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    Dr. Sam Jejurikar Answers Patients’ Top 10 Tummy Tuck Questions

    Tag Archives: Dallas Plastic Surgeon

    tummy tuck surgery 

    It’s part and parcel of mommy makeovers and is more in demand than ever, thanks to the pressures of social media and the washboard abs streaming on our TVs, but tummy tuck surgery, also known as abdominoplasty, is nothing new. The procedure — which is elective and aimed at improving the shape and appearance of the abdomen — was first performed in France in 1890. In 1899, Baltimore surgeon Dr. Kelly performed the first tummy tuck in the U.S. Since then, advances in medicine have transformed this surgery into a safe, streamlined procedure that, according to Dallas-based cosmetic surgeon Dr. Sam Jejurikar, has given the term “cutting edge” a whole new meaning. 

    He’s recognized by Yelp as the best tummy tuck surgeon in Dallas, and Dr. Sam Jejurikar’s years of experience in tummy tuck procedures — combined with his implementation of the latest breakthroughs in medicine — have made him highly sought after by patients. While the surgery is fairly straightforward, those considering a tummy tuck still have questions. Here are Dr. Jejurikar’s answers to the 10 queries he’s most frequently asked.

    What should I expect from tummy tuck surgery?

    According to the Mayo Clinic, people with excess fat and/or skin in the navel area, or those with a weakness in the lower abdominal wall, are common candidates for abdominoplasty. The surgery removes excess skin and fat from the abdomen. Using permanent sutures, the connective tissues in the abdomen are tightened as well. 

    Tummy tuck procedures generally take two to three hours and are performed in a hospital or outpatient surgical facility setting under general anesthesia. During the procedure, the plastic surgeon makes a horizontal, oval, or elliptical incision, depending on the amount of tissue to be removed, just above the pubic line. When the incision heals, the resulting scar runs along the natural skin crease of the bikini line. In addition to removing excess skin and fat and tightening the connective tissues, the surgeon pulls the belly button through a small incision, anchors it into its normal position with sutures, and then judiciously repositions the surrounding skin to achieve a firmer, more toned aesthetic.

    What are the benefits of tummy tuck surgery?

    The main reasons for undergoing a tummy tuck procedure are enhancing body image and boosting self-esteem. Feeling good about how we look has a definite correlation with our mental health.

    While body image concerns are relatively common and are not considered mental health issues per se, according to the U.K.’s Mental Health Foundation, such worries can signal risk factors for potential mental health problems. It reports: “Research has found that higher body dissatisfaction is associated with a poorer quality of life, psychological distress, and the risk of unhealthy eating behaviors and eating disorders.”

    In addition to improving self-esteem, tummy tucks also afford patients a host of other valuable health benefits.

    A tummy tuck can strengthen your abdominal muscles. Having a stronger core can improve flexibility, help alleviate lower back pain, improve posture, and ward off hernias.

    A tummy tuck may reduce the risk for certain medical conditions, including sleep apnea, diabetes, heart disease, and gallbladder disease.

    A tummy tuck can increase bodily function control and decrease urinary stress incontinence occurrences. Many factors lead to the loss of bowel or bladder control. Aging, multiple pregnancies, and significant weight loss can be all factors. These issues can be exacerbated by the presence of excess fat and skin in the abdomen. Removing extra skin and fat and tightening connective tissue in the abdomen can improve control over bodily functions and lessen involuntary urinary leaks.

    How long after a tummy tuck can I sleep on my stomach?

    The accepted rule of thumb is to avoid sleeping on your stomach for six weeks after undergoing tummy tuck surgery. This hiatus from stomach sleeping ensures the skin and muscles have adequate time to heal. However, each patient is different, and some may need to stay off their tummies longer than six weeks. It is highly recommended you discuss a postsurgical sleeping protocol with your doctor prior to the procedure. 

    What’s the best way to recuperate from a tummy tuck procedure?


