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Abdominoplasty/Tummy tuck

SNAPSHOT

Duration: 2.5 hours
Anaesthetic: General Anaesthetic
Stay: 1 or 2 night stay
Recovery: 1 week / 10 days off work
Return to sports: 1 month off sports
Good for: Muscle repair, tummy tightening, skin removal
Contraindications: Smoking, Blood thinners, Obesity
Meds to stop: OCP, HRT 6 weeks prior
Insurance: Not covered

  • Do you choose your clothes based on your abdominal shape and excess skin or overhang?
  • Will you no longer wear a bikini (no there is no age limit in my view) because of the appearance of your tummy?
  • Does your back hurt daily since having babies?
  • Do you have an overhang of tissue over your section scar?

If you answer yes to any of these perhaps it may be worth considering a tummy tuck… read on

It is probably my most favourite procedure in plastic surgery to offer women who are on a daily basis making decisions based on their changed body shape after babies…

if I can free up the brain space you currently consume with this, and take it from you, then it is something to consider.

A tummy tuck is the term used for a procedure to remove excess skin and fat from the abdomen while tightening laxity in the rectus muscle and reshaping the whole area with a new “port” for the native bellybutton.

Abdominoplasty in my view is such a powerful procedure and has changed so dramatically since I started training. About 6 years ago while I was in Australia, I read a paper by who was to become my fabulous mentor, Dr Elizabeth Hall-Findlay. She had alluded to performing abdominoplasties without drains and I vowed to do this on my return. In my opinion it makes such a dramatic difference to a patients recovery after tummy tuck.

Restoration

Gone are the days of stigmas and tolerating physical problems that can be helped with surgery. Abdominoplasty is not purely “cosmetic” – in my view it runs much deeper in womens’ psyche and is much more restorational than many see…

Pregnancy changes:

The tummy changes so dramitically to accommodate a foetus and the rectus muscle spreads apart to accommodate a growing baby .
This muscle often does not return completely to the midline, particularly if the baby is delivered by C-Section as the scar can heal the muscle down in a slightly gapped way. Every post baby recovery is different and so is every tummy. Some need a little help, some bounce back to (almost) normal.

Doodle showing
a) normal muscle disctribution and b) widened rectus ie after pregnancy

Most patients undergoing abdominoplasty or tummy tuck have completed their families, and the abdominal re-configuration or restoration is warranted as the abdominal area has changed shape so much during pregnancy.

Think yoga!

Core strength is so important for our physical stability and skeletal well being (think yoga or pilates emphasis on core strength), and the long term effects of having a core muscle that is not in the midline where it belongs, is a lack of spinal stability and poor core strength.

Our bodies are so amazing to be able to produce and nurture humans that when you think about the changes that must ensue to allow this, a change in our abdominal structure and appearance is almost inevitable. The long term changes range from a small amount of excess skin over the umbilicus (bellybutton) to a massive muscle divarication or gap..
It is intuitive that the bigger the gap, the bigger the problem. The added advantage of repairing the divarication (diastasis) is that I can be opportunistic and tighten up the inevitably looser than ideal skin and tissue of the abdomen at the same time.
Win win!

Ideal parameters:

Ideally you should be close to your ideal weight for best results and also for anaesthetic safety.
No-nos are smoking, obesity and any drugs that make you bleed more (thinners).
I will also not perform an abdominoplasty on anyone who is less than a year post-partum. A year to make a human, a year to allow the body to naturally recover.

I’ll help if needs be after this!

Full or mini?

A full tummy tuck addresses all issues: repair of diastasis, removal of fat and skin and contouring of the umbilicus or bellybutton.
All tissue below the umbilicus is removed during this procedure.

A mini tummy tuck is useful for a smaller problem as it is a slightly smaller procedure. It does not address laxity above the umbilicus (although it can improve this slightly) and is best for women who have a lower abdominal issue with a non stretched bellybutton:

Do I need liposuction?

