Richard A. Baxter, M.D.

The Art Behind Plastic Surgery

Abdominoplasty - Seattle Tummy Tuck Surgery

Not all tummy tucks created equal: Progressive Tension Suture method for better outcomes

A tummy tuck (abdominoplasty) is done to fix the things that you can’t do with diet and exercise alone. No amount of exercise and no dietary breakthrough is going to tighten skin and erase stretchmarks. And, there is no magic number of sit-ups that will give you six-pack abs if the muscles have been separated by pregnancy, or reduce fat that is genetically programmed to park itself on the abdomen until famine conditions come along.

Despite the innocent sounding terms like “tummy tuck” and “mommy makeover” this is a serious decision. Fortunately, there have been some major improvements in technique over the years, resulting in faster recovery and superior results. But, you still have to do your homework in order to find the right surgeon. The basic idea remains the same however, with all versions of abdominoplasty: a football-shaped area of skin between the navel and the pubic area is removed, the belly button (umbilicus or “umbi” in surgeon speak) is left where it is and the skin of the upper abdomen is undermined and pulled down to be sewn to the lower skin edge. The umbilicus is then brought out.

The most important considerations are what the scar will look like and where it will be, how much discomfort there will be after surgery, and of course your safety. For more than a decade, I have been using a technique known as the Progressive Tension Suture (PTS) method, which contributes to an improved outcome by all of these measures. Let’s first consider the scar: by definition, there needs to be a scar where it was all pulled together. Ideally, this scar should be located low so that it can be concealed under a bikini bottom, if desired, and as short as possible without compromising the degree of tightening achieved.

I first developed the PTS method as a way to get the scar low and minimize tension at the wound, which in turn makes for a finer, less obvious scar. Most abdominoplasties are done by pulling the skin down and closing it with several layers of stitches, but the resulting tension sometimes pulls the scar up or widens it. With PTS, there are stitches put into the undersurface of the undermined skin, each one taking up a little more slack, so that the skin can be pulled farther and there is virtually no tension at the edge. This gives complete control over the scar, as opposed to the “cross your fingers” and hope method or simply accepting that it has to be higher and more visible.

Recovery after surgery is another major issue and because of the amount of undermining required, most often a drain tube is used. A serendipitous finding with the PTS technique was that fluid output in the drain tube was much less. Therefore, it can usually be removed in a couple of days as opposed to a week or more. The sooner the drain can come out, the better, as far as most people are concerned. But if it comes out too soon, a fluid buildup called seroma can result. With the PTS method, drains can be removed earlier and the risk of seroma is reduced.

These improvements were so dramatic in my practice that I published the technique (see the publications page for reference). There’s no question in my mind that using the PTS method results in better outcomes.

Looking for Tummy Tuck Surgery?

Dr. Baxter is a nationally recognized plastic surgery expert providing Abdominoplasty with his experienced and caring staff in an accredited, private surgical facility in the Seattle area. He has been voted “Western Washington’s Favorite Plastic Surgeon” and was elected by his peers to be listed in the “Guide to America’s Top Physicians.” We'd like to help guide you through YOUR tummy tuck procedure, just use our consultation form to request a consultation or call us at 425-776-0880.

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