We also do a procedure called abdominoplasty or tummy tuck frequently. This is usually younger women who have had two or three children whose abdominal walls were stretched out massively with a pregnancy and they did not contract back the way some do. Some people contract back, people with good elasticity and you can barely tell that they have been pregnant. Other people have a lot of stretch marks and a lot of skin that was distended and never retracted, so for those people the tummy tuck is a good operation and the procedure involves making a long lower incision across the lower abdomen and then dissecting up around the belly button clear up to the rib cage and then pulling down all that extra skin and cutting it off and sewing it up and in addition what happens is that the muscles, the rectus muscles, the abdominal muscles get pulled apart during the pregnancy and they usually never come back to the middle, so also I like to pull those into the middle to tighten you this way as well, so we are tightening this way and this way. Most of the people that do this are highly motivated. They are often thrilled how much better they look in a swimsuit after surgery. The tradeoff is again this is a big operation. It is a three-hour operation. The muscles are pulled together you walk bent over for a couple of weeks after surgery. You have little drain tubes that are usually in for 5 to 7 to 10 days after surgery, so it is a little more of a commitment than the liposuction in terms of recovery, but you cannot liposuction away a lot of extra tissue across the lower abdomen. You really have to surgically remove that, so again this is a judgment call and when I see people we usually talk about both. We can do this much with liposuction, but you probably ought to think about this for a tummy tuck.
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