    Recuperating from a tummy tuck takes time and proper care of the body. To facilitate a speedy recovery, I recommend the following: 

    Eat right and keep hydrated. High-protein foods benefit healing by boosting energy and promoting muscle growth. Conversely, foods with high sugar and sodium content can have a negative impact on the healing process and should be avoided. While patients who’ve undergone abdominoplasty experience swelling, drinking adequate amounts of water (eight glasses per day is recommended) reduces retention by flushing fluids from your system.

    Don’t overdo it. People are eager to dive back into their everyday routines after surgery, but this can be a mistake. Instead, ease gradually into daily activities, and if your body is giving you the warning to stop doing something, listen to it. In general, tummy tuck patients should refrain from pulling, pushing, bending, and lifting heavy objects for a minimum of six weeks after surgery.

    Look into lymphatic drainage massage. As the name implies, lymphatic drainage massage stimulates the body’s lymphatic system. This enhances its efficiency, speeding the removal of toxins, boosting immune response, and aiding in the overall healing process.

    What’s the difference between a tummy tuck and liposuction?

    As mentioned above, a tummy tuck is a surgical procedure performed under general anesthesia in a hospital or outpatient surgical setting. Liposuction is a much less invasive procedure that does not require a surgical incision and can be performed under a local anesthetic (although general is preferred). Abdominoplasty is strictly abdominal surgery, while liposuction can be performed on any area of the body where stubborn fatty deposits that resist traditional weight loss protocols occur, including the neck, thighs, back, and arms.

    During liposuction, no skin is removed, nor is fat surgically excised. Instead, a saline, water, and anesthesia solution is injected into the target area. A cannula is then inserted, and the fat is sucked out. Those considering either procedure should consult with a reputable cosmetic surgeon before proceeding to better understand which one best meets their needs.

    How soon is it safe to get a tummy tuck after pregnancy?

    Due to significant changes in the body, one of the most prevalent times women choose to get a tummy tuck is after pregnancy. It’s only natural to want to get back to your pre-baby body as soon as you can. However, some guidelines must be adhered to in order to safeguard a woman’s health and achieve the maximum benefits from the procedure. 

    Six months after giving birth is the earliest patients should schedule a tummy tuck. Moms who’ve undergone a C-section may have to wait longer (up to a year) and should discuss any potential surgery with their doctor. There are other factors that may make postponing a tummy tuck a good idea as well:

    Are you still breastfeeding? Breastfeeding influences hormonal changes in the body that can impact the healing process and influence weight fluctuations. It’s recommended to wait until three months after you finish breastfeeding before getting a tummy tuck.

    Has your weight stabilized? Weight gain during pregnancy is normal. Getting back or close to pre-baby weight can take time, and many moms experience postpartum weight fluctuations. While a tummy tuck will improve physical appearance, it’s not strictly intended to be a weight loss procedure. Tummy tucks are most effective when patients are at or near their ideal weight. 

    Do you plan to get pregnant again? The logic of this is pretty simple: Every pregnancy can result in additional stretching of tissues and added fat to the midsection, all of which can undo the good your tummy tuck has done. If you think there might be more kids in your future, putting off tummy tuck surgery is best until after welcoming your last blessed event.

    Can men get a tummy tuck?

    The simple answer to this question is, yes. Men can and do get tummy tucks — and are doing so in increasing numbers. That said, when it comes to tummy tucks, not all men are created equal. Some men make better candidates for this surgery than others. Dr. Jejurikar advises men interested in the procedure to discuss their expectations with a certified cosmetic surgeon to ensure their desired outcome is realistic.

    Can a tummy tuck be combined with other surgery?

    Yes. One of the most popular cosmetic procedures currently performed is what’s known as the “mommy makeover,” which can combine a tummy tuck with breast enhancement and/or liposuction. The upside of combined surgeries is that they require only one recovery period. However, that recovery period will likely be longer than that of a single procedure. Your overall health is the biggest factor in determining whether multiple procedures are viable and must be determined by a doctor on a case-by-case basis.

