Patients in the recovery room after surgery are often already gratified by the change in their abdominal contour. Like breast augmentation, this immediate gratification helps to offset some of the discomfort. The local anesthetic is still working, and will continue to work for several hours.

Sometimes a urinary ("Foley") catheter is used during surgery, particularly if the operation is lengthy (five to six hours), which might be the case if combination procedures are done, such as a simultaneous breast lift and implants. This catheter is typically removed at the end of surgery before the patient wakes up.

The nurse will help you get up and walk. You are in a "stooped" position. This is made necessary by the tightness of the abdominal skin repair. The nurse will help you to the bathroom. She will help you put on your clothes. Your caretaker will be given instructions. This includes taking care of the drain. Most patients are in the recovery room for about an hour.

The drain will accumulate bloody fluid after surgery. It is important to know that this fluid is mainly tissue fluid with a small amount of blood. It is quite diluted, so don't worry that you are losing a lot of blood from the drain. You empty the drain when it is about a third or half full. If it gets too full, it will lose suction. It should always be collapsed, which indicates it is working to produce suction.

You will need to keep your hips flexed to avoid too much tension on the wound closure. You will do this automatically. I tell husbands (and occasionally a wife for a male patient) to help support your legs when you swivel into the car because it is hard for you to lift your legs up.

At home, a recliner works well because it provides elevation of the upper body and flexion of the hips. You can also use a bed, but you need to put a bunch of pillows under your back, shoulders and head, and also one under your knees to maintain a flexed position at the hips. Some patients pick up a foam wedge and use it for their upper body. You will need some help at first getting in and out of bed and up to the bathroom.

You will likely be up to the bathroom to urinate several times during the night after surgery. This is normal. You received fluids in surgery both through the I.V. line and by injection into the tissues. The kidneys work to remove this fluid during the first 24 hours or so after surgery. These short trips up to the bathroom are helpful because they make you use your legs. This ambulation helps to avoid prolonged immobilization, reducing the risk of blood clots after surgery. It is also recommended that you flex your ankles 20 times every hour after surgery while you are awake.

Usually, I see patients the day after surgery. This helps to ensure that they are mobile and getting up and around. The dressing is removed at this visit. The nurse takes the garment down part way to do this and then places gauze along the incision line. Also, a layer of gauze is placed under the drain, between the drain and the skin. This is done to avoid pressure from the drain on the skin. If you don't do this, the drain might leave a dent or even a scar on the skin. You should start bathing the day after surgery, or at the latest, the second day after surgery. You can get into a bathtub or use a shower. You will need some help the first couple of times. While you are bathing, wash the garment. The Band-aids^® can come off the day after surgery, or earlier if any is saturated. Leave the semi-transparent white tapes ("Steri-strips"^TM) along the incision lines. These will come off after about a week. The smaller ones at liposuction sites can come off in a few days.

I see patients three or four days after surgery to remove the drain. They imagine that this must be painful. In fact, it only takes a few seconds to pull out the drain, and usually this is not particularly painful, less uncomfortable than removal of the dressing the day after surgery. The drain site heals on its own in a few days. All you need to do is use a gauze dressing at the site to absorb any fluid that continues to drain.

The abdominoplasty sutures dissolve on their own. The belly button sutures usually come out two weeks after surgery. The skin is still numb so this does not hurt.

Patients often report discomfort in their lower back. This may be due to liposuction used to treat the flank areas, and possibly the stooped posture after surgery. The tummy feels uncomfortably tight. The skin of the lower abdomen is numb, because sensory nerve branches have been traumatized or divided in performing the tummy tuck. It takes months for the feeling to gradually come back and it is possible to have some persistent numbness, although this is not distressing to patients, who are very gratified by their appearance.

Umbilical Appearance

No doubt it would be possible to devote an entire book to umbilical aesthetics. The appearance of the umbilicus today is taking on greater importance, as the midriff is now more exposed. A small, oval umbilicus with a fold over the top part is ideal. It is important for the surgeon to avoid having the umbilicus point upward after surgery. If anything, it should be oriented slightly down. A large, wide umbilicus is undesirable. Ideally, the scar is concealed in a natural fold or tucked in the inside, although this is not always possible, especially in very lean patients. It is possible to make the opening too small, which makes it difficult to clean the belly button. This problem can be treated with a release under local anesthetic if it occurs.

It is not unusual for the umbilical scar to widen, especially on the sides. If this happens, the umbilicus may be revised as an office procedure under local anesthetic. The wider scar tissue is simply excised. This is done at least several months after surgery, when the wound tension has been relieved. With less tension on the scar, there is less likelihood of recurrence. However, for some unfortunate patients, scar hypertrophy or even keloids (tough, raised-up scars that tend to expand- see patient C.B.) can be a recurrent problem and the umbilicus never looks as nice as we would like.

Abdominoplasty Scar

The downside of a full abdominoplasty is the long incision. However, the extra inches at the lateral ends usually heal the best because this portion of the incision has the least tension, and the incision may be kept within the bikini line, hidden in the natural inguinal crease. It turns out that this longer scar is not usually objectionable. A full abdominoplasty requires a scar that goes around the umbilicus. This is because a large flap of skin is mobilized and needs to be freed of its attachment at the umbilicus. While the umbilical scar can heal very nicely and be inconspicuous, in some patients the scar widens and is noticeable. This scar may be revised later on, once the tension has diminished, to make it less conspicuous. There are some patients who form hypertrophic scars and this can be a bothersome complication. Fortunately, the rewards in improved body contour are almost always a worthwhile trade-off even when scarring is more noticeable. With time, scars tend to improve. They are raised and reddened at first, but gradually soften, flatten, and fade. This can take over a year.

Dog Ears

Dog ears occur after abdominoplasties with some regularity. This term refers to puckering at the end of any surgical incision. Whenever a surgeon removes extra skin, usually with an elliptical incision, there is a pucker at the end of the incision that develops when the skin edges are approximated, due to tissue bunching beyond the end of the incision. This is a geometric reality. Dog ears may be avoided by making the incision longer and more tapered. The more tapered the end of the incision, the less redundancy there will be when the edges are brought together. However, this is at the expense of a much longer scar. It turns out that puckering of human skin tends to improve with time. Unlike cloth fabric, human skin is a dynamic tissue capable of contraction. Small dog ears usually flatten out with time. The surgeon's job is to make the incision long enough to avoid a dog ear, but also keep it as short as possible. This judgment comes from experience. It is always possible to come back and remove an extra little pucker in the skin if necessary, under local anesthetic in the office. Sometimes extra fat persists in this area, and may be treated with a touchup liposuction, or simply excised with the extra skin. There is minimal downtime after this touchup procedure.