With age, after pregnancies and in obesity the elasticity of the connective tissues and skin can decrease resulting in folds and rolls on the abdomen. After heavy weight reduction the same phenomenon can occur with skin hanging like an apron. There are no physical activities or medicines capable of tightening the skin.

Often a weakness of the abdominal musculature makes the abdomen protrude like in pregnancy, a condition that can benefit from gymnastics or tightening of the muscles by an operation. In cases of significant obesity an operation will hardly be beneficial.

Principle:

Stretching and removing redundant skin and tighten a protruding abdominal wall.

Technique:

Endoscopic tightening of the protruding muscles is possible when no skin redundancy is present. Otherwise the incisions run low on the abdomen from the iliac crest to iliac crest and around the umbilicus. There can be variations concerning the placement of the incisions depending on the deformity. The pants will hide the scars. The skin is mobilised up to the ribcage and pulled down and shortened. The musculature can now be tightened. If there is only little skin to be stretched, a shorter incision is possible. Drainages are inserted and a compressing garment is applied. This operation is regarded to be a big operation and the immediate course is rather discomfort able. One has to walk and stand in a light forward bent position in order to release tension and to avoid dehiscence of the wound.

Anaesthetic:

General anaesthesia.

Operating time:

2 - 3 hours.

You can expect:

• In spite of the big operation the postoperative course is rather painless. At rest no pain is present but changes of position can cause some discomfort which hardly is prevented by painkillers.
• 3 – 4 days of fatigue are common.
• You should walk and stand in a light forward bent position in order to release tension and to avoid dehiscence of the wound.
• You should ”roll” in and out of the bed.
• You should care for a soft bowel.
• The stitches are removed in 2 intervals.
• The white bandage can be removed after 3-4 days where after you should take shower daily.
• The skin feels numb for a couple of months.
• A swelling over the incisions can persist for several months.

Complications
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is made.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections, which in case it happens will be treated with antibiotics. The placement of the wounds in surgical "unclean" areas increases the risk of infection.

Scars: The forces of gravity and the continuous movements of the area cause a constant tension on the scars. The scars can be broadened.

Nerve injury: Some of the sensory nerves to the skin on both arm and thigh will be cut and transient or permanent numbness is unavoidable.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation