deposits.

If plastic surgeons have to combine tummy tuck and liposuction, they usually perform the fat removal procedure first by making several small incisions where they can insert the cannula, a slender suctioning probe attached to a vacuum pump.  The fatty tissues are then dislodged by moving the device back and forth, although some doctors prefer using the motorized cannula which produces accurate, tiny vibrations.

Once the fatty deposits in the abdomen are suctioned out, plastic surgery specialists will create a U-shaped incision with its bottom touching the pubic line while its two sides are curving upward to the hips.  This surgical approach is highly recommended for patients with a significant amount of panniculus.

But for women who have less sagging skin in their abdomen, the best plastic surgery approach is the mini tummy tuck which uses a shorter incision.

Through the abdominal incision, doctors can manipulate and suture the weakened muscles and remove the excess tissue, skin, and fats.  For patients who need the most correction, they may need a second incision around the navel which will allow surgeons to place this to a higher position and remove the excess skin around it.

After the weakened muscle is repaired and the excess skin and fats are removed, plastic surgery specialists will close the incisions using staples or sutures.  In many cases, they will leave temporary drains to prevent seroma, a condition in which the blood and other body fluids accumulate under the skin.

As with any plastic surgery, this procedure involves using incisions which also means risk of scarring, bleeding, infection, and post-operative pain and discomfort.  For such reasons, plastic surgeons use a strict patient selection method that will determine if a person is a good candidate or high-risk individual.

Because every patient has a varying amount of panniculus, plastic surgeons have developed several techniques in tummy tuck.  For individuals who need a significant correction, the most ideal approach is the complete abdominoplasty which uses a long incision that travels from hipbone to hipbone.

But instead of a horizontal, straight cut, doctors create an incision that is shaped like a smile, with a flat bottom and a gentle curve along the pelvis.  The middle of the incision travels above the pubic line so that the underwear can cover the scars.

Another incision is made around the circumference of the belly button to allow plastic surgeons to free it from the tissue and reposition it to a new location.

With the invasiveness of the complete abdominoplasty, some doctors believe that this is not the right approach for patients who only have a less noticeable panniculus.  In this situation, they will most likely recommend a minimally invasive technique called mini tummy tuck.

In this procedure, plastic surgery specialists make a shorter incision in the abdomen to manipulate the underlying muscles and eliminate any excess tissue and skin.  Compared to the other technique, mini tummy tuck does not cut or reposition the navel to a new location.

One of the most obvious advantages of the mini tummy tuck is that patients can expect shorter scars.  However, they should remember that this approach is only ideal if they have a minimal amount of excess skin and fats which are mostly located in the lower abdomen.

If needed, doctors may complement this procedure with liposuction to remove the excess fats especially in the upper abdomen.

Regardless of which technique is used, tummy tuck involves recovery and risk of complications.  For these reasons, patients are required to follow certain post-operative care, take medications, and avoid strenuous activities and heavy lifting while they are still recovering.

While this approach provides a dramatic outcome, LA plastic surgeons do not perform this when treating patients with a less amount of excess skin and fats since they can also achieve a good result even with the use of smaller incisions which lead to minimal scarring and faster recovery.

In cosmetic plastic surgery, perhaps the most common alternative to the traditional tummy tuck is the mini or partial abdominoplasty in which doctors place a shorter incision below the navel and perform the same procedures to remove the sagging appearance in the area.  But to fully enjoy the benefits of this less invasive approach, a patient should have a minimal amount of skin and fats which should be only located in the lower abdomen.

In case that there are excess fats in the upper abdomen, plastic surgeons will usually complement the mini tummy tuck with liposuction.  This is commonly performed by injecting a solution to make the fatty deposits swollen and firmer for an easier and faster removal.

To further shorten the length of the incision, some doctors in Los Angeles plastic surgery perform the mini tummy tuck with an endoscope, a fiber-optic camera attached to a slender probe.  This instrument is inserted in a very small incision and provides feedback to a monitor where surgeons can see the underlying muscle.

For patients whose only problem is the excess fats in their abdomen, liposuction alone is enough to provide a dramatic result especially if their skin is elastic which will allow it to shrink and tighten on its own.