    Who should not get a tummy tuck?

    Tummy tucks work wonders for some — but they’re not for everyone. The Mayo Clinic cautions that prior to embarking on the procedure, potential patients should thoroughly discuss any of the following conditions or concerns they have with their surgeon:

    You plan to lose a significant amount of weight. A major weight loss can result in excess skin on the abdomen. It’s better to wait until weight goals are met before undertaking tummy tuck surgery.

    You have a severe chronic condition, such as heart disease or diabetes. While abdominoplasty may lessen these conditions, if you already have them, they can put you at greater risk during surgery, especially when a general anesthetic is involved. 

    You have a body mass index greater than 30. Again, while tummy tucks do result in weight loss, it is not considered weight loss surgery. Patients who fare best are at or close to their ideal body weight.

    You smoke. In general, smoking increases surgical risks. It’s not a hard-and-fast rule, but nonsmokers generally enjoy better surgical outcomes.

    You’ve had previous abdominal surgery that resulted in significant scar tissue. Excessive scar tissue can be a side effect of any abdominal surgical procedure. Some patients are more prone to it than others. If prior surgery indicates that’s the case, further procedures might not be in your best interest.

    How do I find a good tummy tuck surgeon in Dallas or elsewhere?

     The qualities that make a good tummy tuck surgeon in Dallas are the same no matter where the procedure is being performed. A good tummy tuck surgeon combines thorough medical knowledge with technical artistry. A good tummy tuck surgeon truly cares about their patients, listens to their concerns, and helps them arrive at realistic goals and expectations. A good tummy tuck surgeon always makes the health of their patients their highest priority — even if that sometimes means saying no to a procedure.

    First and foremost, those considering cosmetic surgery should seek out a doctor who, like me, is board-certified in plastic surgery by the American Society of Plastic Surgeons (ASPS). Only board-certified plastic surgeons have the education, training, and certification to perform cosmetic surgeries on the face, breasts, and body. Always verify your surgeon’s credentials and make sure they have experience in the procedure you’re interested in.

    In the current health care climate of diminishing reimbursements, more and more physicians are performing cosmetic surgery treatments and procedures.  Unfortunately, many of these physicians are not plastic surgeons and have not undergone the same rigorous training as board-certified plastic surgeons.  All patients should take certain steps prior to scheduling a consultation to ensure that their physician has the highest qualifications to perform cosmetic surgery.
    • Ask if the doctor is a member of the American Society of Plastic Surgeons (ASPS).  Membership in the ASPS ensures that the doctor is certified by the American Board of Plastic Surgery and meets requirements for ongoing continuing medical education.
    • Confirm that the doctor is certified by the American Board of Plastic Surgery.  Merely hearing that a doctor is board certified does not indicate which board has certified that doctor.  There is only one board, the American Board of Plastic Surgery, that is recognized by the American Board of Medical Specialties to certify surgeons in the field of plastic surgery.
    • Find out more about the surgeon’s specific hospital privileges.  Although some procedures are commonly performed in an office or ambulatory surgical center, it is important to learn whether the surgeon has the same privileges in an accredited hospital.  Hospital credentialing committees carefully evaluate a surgeon’s training and competency for specific procedures.  If a surgeon performs a procedure in an office or surgical center, but does not have privileges to perform the same procedure in a hospital, it may be because he was deemed unqualified to perform that procedure.

    Taking these steps before scheduling a consultation with a cosmetic surgeon will ensure that you find a plastic surgeon with the highest qualifications.

    Many patients have asked me if they can smoke cigarettes up to the time of their cosmetic surgery.  The procedures most often in question are breast lifts with or without implants, breast reductions, tummy tucks and facelifts.  Simply put, smoking and these procedures can be recipes for disaster.  I strongly encourage smokers to quit smoking before these surgeries, as tobacco, nicotine, and carbon monoxide, all of which are within cigarettes, can impede wound healing.  In operations which involve lifting and tightening large amounts of skin, this can result in skin separation, or worse yet, skin loss.

