This is Jennifer, and she has agreed to let us film this. She has upcoming a Brazilian butt lift. She has already had a tummy tuck, so some of those best donor sites we get from the abdomen are not what they used to be because that came out with the tummy tuck. We will, however, be taking what fat she has right here. This is going to be a donor site. We are going to use the flank and back area as a donor site, and I really like using this, not only because we get great fat from this area but sculpting out this area helps narrow the waist, and it helps with the contour profile, defining and framing out the shape of the buttocks. One thing I try to pay attention to when I do an exam scenario is I’m looking at the shape of the hips. The shape of the hips is defined by the pelvic brim, which is the top of the pelvis, and the greater trochanter of the femur. In some people, this is…they have square hips, narrow hips. Some people, the greater trochanter sticks out more than the pelvic brim. For some, it is more of a pear shape. In some cases, we see he exact opposite, where the pelvic brim is much wider than the greater trochanter. In general, at least the most desirable aesthetic, is sort of a classic narrow waist, round hip, where this area between the pelvic brim and greater trochanter has a nice, gentle curve, and that’s want we’re going to go for. We will have some fat here after we go to these donor sites and remove the fat, isolate those fat cells, we will have some fat for the buttock area, which of course we will volumize here, but we’ll have a little bit leftover, and we’re going to try to round out these hips as much as we can. It is not true for everybody. Every case is individual. Every case is different, and we do try to individualize or customize our treatment based on each person’s needs.
We’re back. We’ve got Jennifer here, and she’s eight weeks postop. We did a Brazilian butt lift using the abdomen, back, and flank and also her thighs as donor sites, and so, she’s back for her eight-week postoperative. We’ve done some after pictures just to demonstrate how dramatic the results are to make sure she’s happy because we want to make sure she likes the results as well. I’m very satisfied with the results, and I’m just going to try to walk you through or exam today.
So, right here, as we may remember…as you may remember from before, she had already had and abdominoplasty, so her tummy’s nice and flat, but we were still able to get some good fat grafts there from her tummy and also from her thighs, but in profile here, we spent a lot of time doing liposuction on the back and also on the flank area to really show that volume and that contour, and of course, we had a really nice result from the fat grafting. We were able to get good volume in here. You can see that her waist is narrow from the liposuction and also that we’ve got great volume here. We know that about 70% of those fat grafts are going to survive; about 30% are not going to survive, so we overfilled her buttock, and…uh…this is what we’re left with at eight weeks. We know that this going to be meaningful volume, which is going to be reliable over time, and I’m very happy to see that. Thanks!
Okay. Thanks for tuning in. We’re here, and we’re going to talk about tummy tucks. We have Sarah here, who is interested in a tummy tuck, and thank you for allowing us to…to, uh, shoot this video. Um…Sarah has a 12-year-old girl, a 6-year-old boy. Everybody’s healthy. She is finished having children. That’s an important part of this. Uh…she’s had a tubal ligation, and so she knows that she’s not going to have any other children. She is interested in improving the appearance of her abdomen and restoring what she lost with pregnancy and some time and so forth. When we initially met, we did our exam like we typically do, and when I examine the abdomen, I’m looking at the skin and the fat and the muscle. I want to see what the skin elasticity is like? Where is it redundant? Are there stretch marks and things we want to address? On the fat, I’m really looking at how much and where that fat is located. Is it around the bellybutton? We’re also looking at the muscles, and we say we’re looking at the muscles. We’re looking at what we call the abdominal wall. The six-pack muscles or rectus muscles typically run up and down, they serve some very important functions. Mechanically, they allow us to do sit-ups and move our body from side to side. Uh…they hold our…hold our intestines and some really important things in. When we have a baby that we carry to term, those muscles tend to migrate laterally, and the fascia or the tissue in between those muscles stretches, and that’s an irreversible change that’s an important part of a tummy tuck and something we want to address. A tummy tuck is really a series of steps that address all of these different things; the skin, the fat, and the muscle.