Liposuction as the name implies, sucks out fat. Literally. It is not, however good if used inappropriately. I fine liposuction crucial to give a nice contoured look to most women (some very thin women obvsuouly don’t benefit from it!) and I routinely use it in my abdominoplasties.
It is good for focal contouring and sculpting, and NOT as a weight loss tool. Obviously it can be used in many other locations and for things like fat grafting but that’s another discussion.

Procedure –
No drains hurray!!

Your procedure is performed under General Anaesthetic (completely asleep). After marking your tummy, you will be given medicine by the Consultant Anaesthetist to make you delightfully sleepy. The anaesthetist is with you throughout the procedure, keeping you safe and asleep.

I make a lower incision along the tummy, and raise up a flap of skin and fat as far as the bellybutton.
The bellybutton is taken out from this skin flap and left attached to you. This flap of tissue is lifted up to the ribcage centrally, allowing me to assess the muscle integrity.
I will then repair the muscle down the middle and often at the sides if required.
The flap of tissue is then pulled tight downwards, and the flap of tissue is sutured down to the tummy muscle as the abdomen is closed back up and then the bellybutton is brought out through a new small neat hole and sutured into position.

Image showing 3 images –
a) Pre op with excess tissue and rectus laxity
b) Retracted flap showing splayed rectus muscle and start of rectus repair
c) Restored contour post op with low long “section” type wound

The “tacking” technique allows me to perform the tummy tuck without the use of drains, hence the term “drain free” which to you means a faster smoother recovery with no bottles and no binder! This procedure is not routinely carried out in Ireland, and is a wonderful progression in techniques that allow a faster recovery for you.

When you wake up, your legs are bent and on two pillows and your tummy feels tight, almost like the day after a binge session of situps! All good!

 

Recovery

You will spend usually 2 nights in the hospital (sometimes 1)
You can shower the next morning – no baths. There is a line!

1 week to take it easy (pottering around at home, though you can drive once home)
You should be able to go back to an office job after 10 days or so (everyone is a little different)
You will have a little strip of brown tape on the incision and some antibiotic ointment to apply to the bellybutton for a week.


Appointments

Post op appointments are at 3 weeks and 3 months, then at a year.

 

If you feel like I can help, come and see me to figure out if a tummy tuck is right for you..

I love helping a fellow mama restore her mojo!

Introducing the EarFold to Ireland

We are delighted to announce that EarFold, the new minimally invasive technique for prominent ear correction, is now available for the first time in Ireland at Blackrock Clinic!

The procedure is done under local anaesthetic using a small incision in front of the ear to insert the small titanium clip, and takes about 30 minutes to complete.

No incision behind the ear, no head bandages, less down time and less side effects than with a traditional otoplasty.

Developed by renowned plastic surgeon Mr Norbert Kang and now part of the excellent Allergan range of products, this is a very exciting development in ear surgery and fits in beautifully with my preferred small scar, limited downtime approach to surgical procedures*.

Prices start at  2500 Euro for 1 device

See www.earfold.com or contact us for further information or to arrange a consultation.

Procedure video:

 

*Only available from EarFold trained consultant surgeons

Tongue Tied no more…

 

IMG_7759
So my first blog post – it had to be this topic..

I have been brewing a fair few blog posts in my mind on this subject over the last year or so. Quite cathartic to have a forum to vent (sorry all those of you who have been in with your beautiful babies and heard me on a rant about any one of these parts of the politics and pathology of tongue tie treatment in Ireland!)

Tongue tie classification

Currently the classification system for tongue tie that we hear can go from the mild-moderate-severe as a grading system, but oddly with this one, we only ever hear “mild” on referrals – which is most interesting; if I was to ever collect this data as I can be sure that if “mild” is mentioned, the baby will always have a complete tongue tie..

The current accepted classification system that we all use classifies the ties into anterior (or close to the front of the mouth) and posterior (closer to the back).

