Category: body

INTRODUCTION

• Cryolipolysis (Coolsculpting) by Zeltiq is a safe, effective and non-invasive treatment to reduce unwanted fat bulges by cold treatment.
• An applicator is applied to the targeted area causing cold injury to the fat cells. The injured fat cells are gradually resorbed and eliminated from your body over a period of 2-3 months.
• This treatment reduces the fat bulges slimming the body contour.
• The results are proven, noticeable, and long-lasting. Visible results can be seen from the first session.

MECHANISM OF CRYOLIPOLYSIS (COOLSCULPTING)

• The Cryolipolysis (Coolsculpting) applicator creates a vacuum to suck in the targeted fat bulge. Significant cooling occurs in the applicator chamber damaging the fat cells by crystallisation without affecting the surrounding tissue. This is because the fat cells are more easily damaged by cold temperature than the surrounding cells.
• The damaged fats cells are removed by the body starting from 2-4 weeks after treatment. This process is complete by 2-3 months.

Coolsculpting – Cryolipolysis – Mechanism

WHO DEVELOPED CRYOLIPOLYSIS (COOLSCULPTING)?

• Dr Dieter Manstein, MD, PhD and R.Rox Anderson, MD of teaching affiliate of Harvard Medical School and their team discovered “selective cryolysis” in which selective fat reduction without affecting adjacent tissue can be achieve via prolonged controlled cooling / energy extraction of targeted fats.

COMPARISON OF CRYOLIPOLYSIS (COOLSCULPTING) AND LIPOSUCTION

SUITABLE CANDIDATES

• Most patients are able to undergo Coolsculpting except for the rare few with poor cold tolerance.

Coolsculpting – Cryolipolysis – Body – Front

Coolsculpting – Cryolipolysis – Body – Back

DESCRIPTION OF PROCEDURE

• Pre-procedure marking of the treatment area.
• A gel pad and a suction applicator are applied to the treatment area.
• During cooling of the fat bulge, some patient may feel pulling, tugging, and/or mild pinching sensation for the first few minutes. Thereafter, they can read, check email, or even take a nap
• Each area takes 60 minutes to treat. (The new applicator, Cooladvantage takes 35 minutes)

ANAESTHESIA

• Anaesthesia is not required.
• CoolSculpting is virtually painless.
• Some people experience mild pain for which simple analgesics would suffice.

POST OPERATIVE CARE

• Immediately after the procedure, the treated area may feel stiff and numb. This resolves with a few minutes of massage.
• Bruising, swelling and tenderness tend to be transient.
• No downtime otherwise.

COMMON AFTER EFFECTS

• Temporary numbness
• Mild soreness and redness
• Mild bruising
• Other possible effects :
  • Treated area may form darker skin colour, hardness, frostbite
  • In rare cases, the treated area may result in an unwanted indentation

FINANCIAL COUNSELLING

• This procedure is not Medisave or insurance claimable

During the consultation, Dr Ng would advise the best option for sculpting and slimming the body by Coolsculpting or liposuction. The top priority for the plastic surgeon is to plan the location and distribution of the Coolsculpting applicator on the treatment area for best outcome.

INTRODUCTION

• Weight gain and post-child often result in excessive abdominal skin, fats and skin striae. Liposuction is useful in removing excessive fats in young patients with good skin elasticity. However for older patients with poor skin elasticity, liposuction may result in excessive unsightly loose skin.
• Abdominoplasty (Tummy Tuck) is a definitive way to remove excessive skin and fat from the abdomen. It is particularly helpful in removing post childbirth abdominal skin excess with stretch marks (striae).
• The rectus abdominis muscle (the 6 pack muscle) can be overstretched during pregnancy leaving a gap between them (divarication of recti). This gives the abdomen a very full appearance even if there is little excess fat.
• During this procedure, any abdominal muscle separation (divarication of recti) will also be tightened (plication of divarication of recti), resulting in a flatter abdomen and more of an hour glass waistline.
• To further improve the result liposuction of the abdomen can be done during the same surgery.

• Occasionally abdominoplasty can also be combined with abdominal hernia repair. Abdominal hernia is a result of bulging of abdominal contents through the weakness of the abdominal wall.
• Abdominoplasty is a procedure that can radically contour the abdomen at the expense of having a reasonably well hidden scar. There are many patients who cannot accept having an abdominal scar and who are willing to live with a less than ideal abdominal contour.