In plastic surgery, most doctors perform abdominal liposuction through the use of tumescent technique in which they inject the area with a drug that is a mixture of lidocaine which provides the numbing effect, and epinephrine which constricts the blood vessels to inhibit bleeding.

Regardless of which body contouring procedure is performed, the result is supposed to last a lifetime, although this can be reversed with significant weight fluctuations and pregnancy.  For this reason, plastic surgeons require their patients to postpone any abdominal cosmetic surgery if they are planning to have children or have unstable weight.

There are two kinds of patients who usually ask for this plastic surgery treatment: mothers who want to remove the physical effects of childbearing, and massive weight loss patients who are left with excess, drooping skin in their abdomen.

During pregnancy, the muscles and tissues are stretched to their limit in order to accommodate the growing baby.  For this reason, some women develop pockets of fats and hanging skin after giving birth, a condition which unfortunately may not respond even to the most rigorous exercise and diet.

On the other hand, people who have had massive weight loss surgery such as lap band and gastric bypass usually developed excess skin, a condition which is common for those who lose more than 100 lbs. of weight.  This happens because the skin and tissue cannot easily catch up with the “shrinking” body as it is forced to take a lesser amount of calories.

One of the most obvious benefits of this procedure, according to plastic surgeons, is that patients can achieve a slimmer waistline, thus resulting to a better figure.  However, it is important to note that they should not treat this as a substitute for diet and regular exercise; in fact, doctors turn down anyone who is more than 25 percent of his/her body weight.

Aside from aesthetically improving the body, this plastic surgery procedure also treats the physical symptoms associated with excess, hanging skin such as breakdown of skin, ulcers, irritation, back pain, foul odor, poor hygiene, and difficulty in sitting and walking.  For this reason, some insurance company may provide coverage for patients who are experiencing physical difficulties because of such condition.

On the other hand, tummy tuck, if performed purely for cosmetic reason, is not covered by insurance companies since it is considered as an elective procedure and not “medically” necessary, according to plastic surgeons.

The good thing about tummy tuck surgery is that it generally provides a permanent result as long as the patients will maintain a stable weight and will not get pregnant.  With this, plastic surgeons recommend people to postpone the treatment if they are considering getting pregnant or have fluctuating weight.

Meanwhile, the best way to maintain the result of this procedure is to engage in a regular exercise and healthy diet.

Panniculectomy is probably the most popular plastic surgery procedure for massive weight loss patients as it targets the midsection of the body, the area which has the most tendency to develop hanging skin and tissues that may lead to back problem, breakdown of skin, ulcers, irritation, foul odor, and poor hygiene.

Abdominoplasty (tummy tuck) is different from panniculectomy, although these two plastic surgery procedures treat the abdomen.  In abdominoplasty, plastic surgeons reshape and tighten the underlying muscles and eliminate the excess skin and fats, but in panniculectomy, they only remove the hanging skin and fats.

In some cases, panniculectomy is performed with another abdominal surgery such as hysterectomy (surgical removal of a woman’s reproductive organ) or repair of the abdominal wall.

According to plastic surgery specialists, candidates for this procedure should have excess skin and fats extending as low as their hips, genitals, and buttocks to the extent that walking, sitting, and standing have become relatively difficult.

To make sure that the result of panniculectomy will most likely last a lifetime, plastic surgeons require their patients to have a stable weight for at least one year or even longer if they have had lap band or gastric bypass surgery to make sure that they are no longer nutritionally deficient due to the sudden decrease of food intake.

Plastic surgeons start the procedure by administering general anesthesia that will put their patients in a state similar to sleep.  And once the drug takes effect, they will create a vertical incision that starts from the lower area of the breast bone (sternum) to the pubic bone, and another horizontal cut that covers the pubic area.

Through these incisions, plastic surgery specialists can remove the excess skin and fats and then pulled together the remaining skin to close the surgical wound.  In some cases, small tubes are inserted to drain the excess fluids which can promote faster recovery.

As with any surgery, panniculectomy involves risk of complications and recovery.  With this, it is important for patients to rigidly follow their surgeon’s post-operative instruction that will reduce the risks and promote faster healing.

During the recovery period, patients are restricted to lift more than 10 lbs. and perform rigorous exercises that may put pressure on their abdominal area.