charles durrant plastic surgery

Abdominoplasty (Tummy Tuck)

What is abdominoplasty?

Abdominoplasty is the removal of excess skin and fat from the abdomen (belly) and, if necessary, also involves tightening of the abdominal muscles. Contrary to the rather trivial-sounding 'tummy tuck', it involves significant surgery and should not be undertaken lightly. It generally leaves a scar from hip bone to hip bone and a scar around the belly button, but this scarring can be more extensive in severe cases.

Before

After

Who is a good candidate for abdominoplasty?

The best results from abdominoplasty tend to be achieved in otherwise healthy patients who have more excess skin than excess fat. The classic example would be a post-pregnancy tummy. In these cases, the outcome is further improved by the tightening of the tummy muscles which are often separated following pregnancy. Another instance where results are predictably favourable is in exercise-induced weight loss where the fat has been burned off and the excess skin remains stubborn.

Weight loss through diet or weight-loss surgery may appear to be suitable, but these patients tend to have poorer nutrition which can affect healing and infection resistance leading to a higher rate of complications. Therefore, it is essential that such patients optimise their nutrition before embarking on corrective surgery.

How is it done?

Broadly speaking, there are 4 main categories of abdominoplasty:

  1. The 'Mini' Abdominoplasty
  2. The 'Regular' Abdominoplasty
  3. The 'Fleur de Lis' Abdominoplasty
  4. The Circumferential Body Lift

The mini abdominoplasty is suitable for patients who have a small amount of excess skin and fat in the tummy area that is limited to the area underneath the belly button. Although it still involves a lengthy incision, the amount tissue removed and the amount of 'undermining' required to achieve wound closure is less, generally leading to a speedier recovery. In addition, it is not necessary to move the umbilicus (belly button) in a mini abdominoplasty.

The regular abdominoplasty involves making an incision from hip to hip. All the skin and fat below the umbilicus to the area just above the pubic hair is removed. The remaining skin and fat above the umbilicus is lifted off the abdominal wall muscles, which are then sutured closer together if necessary. The skin is then pulled down over the umbilicus and sutured back down to the hip-to-hip incision. A new hole is then made where the umbilicus should be, and the umbilicus is pulled through on its stalk and sutured into place, leaving a long scar along the lowest part of the abdomen and another around the umbilicus.

The Fleur-de-Lis abdominoplasty is reserved for severe cases of excess skin and fat as one might see in extreme weight loss cases. In this instance, the surgery is the same as for a regular abdominoplasty, but with an additional vertical component of excision above the umbilicus to excise the excess tissue. It is called the Fleur-de-Lis as the pattern of excision resembles the stylised lily flower found in heraldry.

The Circumferential Body Lift involves either a standard abdominoplasty or fleur-de-lis abdominoplasty and this is combined with an incision that extends all the way around the lower back and upper buttock area. This technique is excellent for extreme cases of loose skin and where removal of 'love handles' and lifting of the upper buttocks and lateral things is sought.

During our initial consultation, I will evaluate your overall health and make a surgical plan based on skin type, excess tissue and expectations.

What are the risks?

Abdominoplasty is not straightforward surgery. It should be performed by a qualified plastic surgeon. As with all surgery, there are certain risks associated with it. All surgery involves a degree of bleeding. In the vast majority of cases, this is minimal and easily controlled during the procedure itself. In a small percentage of patients, there may be a more significant collection of blood that may even require a return to the operating theatre to remove it.

Meticulous steps are taken before, during and after the surgery to ensure that the risk of infection is minimal. However, the risk of infection can never be completely eradicated. In a few cases, the incision can become red and inflamed. This usually settles down with simple antibiotics.

All surgery involves the formation of scars. The incision scars will be raised and pink for the first few months, but will usually settle into fine white lines after several months. In some cases the scars can remain raised and pink.