    Most board-certified plastic surgeons are selective in the procedures that they will offer to tobacco users.  Some procedures that do not require a significant amount of skin lifting, such as rhinoplasty, liposuction and breast augmentation, are thought to be somewhat safer to perform in smokers than procedures that require more skin manipulation.  For that reason, most plastic surgeons will perform these surgeries in smokers, but will still extend significant disclaimers and warnings.

    Virtually everyone knows that smoking can cause pulmonary problems, heart disease and lung cancer.  For those reasons alone, I encourage all patients to quit using tobacco products.  In regards to cosmetic surgery, tobacco usage can cause significant problems with healing.  Because cosmetic surgery is elective, it only makes sense to quit tobacco usage prior to surgery to minimize this potential risk.

    Many of my patients ask how I choose the optimal size for a breast implant. Some women are very concerned about choosing too large of an implant, as they know this can make their breasts look unnatural. Other women are afraid that they won’t choose a large enough implant to see a discernible difference. There are a variety of tools that I use to help my patients select the best breast implant size:

    • Photos. Having patients bring photos of breasts they like and breasts they detest help me determine their goals. Some women desire subtle enhancement and others desire much more dramatic enlargement.
    • Measurements. The chest wall diameter, breast width and height are all important factors in selecting an appropriate implant. The breast skin envelope is only so large; selecting an implant that is too large invariably means that implant will sit too high, too low, or too lateral.
    • Trial sizing. Although it is inexact, having patients try different implants in a bra in the office is a useful exercise. It gives them a crude idea of breast size and shape in clothing and often helps them verbalize their goals.
    • Conversation. Different implants have vastly different shapes and profiles. It’s important that patients understand how this differs in appearance from other types of implants, and that can only conveyed adequately in the preoperative consultation.
    • Intraoperative sizing. I will often utilize intraoperative trial implants and always sit the patient up during surgery to ensure that the breasts have a pleasing appearance.  This is particularly the case for patients with breast asymmetry, to ensure that the final implants utilized provide the greatest possible symmetry.
    All of these tools play a valuable role in choosing the best possible implant size.

    In the past couple of weeks, I’ve had some patients engage me in conversations about breast implant profiles.  They had seen pictures on the Internet of patients with breast augmentation results they liked and wanted the same style implants as in the pictures.  These patients had a limited understanding as to what breast implant profile refers, prompting this blog entry.

    The naming for implant profiles predominantly refers to smooth, round implants, which are the most common type of implants used for cosmetic breast augmentation.  The two major breast implant manufactures have different names for their implants.  Allergan refers to its saline implants as low, moderate, and high profile and its silicone implants as moderate, midrange and high profile.  Mentor has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants.

    The profile of an implant equates to the projection of that implant.  For a given volume, the higher the profile, the fatter and narrower an implant is.  As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast.  Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region.  In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection.  Higher profile implants also tend to be useful in women who desire a small breast lift without the incisions associated with a formal lift.

    Almost no patients choose low profile implants for aesthetic breast augmentation; the limited amount of projection provided with these implants does not coincide with their aesthetic goals.  Generally speaking, women looking to maximize their cleavage and perkiness often times opt for high profile implants.  Ultimately, though, the best implant profile for a patient can only be determined after a careful examination by a board certified plastic surgeon, taking into account the specifics of a patient’s breast anatomy, as well as their desired appearance.

    Treatments with injectable fillers, such as Juvederm, Restylane, Radiesse, and Evolence, not to mention others, can restore a youthful appearance to the lips, nasolabial folds, marionette lines, midface, jowls and lower eyelids, with minimal to no downtime.  Many patients avoid these treatments, though, because they have heard horror stories from friends or colleagues about the pain associated with these treatments.  Suffice it to say, this needn’t be the case – there are steps your plastic surgeon can take to make these treatments more comfortable.

