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Video: Dr. Patronella Shows You the Details of His No-Drain True Form Tummy Tuck

Posted March 26, 2024 in Mommy Makeover, No Drain Tummy Tuck, True Form Body Contouring®, True Form Tummy Tuck®, Tummy Tuck

By Plastic Surgeon Dr. Chris Patronella

The evolution of the drainless True Form Tummy Tuck® began about 25 years ago. Generally speaking, I was dissatisfied with the way I had learned to perform a tummy tuck and the results that were standard at the time. Often, the patient looked very artificial—the abdomen was flat as a board. It did not look natural or athletic. It just looked like skin had been removed and tightened. Generally, I felt it was unimpressive.

So I begin working on a few elements of the tummy tuck procedure in order to create a more natural aesthetically-appealing effect—a more athletic, toned abdomen that had some character and differential thickness of the tissue over the abdominal wall.

There are several elements that are involved in this process. The oblique view is probably the most important view of the tummy when taking before and after photos because you can see so many of these elements. This view, in particular, highlights the detail via the shadows and natural lines of the abdomen. This is what I’m trying to accomplish every time I do the True Form Tummy Tuck®.

I primarily use two tools to accomplish this:

Sculpting the Abdomen

  1. Differential Fat Thinning
    I don’t want the fat to be the same thickness over the entire abdominal wall. I want there to be some differences between one area and another so that the natural anatomical nuances are evident. To achieve this, I specifically thin the fat pads over the areas where the muscles groups fuse in order to create the definition which separates them. This creates the 3-D definition that one sees on an attractive, toned abdomen.The linea alba is the nice, soft valley in the midline. Between the navel and waistline is a contour shaped like a half-moon—hence it’s called the semilunar line. When viewing these areas on the patient, you can see that the fat has been thinned more specifically compared to the region in the lower center of the abdomen. In addition, I trimmed the fat over the external oblique muscle in order  to create a nice, soft concavity there.This technique reveals the natural lines that separate the rectus and external oblique muscles, which, in combination with the other elements I incorporate into the True Form Tummy Tuck, results in a very natural-looking abdomen, one in which a patient is not going to be reluctant to put on a two-piece swimsuit. And that’s always the goal in the back of my mind when I’m performing the procedure: to create results of which a woman can be proud of and which leave her feeling comfortable and confident to put on a two-piece swimsuit.
  2. Anatomy-Defining Progressive Tension Sutures
    I’ve adapted progressive tension sutures to assist me in sculpting the soft nuances present on a beautiful abdomen. I place the progressive tension sutures in a very specific way in order to create depth along the midline valley (linea alba) as well as along the semilunar lines. When using them in this way, I refer to them as Anatomy-Defining Progressive Tension Sutures. It’s an important tool that I used to create this look.Apart from their valuable role as a contouring technique, progressive tension sutures have the added benefit of allowing me to do a tummy tuck without using drains. The space between the skin and the underlying muscle is closed off with progressive tension sutures so that fluid can’t collect following surgery.

True Form Tummy Tuck® Belly Button

In my consultations with women, many initially are reluctant to have a tummy tuck because they’ve seen friends who, after having the procedure, were left with artificial-looking belly buttons that have a  large circle scar shaped like a donut around the perimeter. Understandably, that is an unacceptable appearance to most patients.

To avoid these pitfalls, I incorporate six maneuvers when treating the bellybutton during the True Form Tummy Tuck® procedure to achieve the following objectives:

1. The belly button should have depth. You should see a shadow on the inside of it rather than on the skin’s surface.

2. I ensure that the belly button is slightly oval or vertically-oriented because that is the most aesthetically-appealing look.

3. I tuck the scar that’s created along the inside perimeter of the navel so that it’s inconspicuous.

360 Liposuction and Waist Contouring

I treat the waistline during a True Form Tummy Tuck procedure because a flat, athletic-looking abdomen does not harmonize with a waist that is full. So we really have to think about more than one area when we’re treating the abdomen in order to create a proportioned, authentic look where one part of the body matches another part of the body. I have found that this approach is the best way to ensure a patient’s results look less surgical and more natural. Liposuction is performed to create an attractive concavity of the waist. Frequently, the back is treated as well in order to eliminate stubborn bra-strap bulges.

Diastasis Repair: Getting Rid of  a Tummy Bulge

Most women will have some separation of the muscle wall after having one or more children. The degree of separation varies among women. It can be very minimal separation or wider—two or three inches. Most commonly, it’s about a one-inch separation.

Diastasis is what gives rise to the forward bulge of the abdomen that you can see in the profile view. This projection which is reminiscent of pregnancy is the residual of having carried a child. And you can see it both on the upper and lower abdomen. After diastasis has been repaired, there is a slight cavity of the upper abdomen, and a slight convexity of the lower abdomen— the soft “S” contour line I strive to create during this step of the True Form Tummy Tuck.

In the back view, you can see the striking transformation of the waistline where I performed liposuction to attain an elegant curve which blends seamlessly with the rest of her body. For patients who desire a rounder buttocks’ appearance, I frequently also will do fat grafting to the buttocks (Brazilian Butt Lift) using fat taken from the waistline.

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