The skin of the lower abdomen will become somewhat numb after the surgery and, although this sensation returns to a degree after a few months, some numbness will be permanent.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a general anaesthetic (with you asleep). It takes about 1 to 4 hours to complete, depending on the extent of the surgery required. I do not use suction drains for these surgeries. Instead, I use a technique called 'quilting sutures', which perform the same function as a drain but without the discomfort and impracticality of a suction drain. The incisions are closed with sutures and covered with several layers of tape.

After the Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary and you can expect to leave hospital the same day for a mini or standard tummy tuck and most fleur-de-lis approaches. It may be necessary to spend one night in hospital for the larger fleur-de-lis or circumferential body lift but not always. You will need someone to drive you home. You will find the suture line quite tight following the surgery and you should expect to be walking a little hunched over for the first week or so as the tension along the suture line will take a little time to relax. You will feel a little sore for a few days following the surgery, but this is usually well controlled with normal painkillers. You will be given a support garment to wear and this should remain in place for 1 week followed by compression underwear for a further 5 weeks.

You will be able to shower normally from one week after the operation.

A week after your surgery you will visit the dressing clinic. Here, the dressings are removed. The sutures are dissolvable and do not need to be removed.

The tummy may be quite swollen following the surgery. However, this generally resolves well within a few months.

Returning to work and play

Most people can return to work after 1-3 weeks. More active occupations may require longer, but this will be discussed fully with you. It's important to stay active during recovery to prevent blood clots but you must avoid 'core' exercises which strain the tummy muscles for 6 weeks to protect the muscle repair.

After a final review with your surgeon at 3 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

In the right patient, with the right expectations, abdominoplasty produces excellent results. Although the scars are significant, they fade with time and the firmer, flatter tummy generally lasts well. It is recommended that you continue with a balanced diet and regular exercise in order to get the best and longest benefit from the procedure.

Thigh Lift

What is a thigh lift?

A thigh lift is a surgical technique to remove excess skin and fat from the upper inner thigh in order to improve the contour.

How is it done?

The simplest way to perform a thigh lift is to perform an incision within the natural crease of the groin. The extra thigh tissue is then pulled upwards to remove any remaining slack and sutured to the original incision in the groin crease. Due to the risk of scar migration, this technique is only suitable for a small percentage of people. In fact, if you are suitable for this smaller thigh lift then it may be worth considering if you need surgery at all! For most patients, it's necessary to make an additional incision down the inside of the thigh in an upside down 'L' shape in order to achieve the best result.

During our initial consultation, I will evaluate your overall health and make a surgical plan based on your skin type and laxity.

What are the risks?

Thigh reduction is relatively straightforward surgery. However, there are risks involved as with any surgery, and it should be performed by a qualified plastic surgeon. All surgery involves a degree of bleeding. In the vast majority of cases, this is minimal and easily controlled during the procedure itself. In a small percentage of patients, there may be a more significant collection of blood that may even require a return to the operating theatre to remove it.

Meticulous steps are taken before, during and after the surgery to ensure that the risk of infection is minimal. However, the risk of infection can never be completely eradicated. In a few cases, the incision can become red and inflamed. This usually settles down with simple antibiotics.

All surgery involves the formation of scars. The incision scars will be raised and pink for the first few months, but will usually settle into fine white lines after several months. In some cases the scars can remain raised and pink.

There will be some change in sensation to the inner thigh. In most cases it will feel somewhat numb, but may even be overly sensitive. This usually settles down after a few months. In very few, however, the change can be permanent.

Since the surgery involves the groin area, it can be difficult to keep it clean and dry and so there can be delayed healing in some areas. This is usually not a problem and settles down with simple dressings.

The surgery is close to the lymph nodes that drain the leg. The fluid that these lymphatics produces can gather in the thigh (seroma) and may need drainage in the outpatient department. It is possible, although extremely rare, that damage to these lymphatics can cause swelling in the leg (lymphoedema). In the unlikely event that this occurs, it usually settles on its own. In a very few cases, it can be permanent.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a general anaesthetic (with you asleep). It takes about 2 hours to complete. I do not use suction drains for this procedure. The incisions are closed with sutures and covered with dressings and a compressive bandage.

