Tighten abdominal muscles during tummy tuck
A diastasis or separation of the sit-up muscles can occur as a result of pregnancy or with weight gain and loss.
The separation can be felt if your fingers are placed running vertically along the belly button as you lift your head up as in a sit-up position.
The muscle is tightened so that the edges of the sit-up muscles come together fully in the middle. The muscle is then able to control tone in the horizontal direction effectively.
Abdominal tone after tummy tuck will remain dynamic as you should be able to relax and protrude the abdomen and well as pull in with the sit-up muscles with good fitness and posture. (Peter E. Johnson, MD, Chicago Plastic Surgeon)
It’s all about the shape
Your examination will tell me more than any test. Several points to consider: First, the abdominal muscles should not be tightened more than their separation. This may produce unwanted or uncoordinated muscle function. Second, if there is excess looseness in the horizontal direction (not common), pleats can be used to also tighten in this direction.
Third, there is a limit to the tightening produced due to suture failure, abdominal wall failure, and risk of increasing the pressure intra-abdominally. This could cause an increase in your chances for a blood clot. You should be able to achieve an excellent, natural result without having to extend your risks. (Ricardo Izquierdo, MD, Oak Brook Plastic Surgeon)
How tight is tight!
When I started my practice, 16 years ago, I pulled the fascia as tight as possible, even pulling the muscle so it bunched in the middle. However, aside form the added pain, it did not change the shape as much as hoped. Then I adopted the Lockwood High Lateral tension abdomenoplasty. This technique pulls the muscle to the way they were prior to pregnancy – not too loose, not too tight.
Then horizontal pleating is addaed around the belly button. The skin i then pulled Dowbward and inward – creating tension along the hips and waistline – hence High Lateral tension Abdomenplasty. Whats great about this technique is that because the undermining of the skin is limited, liposuction can be performed with minimal risk of injury to the local tissues. (Robert M. Freund, MD, New York Plastic Surgeon)
How to determine fascial tension during abdominoplasty
The use of a CT scan to diagnose rectus separation (diastasis) is overkill and is not as useful as a good clinical exam in the hands of a boarded plastic surgeon. This will combine your reproductive history,skin elastic potential, presence of stretch marks or scars and The DYNAMIC. status of your rectus muscles. These factors help guide the surgeon in determining intraoperative tightening while you are asleep and relaxed on the OR . Once the muscles have have healed in the approrpriate anatomical position post op THEN exercises can strengthen and shorten them. (Barry H. Dolich, MD, Bronx Plastic Surgeon)
During Abdominoplasty, How Does a Surgeon Estimate How Much to Tighten the Fascia?
This is determined by the experience of your surgeon. There is no specific formula it is all judgment (Robert D. Goldstein, MD, Bronx Plastic Surgeon)
How much to tighten the muscles in a tummy tuck?
No lab test can tell you how to do this so none are usually done preop. It is all experience. Finally, as compared to many surgeons, I like to have my anesthesiologists NOT routinely paralyze the patients during the muscle tightening because the looseness caused by these medications can lead a surgeon to over-tighten the muscles. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
Experience
You look like a perfect candidate for the surgery. In the 30 or so years I have been doing this, I have not used any lab tests to determine how much I tighten your muscle, it is all from experience and how you look when I get in there. (William B. Rosenblatt, MD, New York Plastic Surgeon)