So…uh…we’re going to perform an exam again…uh…looking at those areas—the skin, the fat, and the muscle. When I address the abdomen, I don’t just want to address the abdomen, which is the front part of your torso. I want to address the…the flanks, or the love handles as they are commonly called, and even the lower back. I typically use liposuction as an adjunct, and I like to do that to transition the areas where we haven’t actually performed surgery, so it doesn’t look strange in any way—it looks proportional—and…uh…and that the silhouette all the way around is improved. We’re looking at a few different things. First, we’re just looking at the skin, and so, I’m going to pull this down just a little bit to illustrate your C-section scars, and this a very typical location. Our scar for abdominoplasty actually, in most cases and in this particular case, will go below the scar for the C-section, so that will not be there when we’re all finished. Um…most of the skin excess is—again, she works out; she’s in good shape; she just has some skin excess, especially here below the bellybutton, so we’ll get rid of all the skin and fat here, and poke your tummy out, would you please? Hee! Hee! It’s hard to do. People instinctively want to hold that in, but I can feel that outside edge of her rectus muscle, and it’s displaced laterally, and I can…I can feel the space, and I can feel the medial edges of that rectus muscle as well by pushing deeply, and I don’t want to push too hard because it can be tender, but there’s also some fat on the sides. We’re going to treat that with liposuction. The skin elasticity here is good and will snap back. We don’t have to remove any skin excess there, and of course, we’ll tighten those six-pack muscles…uh…or the rectus abdominis muscles. It has a really dramatic effect. It will flatten the tummy and will also sort of have a corset effect and bring in the waist just a little bit here. A couple of details that I tend to fuss on—I like to reduce the pubic area here just to…uh…to make that confluent with the lower abdomen so it’s smooth and you don’t see a pooch there, and then, I just fuss with the bellybutton quite a bit to really…I want to make an innie. I want that scar to be down at the base of the umbilicus so it’s not visible.
DR. ROBBINS: This is a very lovely 47-year-old woman who I’ve met before, and we’ve worked together before. About two years ago, she had a gastric sleeve procedure, which is a bariatric procedure, lost a tremendous amount of weight—last I saw about 107 pounds?
DR. ROBBINS: 117! She’s shrinking! Uh…anyway, that’s an incredible amount of weight, especially for somebody your height. Um…you know, obviously, that’s related to proportions, but not uncommonly, when people lose that much weight, they have hanging skin, and uh…as she will tell you, during our initial consultation, I typically have people who’ve lost that much weight and have complaints about the skin; just to prioritize, top to bottom—what bothers you most, what bothers you least—and it’s usually a list. Top of the list tends to be trunk or abdomen area. Uh…many women complain about their breasts. You’ve been happy with that part, so we haven’t done anything there, but that’s usually in the top three—arms, thighs, and sometimes facial aging. There are other areas, too, where people have hanging skin. Sometimes, people have what we call the upper back roll and some other areas, but that tends to be less common. At any rate, at least in my practice, you know I split these up. I like to keep, um…keep these procedures less than six hours of operative time. I like to keep them in an outpatient setting. I don’t want to do anything that’s going to be such a difficult recovery that you can’t walk, that you can’t actively participate in your recovery. I find that…uh…that when we do that, or when surgeons do that, sometimes, it puts you at risk for some complications that we want to try to avoid, like blood clots and pneumonia. So, I want people to be walking that day, walking the next day, and much of a slog and struggle as it is, you’ll do it. So, Sue here is a great example of that. We met. She had numerous complaints. I said we should start here and focus on what we feel is going to address your top concerns first….
DR. ROBBINS: …safely, and then, now, we’re getting into stage 2, which is where we’re going to address some other concerns, so today, our biggest concern, I think…. Would…would you like to say what your biggest concerns are?
SUE: Well, initially, I thought it was going to be my neck because of the wrinkling from shrinking, but it moved to my thighs because I look disproportionate now.
DR. ROBBINS: Yeah.
SUE: My thighs, you know, have always been big, but now, since the rest of me is smaller, my thighs just stand out tremulously, especially in clothes, and I have these little pooches, little saddlebags or whatever, that I hope can be smoothed.
DR. ROBBINS: Right.
SUE: So, my priorities moved.
DR. ROBBINS: Right, and….uh, I know I’m the one talking at the camera here, so I don’t know if you all heard what she said, but we…we did, on stage 1, we did a fleur-de-lis lower body lift, so a circumferential scar to elevate the hips and buttock, to pull the tummy tight, tighten the muscles, and then we also did arms…um…but things change. Proportions change, and things that may not have bothered you as much initially bother you more later because you’re fitting into clothes differently, finding yourself in situations where you may or may not be more interested in treating other things. So, that is what we’re here to talk about today. This is the kind of care you get here; we put you on a pedestal.