After The Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary and you can usually leave hospital on the same day. You will need someone to drive you home. You will need to wear a support garment such as cycling shorts for the first 6 weeks after the surgery. You will feel a little sore for a few days following the surgery, and may find walking difficult at first. However, this is usually well controlled with normal painkillers and it is important to start getting up and about early after the operation.

You will be able to shower normally after the first dressing change.

A week after your surgery you will visit the dressing clinic. Here, the dressings are removed. The sutures are dissolvable and do not need to be removed.

The thighs will remain swollen for a few weeks and you may even notice that they settle down at different rates. However, after a couple of months the swelling should have resolved and the thighs will have settled.

Returning to work and play

Most people can return to work after 2 weeks. More active occupations may require longer, but this will be discussed fully with you. The thighs will remain tender for up to 4 weeks, so you should avoid too much physical contact during this time.

After a final review with your surgeon at 3 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

Brachioplasty (Arm Lift)

What is an arm lift?

An arm lift is a surgical technique to remove excess skin and fat from the upper inner arms in order to improve the contour.

Before

After

How is it done?

The simplest way to perform an arm lift is to perform an elliptical incision along the inside border of the arm. The skin and fat within this ellipse is removed. The remaining arm tissue is then pulled together to remove any remaining slack and sutured along the inside of the arm. For more severe laxity, it may be necessary to extend the incision into the armpit and down the side of the chest to achieve the best result.

During our initial consultation, I will evaluate your overall health and make a surgical plan based on your skin type and laxity.

What are the risks?

Arm reduction is relatively simple surgery. However, some difficulty lies in the ability to judge the amount of excision and adequately hide the scars. It should therefore be performed by a qualified plastic surgeon. All surgery involves a degree of bleeding. In the vast majority of cases, this is minimal and easily controlled during the procedure itself. In a small percentage of patients, there may be a more significant collection of blood that may even require a return to the operating theatre to remove it.

Meticulous steps are taken before, during and after the surgery to ensure that the risk of infection is minimal. However, the risk of infection can never be completely eradicated. In a few cases, the incision can become red and inflamed. This usually settles down with simple antibiotics.

All surgery involves the formation of scars. The incision scars will be raised and pink for the first few months, but will usually settle into fine white lines after several months. In some cases the scars can remain raised and pink. The aim of the surgery is to hide the scars within the inside of the arm. The scars will be visible, however, when the arm is lifted up away from the body.

There will be some change in sensation to the inner arm skin. In most cases it will feel somewhat numb, but may even be overly sensitive. This usually settles down after a few months. In very few, however, the change can be permanent

Since the surgery involves the armpit area, it can be difficult to keep it clean and dry and so there can be delayed healing in some areas. This is usually not a problem and settles down with simple dressings.

The surgery is close to the lymph nodes that drain the arm. The fluid that these lymphatics produces can gather in the arm (seroma) and may need drainage in the outpatient department. It is possible, although extremely rare, that damage to these lymphatics can cause swelling in the arm (lymphoedema). In the unlikely event that this occurs, it usually settles on its own. In a very few cases, it can be permanent.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a general anaesthetic (with you asleep). It takes about 2 hours to complete. I do not use suction drains for this procedure. The incisions are closed with sutures and covered with a dressing and compressive bandages.

After the Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary and you can expect to leave hospital the same day. You will need someone to drive you home. You will need to wear a compression garment for the first 6 weeks after the surgery. You will feel a little sore for a few days following the surgery, and may find lifting the arms and performing manual tasks difficult. However, this is usually well controlled with normal painkillers normal function returns within a few days.

You will be able to shower normally from the first week after the operation.

A week after your surgery you will visit the dressing clinic. Here, the dressings are removed and the wounds examined. The sutures are dissolvable and do not need to be removed.