    Recently, BioForm Medical, Inc., makers of Radiesse, received approval from the Food and Drug Administration to mix the filler with lidocaine, an injectable local anesthetic, prior to injection into the skin.  This approval was based on a large study of patients, in which 100% of patients reported feeling less pain when Radiesse was pre-mixed with lidocaine.  Many plastic surgeons, including me, have begun to pre-mix lidocaine with all fillers, including Juvederm, Restylane, and Evolence, not to mention Radiesse, prior to injecting into patients.  The results of treatment are still great, but patients are significantly more comfortable during treatment.

    Others things your plastic surgeon can do to make your treatment with injectable fillers more comfortable include:
    •    Using topical anesthetic gel for at least 30 minutes prior to commencing any injections.
    •    Augmenting treatment with topical anesthetic gel with injections of local anesthetic into nerves above and below the lips.
    •    Using small gauge needles and slow injection techniques

    Combining all of these treatments can ensure that you’ll not only look fantastic after your treatment with injectable fillers, but you’ll feel pretty good during the treatment too!

    Breast augmentation can give women with small or uneven breasts a fuller, better-proportioned look through the placement of saline breast implants or silicone breast implants, dramatically improving self-esteem and confidence. Any operation, though, including breast augmentation, poses some risks that can lead to complications or unfavorable results.

    The most common complication is capsular contracture, or hard, firm scar that forms around the implant. Because the breast normally is soft, the development of scar tissue can make the breast feel and look hard, and in severe cases, can cause pain. With older silicone breast implants, capsular contracture was much more common. The frequency of capsular contracture has diminished with currently utilized silicone breast implants, so that the occurrence rate is now similar between silicone and saline breast implants. Mild capsular contracture is hardly perceptible, but severe contractures can be painful and unattractive. Treatment consists of surgery to remove the entire capsule and placement of a new breast implant. Placement of the implant in a pocket below the chest wall muscle results in a lower risk of capsular contracture than placement over the muscle.

    Infection, if it occurs, usually does so within a few weeks of surgery. Infection occurs very rarely, but if an infection occurs it often requires antibiotics and the removal of the involved implant for several months.

    Some women report that their nipples become oversensitive, undersensitive, or even completely numb. Some women also report small patches of numbness near their incisions. These symptoms usually disappear within time, but may be permanent in up to 15% of patients. If the possibility of having numb nipples is unacceptable to a patient, she should not have breast augmentation, as no plastic surgeon can predict which patients will develop this complication.

    There is no evidence to indicate that breast implants will affect fertility, pregnancy, or the ability to breastfeed. If, however, a patient has nursed a baby within a year before breast augmentation, she may produce milk for a few days after surgery. This may cause some discomfort, which usually resolves within a few days. For women who get pregnant after having breast implants placed, in most cases, breast implants will not affect the fate of the breasts. After the breast tissue shrinks after pregnancy and breastfeeding, the breast skin may or may not shrink. If the skin does not shrink, the breasts will likely droop. Whether or not the skin shrinks is controlled by factors other than the presence or absence of breast implants.

    Breast implants may break or leak. Most often, breast implant rupture is the result of normal wear and tear on the breast implant shell. If a saline-filled implant breaks, the implant will deflate within a few days and the salt water will be harmlessly absorbed by the body. To restore volume, another implant needs to be placed. If a break occurs in a silicone breast implant, silicone gel may move into surrounding tissue, provoking an inflammatory reaction which can lead to a severe capsular contracture. There may be a change in the shape of the breast, and the breast may become hard and painful. This will require a second operation to remove the breast implant shell and to replace the leaking implant.