Currently the descriptive terms are generally accepted as follows:

  • Anterior type 1 – accepted as 100% tie to the tip
  • Anterior Type 2 – slightly behind the tip
  • Anterior type 3- further back – some include this as a posterior tie
  • Posterior type 4- under the mucosa/ the invisible, palpable tie

But why do some in one type do well, while others do not?

Well, what the current classification does not address are:

  1. The attachment to the tip of the tongue,
  2. The attachment to the floor of the mouth
  3. The position of the muscle (genioglossus) underneath the tie.

I think the latter has more of an impact than we realise on the outcome of a frenotomy, and what I have found is that one seems to dictate the other.

These three components are all hugely variable between babies, but there is still a pattern if you look (and feel!).

These anatomical features are also critical to outcome prediction.

The more tongue ties I see, the more I think that the anatomy is what dictates function, and therefore the function post release, as well as the concept of “reattachment” (dreadful term; next blog!)

So why don’t we use anatomy instead? Well, why not!? Just because an old system exists is no reason to plod on with the same old system. Time moves on, and education and experience improves both our understanding and patient care.

So how should we classify them?

Tongue ties need to be classified and descriptively rather than anterior and posterior types (which doesn’t make sense given what these terms mean). I have broken it down into 3 concepts.

1.Rebrand.

Anterior should be thought of as “Classic”

Posterior should be thought of as “Submucosal”

2. Think bidimensionally!

Don’t think of ties in one dimension. When looking at a tie what matters most is whether the tie is vertical or oblique – I think this is what dictates the outcome.

Oblique attachments inevitably have the genioglossus muscle right behind the tie, not leaving a whole lot of room for division as I am limited by the presence of the muscle (no, we don’t divide the muscle!). (Think the “Eiffel tower” type)

3. Tension= poor function!

On division (And sometimes before, with manual examination or using a retractor), the fibrous composition of a tie can be commented upon. Some are tighter than others, and this isn’t new science.. but the tight ones seem to get an immediate result when it comes to maternal discomfort.

Having a more accurate terminology is far more useful in identifying the babies that will need extra support, providing better information to assess outcome, help to manage expectations, and most importantly help us to further understand and improve our service to these babies and their mums.

Confused or clarified?

Siun x

Tongue-Tie

Blackrock Aesthetics Blog

Welcome to our blog from Blackrock Aesthetics!

We will rotate topics to cover all treatments offered by us –

From skincare to surgical procedures, whats hot in aesthetic and plastic surgery, topics of interest, and tongue ties of course!

Watch this space…

Siún x

 

Choosing your surgeon in Ireland

Patients seeking plastic, cosmetic (aesthetic) or reconstructive surgery should always check to see if their doctor is qualified to perform plastic surgery.

In Ireland, just about anyone with a basic medical degree is allowed to perform cosmetic surgery. Hard to believe, but currently there is no legislation in place that prevents any doctor, even your local GP, without having undergone formal surgical training to call themselves a ‘surgeon’.

Your only safeguard is to look for the letters FRCS (Plast) with a doctors name and check that they are affiliated with the Irish Association of Plastic Surgeons (IAPS), as only fully qualified plastic surgeons have these titles and memberships. Only after surgeons have completed extensive higher surgical training (six years) in Plastic Reconstructive and Aesthetic Surgery, specialist examination (FRCS Plast) and in-service assessments by the Royal College of Surgeons are they eligible to be entered onto the Irish Medical Council’s specialist register.

In other European countries, such as France and Denmark, there are clear legal guidelines that state what type of surgery can be performed and which practitioners can offer what type of services. These were developed, in the interest of patient safety, after years of misleading advertising, inaccurate website claims and unsubstantiated claims of success by non-specialist doctors and commercial clinics in those countries.

Check www.plasticsurgery.ie for a comprehensive list of all accredited plastic surgeons. Choose wisely. Protect yourself.

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