The arms will remain swollen for a few weeks and you may even notice that they settle down at different rates. However, after a couple of months the swelling should have resolved and the arms will have settled.

Returning to work and play

Most people can return to work after 2 weeks. More active occupations may require longer, but this will be discussed fully with you. The arms may remain tender for up to 4 weeks, so you should avoid too much physical contact during this time.

After a final review with your surgeon at 3 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

Liposuction/Liposculpture and VaserLipo

What is liposuction/liposculpture?

Liposuction (also called 'vacuum-assisted lipectomy') is the removal of fat in specific areas of the body using a suction device. Liposculpture is a relatively new term that refers to the selection of specific areas for liposuction in order to scuplt the required body shape, possibly combined with re-injection of fat into other areas that require it.

Before

After

What is VaserLipo

VaserLipo is a type of liposuction that uses ultrasound energy to 'melt' the fat before it is gently removed by standard liposuction techniques. The benefits to this technique are that the removal of fat relies on a gentle melting of the fat first which means that the actual suction is a more gentle process with less surrounding tissue destruction leading to less bruising, swelling and pain and a faster recovery. It also allows a very precise removal of fat, allowing more dramatic contouring of the body shape. The downside is that it involves very specialist equipment and so is more expensive overall and, particularly with so-termed 4DLipo (etching), may require suction drains for a day or two.

How is it done?

Because the suction tubes (cannulae) used for liposuction are thin (2 to 4mm in diameter), the incisions required to insert them under the skin are also very small. This minimally invasive aspect of liposuction is probably its greatest advantage. Liposuction most commonly targets the tummy and hips, but may also be a useful tool for moulding the arms, legs, buttocks, knees, ankles, neck and even face.

However, liposuction does have its limitations and so you should approach it with realistic expectations. It is best used in patients within the normal weight range who have isolated pockets of fat that can be targeted. Liposuction removes fat, but does not remove excess skin. In younger patients with more elastic skin, the skin will tend to redrape itself over the new body contours. However, in older less elastic skin or in areas where there is already skin excess, liposuction alone is not likely to be as effective.

Commonest areas for liposuction

During our initial consultation, I will evaluate your overall health and together we will make a surgical plan based on your fat distribution, expectation, and skin type.

Commonest areas for liposuction

What are the risks?

Liposuction is generally a safe procedure as long as the patient is appropriate, the surgeon is adequately trained, and the hospital is well-equipped. Although exceedingly rare, liposuction is associated with some serious complications such as fat clots and blood clots that may become lodged in the lungs. However, more common complications include irregularities of the skin contour, loose skin, bruising, numbness, and some pigment changes. Most of the time these minor issues settle with time, but occasionally they will need correction.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a general anaesthetic (with you asleep). It takes up to 2 hours to complete, but may take longer depending on the amount of liposuction required. I perform the surgery using a 'tumescent' technique, which means that I inject medicated fluid into the area of concern prior to starting the liposuction in order to reduce bruising and help prevent discomfort. The incisions are closed with sutures and covered with dressings.

After the Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary. Liposuction is generally a day case procedure, so remember to bring someone with you who can drive you home. You will need to wear a compressive support garment for the first 6 weeks after the surgery. You will feel a little sore for a few days following the surgery, and may find a good deal of bruising in the involved area. However, this is usually well controlled with normal painkillers. It is a good idea to undergo regular lymphatic massage after the procedure to maximise the results.

You will be able to shower normally from one week after the operation.

One week after your surgery you will visit the dressing clinic. Here, the dressings are removed.It takes quite a long time for the swelling to settle and for the skin's natural elasticity to conform to your new shape, so although you will see an immediate difference, do not expect to see the early benefit of the procedure for up to 3 months afterwards. The final result will take a year or so.

Returning to work and play

Most people can return to work after 2 weeks. More active occupations may require longer, but this will be discussed fully with you. The area may remain tender for up to 4 weeks, so you should avoid too much physical contact during this time.

After a final review with your surgeon at 3 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

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