Q&A – DR. FRANCISCO DE MELO CONSULTANT PLASTIC SURGEON

  1. Can you tell us about Tummy Tuck-body contouring? How effective is this procedure in getting rid of excess body fat?

Tummy tuck, also known as abdominoplasty removes excess fat and skin, and in most cases, restores weakened or separated muscles creating an abdominal profile that is smoother and firmer. It is usually combined with liposuction to achieve a better contour and well-defined waistline.

But one must know that tummy tucks are not a substitute for weight loss or an appropriate exercise program. Also, tummy tuck operations cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised, generally the treated areas below the belly button.

A tummy tuck is an in-patient procedure performed under general or epidural anaesthesia. One must consider a downtime of 7 to 10 days and after that, they can return to daily activities but not physical exercise. After one month, in most cases, there will be no restrains.

  1. How is Mini-Abdominoplasty different from Abdominoplasty?

Mini-Abdominoplasty or a mini tummy tuck is a less extensive variation of the full abdominoplasty and is typically employed when loose abdominal muscles and a minimal amount of excess skin are confined to the lower abdomen below the belly button.

The goal is to remove the excess fat and skin, but only from the lower abdomen, without having to transpose the navel, as in a full abdominoplasty. The skin incision and the scar are smaller, and it is usually combined with a liposuction of the upper and lateral abdomen. When there is an existing scar, like the one from a cesarian, we can use it to remove the excess skin and so improve the tightening of the lower abdomen. The post-op recovery is also better tolerated and faster than with a traditional abdominoplasty, but this is also a hospital-based surgery usually with an overnight stay.

  1. Liposuction is known to be an effective fat removal procedure. Can you tell us how does Liposuction work? Is it different from Liposculpture?

Liposuction and Liposculpture are two words for the same procedure. The technique is similar, and I think that the word “Liposculpture” is more a marketing-driven word. There are other words like “Liposelection”, “Vibrolipoplasty”, ”SmartLipo”, and so on, that are much more related to the devices that are used, than the purpose behind them that is removing fat. I think that Lipoplasty is the right term.

The principle behind these techniques is to remove fat in a way that will improve the body contour. They should be small or minimal invasive, and the fat will be excised through small skin incisions (2-5mm) using a cannula connected to a vacuum pump or a syringe. These can be done with the help of different power assisted systems: Mechanical ( Microair, Vibrolipoplasty, Water Jet System), Ultrasound assisted (UAL), Laser (LAL) or Radiofrequency (RAL).  Liposuction can be performed in very different areas, as the neck, arms, abdomen, back, buttocks, thighs, knees, male breast, etc. It can be done under general or under local anaesthesia, depending essentially on the extent of the procedure and the risk factors of the patient. The extent of the procedure also defines the regime (outpatient or inpatient) as the duration of the recovery period.

  1. Tell us about buttocks augmentation and the different types of techniques that are involved?

Buttocks augmentation is a procedure that reshapes and enhances your gluteal area, providing you with an uplifted and shapelier buttock profile. The purpose is to augment and reshape the buttocks, improving is projection. This can be done in three different ways:

  1. Enhancement with Fillers: The shape and volume of buttocks will be enhanced by injecting hyaluronic acid (HA). It works like a “filler” and the substance is very safe and used for other cosmetic procedures, like lip augmentation, facial and hands rejuvenation, etc. The procedure varies from case to case and can be performed under local anaesthesia. As the HA will be reabsorbed by your body, it will need annual touch-ups to maintain or increase the volume.
  2. Fat graft or lipofilling: In this technique, we use the patient’s fat instead of the HA. So, at first a liposuction is performed to collect the amount of fat that we need, it will be further processed and then transferred to fill the buttocks. The only limitation of this procedure is the amount of fat available (“donor areas”) and the desired volume. The downtime will be determined by these factors but usually, it will take from 7 to 10 days. Sometimes there is a need for a second procedure in order to obtain symmetry and if a bigger volume is desired.
  1. Buttocks implants: If the desired volume cannot be obtained by the previous techniques the option is to implant a prosthesis to achieve the desired goal. There are some drawbacks with this procedure, mainly the physical stress resulting from the procedure – sitting, lying on the back, walking, jogging, workouts and so on. In order to protect the implant, it is placed inside the Gluteus muscle. This is a major surgery and the recovery period will be longer (up to one month).
  1. Can you tell us about Arm Lift and Thigh Lift? How different or similar are these procedures from one another?

Thigh Lift is a procedure to correct the loose and drooping skin of the inner thighs. It is usually performed under general anaesthesia, and with a relatively long recovery period. The incision and the resulting scars are placed on the groin and inner face of the thighs, depending on the extension of the procedure. It is usually indicated for massive weight loss patients and when liposuction alone is not enough. Arms Lift is the same procedure than the previous one, but directed to the arms in the same situation and when liposuction is not sufficient due to skin laxity. The resulting scar is located on the inner face of the arms and in the armpit. The recovery period is short (one week) and is also conditioned by the extension of the surgery. This is frequently combined with other cosmetic procedures.

  1. Is it true that we can also augment and shape calves? Does this procedure affect the muscle in any way?

Yes, we can also augment or reshape the calves. The procedure is called Calf Enhancement. Basically, we use the fat, Hyaluronic Acid (Macrolane) or implants in this procedure. The goal of the procedure is to obtain a better contour of the leg, usually in the inner part, by increasing the volume. The fat graft can offer a definitive result but usually, needs a second procedure to obtain a good symmetry and volume.

A liposuction is needed for this procedure to collect the necessary fat; it’s an invasive procedure. With Macrolane, (office based procedure), it will be simpler but you will need annual touch-ups to maintain or increase the volume. I generally don’t prefer and recommend implants in this area because the skin is very thin and elastic in this area; so, the risks of getting a visible implant or extrusion are high, especially in women. The downtime in this procedure varies with the technique and will be around 1 day for Macrolane and 7 days for the fat graft.