TYPES OF ABDOMINOPLASTY:

	Conventional Abdominoplasty	Mini Abdominoplasty	Fleur De Lis	Belt Abdominoplasty
Diagram	Abdominoplasty – Conventional Tummy Tuck	Abdominoplasty – Mini Tummy Tuck	Abdominoplasty – Fleur de Lis	Abdominoplasty – Belt
Purpose	Removal of massive abdominal skin and fat; and plication of divarication of recti.	Removal of minimal to moderate abdominal skin and fat just below the umbilicus.	Removal of the massive upper and lateral abdominal skin and fat. ie. removal of vertical and horizontal abdominal excess	Removal of massive abdominal, hip and back excessive skin and fat.
Incision	Above pubic hairline, slightly extended to the hip bones.	Short incision above pubic hairline.	Above pubic hairline, slightly extended to the hip bones and vertical extension upwards.	Circumferential incision from front to back.
Umbilical Repositioning	Umbilicus repositioned as the abdominal skin pulled downwards. Small scar around the umbilicus.	Umbilicus left intact as abdominal skin pulled down. It may be separated from underlying attachment.	Similar to Conventional Abdominoplasty	Similar to Conventional Abdominoplasty
Associated Procedure	Liposuction of the love handles and upper abdomen for further enhancement of the abdominal shape.	Similar to Conventional Abdominoplasty	Similar to Conventional Abdominoplasty	Liposuction and buttock lift

CONCURRENT PROCEDURES

Abdominoplasty can be combined with the following :

• Liposuction and fat grafting to breasts and face
  • Fat can be harvested using a syringe from the abdomen before abdominoplasty. The harvested fat can then be injected into the breast for volume enhancement and into the face for rejuvenation.
• Mommy make-over – abdominoplasty combined with breast augmentation
  • It is common for women after childbirth to experience both deflation in breast volume and lax abdominal skin with stretch marks. Mommy makeover which is a combination of breast augmentation (lift and implant) with abdominoplasty (tummy tuck) is a common request. This combination treatment provides significant rejuvenation effects to the entire torso.
• Abdominal Hernia Repair
• Buttock Lift
  • Can be done with Belt Abdominoplasty
• Thigh Lift
  • Can be done with Belt Abdominoplasty

SUITABLE CANDIDATES

Patients who have :

• Excessive abdominal fat and poor skin elasticity.
• Excessive abdominal skin striae (usually post childbirth).
• Abdominal muscle laxity (divarification of recti) usually post childbirth.
• Concomitant abdominal herniation
• Completed family planning. Female patients who intent to become pregnant in future may decide to defer this procedure.

ANAESTHESIA

• General anaesthesia

DESCRIPTION OF PROCEDURE

• Pre-operative marking to determine incision and amount of skin to be removed with agreement of patient.
• Liposuction of the love handles and upper abdomen for further enhancement of the abdominal shape (if necessary).

• Excision of the excess skin and fat according to markings.
• Plication of the divarication of recti (tightening of the abdominal muscles by suturing) if necessary.
• Insertion of wound drains (plastic tubings) near the pubic hairline for evacuation of residual blood to prevent blood clot accumulation.
• Closure of the abdominal fat and skin in layers and skin dressing. The patient is at rest in a Jack-Knife position (abdomen is flexed)

• Surgical duration : 4-5 hours

POST OPERATIVE CARE

• After the procedure the patient may opt to stay in the hospital ward or hotel room with a private nurse for recuperation.
  • The patient usually goes home by the 3^rd or 4^th day after surgery.

• In the 1st and 2nd day after surgery the patient rests in a jackknife position to relieve abdominal wound tension.
• The patient may be able to ambulate with support from 2nd to 3rd day onwards.
• Removal of drains usually by second or third day when the drainage decreases to an acceptable level.
• Abdominal binder : Wear round the clock for about 3 months to provide support and to reshape the abdomen.
• Medication: Analgesics (pain killers), Antibiotics and medications to reduce swelling and bruising.
• Suture removal : 1-2 weeks
• Bruising and swelling : May last for about 2 weeks.
• Return to exercise : Light exercise permitted at about 4 weeks: heavy exercise at about 3 months.

FINANCIAL COUNSELLING

• Abdominoplasty for cosmetic purposes is not insurance claimable.
• There are very few insurance claimable procedures that can be done together with abdominoplasty.

RISK AND CAUTION

• Infection
• Bleeding
• Bruising – usually resolved by 2 weeks
• Swelling – usually resolved by 2 – 4 weeks
• Wound dehiscence – may occur in patients who have a tendency of poor wound healing eg. Diabetes, Smokers, Patients on chronic consumption of corticosteroids, and patients with vascular disease.
• Numbness – over the abdomen within expectation and can last for 6 – 12 months
• Undesirable scar can be address by injection or simple scar revision.

During the consultation, our plastic surgeon would guide you to choose the best tummy tuck surgery method used most commonly by some of the leading plastic surgeons in Singapore and Korea. Apart from abdominoplasty, Dr Ng would discuss associated procedures like liposuction, fat grafting and mommy makeover.

WHAT IS LIPOSUCTION?

Liposuction is a body contouring and sculpturing surgery.  It is not meant for patients who just want to lose weight. The best liposuction surgery results can be achieved in conjunction with exercise and diet planning.

HOW IS THE LIPOSUCTION SURGERY PERFORMED?

CONSULTATION FOR LIPOSUCTION SURGERY

During your consultation, Dr. Ng will advise you on the best option for sculpting and slimming the body — either by liposuction or coolsculpting. The top priority for our surgeon is to plan the location for fat removal to ensure the optimal outcome. Liposuction is best combined with a slimming regime, including mindful eating habits and exercise.