SUE: Ha! Ha! You’re the only people!
DR. ROBBINS: Ha! Ha! You deserve it. On round 1—before we get to our exam—I just want to prep the viewers about, in round 1, we did a fleur-de-lis lower body lift. That’s a scar that goes 360 degrees around the body—also a vertical scar to treat the excess, especially…. The vertical scar is especially good at treating the excess between the breasts or ribcage and the bellybutton and the upper abdomen. We also did arms, and we’re not going to focus too much on that. We’re focusing on a thigh exam today, but I just wanted to at least prep our viewers, so if you see scars, you know what that’s from. Ready?
DR. ROBBINS: Alright. We’re just going to take your gown off. Alright, and I’m going to set this down here, and you know, one of the things I like…We are four months out now, right?
DR. ROBBINS: Yeah, scars are still a little bit pink, but they look great. Of course, the lower abdominal scar is down here in your panty line, and it looks really nice—but a flat tummy, a waste. I mean, just a really nice waist all the way around. I’m very pleased with that.
SUE: Me too.
DR. ROBBINS: But…uh…you still have your thighs, and like you said, oftentimes when we change proportions in one part of the body, it affects how we see or feel about other parts of our body, so now, we’re focusing on the thighs. Uh…this part, of course, is the outer thigh. We are going to do some liposuction to reduce this area and just help with your silhouette a little bit there. On the inner thighs—and if you would spread your feet just a little bit—there we go. There are two issues going on. There’s a little bit of fat there, but primarily, we’re dealing with skin excess on the inner thighs. That is because inner thighs tend to have this sort of crepey skin, and it is normal. Everybody has it to some degree, and what we want to do is to create a nice taper. To do that, we’re going to get rid of the excess in this direction but also get rid of the excess in this direction because you have excess in both. Down here, from here down, very nice and that’s not always the case. Um…Sue here just has a very nice taper to her legs. When we’re done, we will address this area on the inner part of her knee with a little bit of liposuction, uh…but I can draw out or show you guys.
So, our patient is getting dressed, and she’s going to be on to the next thing. I think she’s got to go to work today, but, at any rate, I just wanted to draw a quick illustration just to show what type of thigh lift that I recommend for her. Not everyone is shaped the same, and not everyone has the same problems. Some people have more fat. Some people have more skin excess. Sometimes it’s the inner thighs that seem to be the problem, sometimes the outer thighs. I really like to preserve…um….the fat on the waist—I say the waist…the hips—when we can, especially for women. That’s a feminizing feature. We want to round the hips, but when we see what we call saddlebags or um…fat…concentrations of fat on the upper thigh, especially upper outer thigh, we want to address that. In her case, she has enough skin elasticity there that we’re just going to use liposuction to remove the fat. On the inner thigh, there is going to be skin excess after we do liposuction, so there are different scar patterns…um…and I don’t know if you follow me here, but—and this is the crease. The crease where the thigh meets your bod—it’s your groin—and so this is a great place to hide scars on a thigh lift. Unfortunately, when we do a horizontal-only scar, which is what we call this type of thigh lift, it only addresses the crepey skin on the upper part of the thigh. Once you get crepey skin and skin excess on the middle third of the thigh, you’re looking at a different scar pattern to address that, and certainly, when you have…uh…we see people that have lost a tremendous amount of weight and have skin excess all the way down to and, in some cases, below their knee, that’s…that’s going to be more dependent on a vertical scar to take out that excess. So, uh…what we do in the case that we just saw here is take out skin in this direction, and when we close it, we bring this point to this point to this point, and it closes like a T, and the T is…uh…oriented so that this top part is a groin crease. This vertical part of the scar is oriented right on the medial or inner part of the thigh to minimize visibility. In her case, she had a very nice shape to her leg, especially from the lower third of her thigh down. We are going to do some liposuction to treat or feather these areas and…uh…help the contour there. I typically do liposuction also to the anterior or the front of the thigh and the back of the thigh to, again, facilitate shape and get those legs as good looking as we can, but that’s the scar pattern I recommend for this particular patient. We call that a T-scar thigh lift.