    No data exists suggesting that breast implants cause breast cancer. Silicone and saline breast implants, however, can alter surveillance for breast cancer. Breast implants can alter the amount of breast tissue visualized on a mammogram. When placed below the chest wall muscle, greater than 90% of breast tissue can be seen well on mammogram. When placed above the muscle, only about 75% can be visualized. Breast implants do not interfere with the ability to detect masses with self breast examination, regardless of position relative to the chest wall muscle. Self exam is the most successful way to discover new breast masses. Implants also do not interfere with ultrasound or MRI scans, which are helpful in the evaluation of breast masses.

    Breast implants can move out of position anytime after breast augmentation surgery. If they move a lot, surgery may be needed them back into position. The larger the implant, the more likely it will displace downward.

    Rippling or wrinkling of the implant is much more common with saline breast implants compared to silicone breast implants and in thin patients. The visualized wrinkles are the folds of the breast implant shell. Ripples can be particularly disconcerting if they occur on the upper pole of the breasts.

    Because breast implants are manmade, mechanical devices, they are prone to problems over time. All women who undergo breast augmentation surgery should assume that, at some point in their lives, they will require a secondary procedure, whether it’s for capsular contracture, rupture, displacement, etc. Some women may never have problems, but it’s impossible to predict which patients will fall into this category.

    Many patients want to know, “What’s better – silicone or saline?”  The answer is that it depends.  Both silicone and saline implants have pros and cons.  It’s important that the educated patient understands these differences before making an informed decision.  Before delving into these differences, though, it’s important to state unequivocally that currently utilized silicone breast implants are safe.  Over the past 15 years, many large and rigorous studies have been performed investigating whether silicone breast implants are associated with autoimmune diseases or any types of cancer.  All studies performed reached the same conclusion; there is no conclusive data supporting any link between silicone implants and these diseases.  Only after carefully considering these scientific studies did the U.S. Food and Drug Administration approve the use of silicone breast implants in all women for breast reconstruction and in women over the age of 22 years for cosmetic breast augmentation.

    Some good things about silicone breast implants; breast implants filled with silicone gel look and feel more like natural breast tissue.  Also, particularly in thin patients, silicone breast implants tend to have fewer problems with visible rippling than saline breast implants.

    Some bad things about silicone breast implants; breast implants filled with silicone are more expensive.  Silicone breast implants are approximately twice the cost of saline breast implants, which is factored into the price of surgery.  Also, a breast implant rupture is easy to detect when the implant is filled with saline; the breast tends to deflate rapidly, in the span of a few days.  A silicone breast implant ruptures is much more subtle to detect.  For that reason, the Food and Drug Administration recommends an MRI to monitor for rupture, the first one 3 years after surgery, and then every 2 years thereafter.  This test is expensive and most likely will not be covered by third-party insurers.  Lastly, capsular contracture rates, or pathologic scarring around the implant, traditionally were much higher with the older generation of silicone breast implants.  This does not seem to be the case with the newer generation of silicone breast implants used, which is largely attributable to a thicker implant shell and thicker, more viscous silicone gel within the implant.

    So, what’s better?  To repeat, silicone breast implants look and feel much more natural, but it comes at a higher financial cost, the recommendation for MRI monitoring to detect for rupture, and a larger incision.  Despite this, with each passing year, more and more patients are opting for silicone breast implants.


    <!–[endif]–>Evolence®, a collagen-based injectable filler used for the correction of facial wrinkles and folds, has recently been given permission by the FDA to advertise results lasting 12 months. While relatively new to the United States, Evolence® has been available in Canada and Europe for many years.

    The filler uses porcine (pig) collagen to restore a more youthful appearance. This new generation collagen filler is injected into the mid-to-deep layers of the skin for the correction of moderate to deep facial wrinkles and folds, such as nasolabial folds. Results are visible immediately after treatment.

    The most common side effects include mild swelling, redness, and pain. A skin test is not required because porcine collagen is the most genetically similar to human collagen.

    Evolence® is now clinically proven to last for 12 months! Call 214-827-2814 to learn about our special rates!

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