What is Awake (Avelar) Tummy Tuck?
The Awake Tummy Tuck technique was introduced by Dr. Juarez Avelar, MD in 1999. The Awake Tummy Tuck combines abdominal liposuction with excision or surgical removal of the excess skin on the lower abdomen. The liposuction is performed using tumescent anesthesia. Tumescent anesthesia is a form of local anesthesia where a special fluid is pumped into the surgical area. The fluid numbs the area as well as reducing bleeding and bruising. This allows the liposuction and later the excess skin removal to be done comfortably with the patient awake. Since the patient is awake, the term Awake Abdominoplasty or Awake Tummy Tuck has become popular. The end result is a flat stomach with no excess skin.
Why have an Awake Tummy Tuck?
Simply put, anyone who has a significant abdominal bulge should consider an Awake Tummy Tuck. Abdominoplasty or tummy tuck gives the very best result of any abdomen reducing cosmetic procedure a smooth, flat stomach. Thermage works well with limited amounts of loose skin. Liposuction can greatly reduce fat and size, and when SmartLipo is used it can give excellent results. However, when a large bulge or a large amount of loose skin is present, tummy tuck should always be considered as an alternative. Awake Tummy Tuck has several advantages over conventional procedures:
- Use of local anesthesia avoids the potential complications of general anesthesia.
- Use of liposuction with skin reduction allows a more complete removal of abdominal fat and often a more natural and sleeker look.
- Use of local anesthesia and liposuction as part of the tummy tuck reduces down time to essentially that of liposuction.
- Avoiding sewing of the abdominal musculature reduces the pain and recovery time.
- Use of a closed suturing technique to close the incision all but eliminates post operative wound care.
- Use of a closed suturing technique promotes a thin less noticeable scar.
When compared to other, less aggressive methods of abdominal reduction, tummy tuck gives the flattest result and can handle the most excess abdominal tissue.
What are the steps leading to the Awake Tummy Tuck?
It is important to understand what you will experience when you undergo an Awake Tummy Tuck procedure. The procedure usually proceeds in this manner:
You will come in for consultation to determine if Awake Tummy Tuck is a good procedure for you. After discussion and evaluation Awake Tummy Tuck is chosen as the best procedure. A pre-operative evaluation is scheduled for you.
Prior to your pre-operative evaluation you will be given some written materials to review. These include:
- Written consents for liposuction and Awake (Avelar) Abdominoplasty
- Instructions for the day of surgery.
- Medication instructions.
- Written prescriptions for your post-operative period.
- Some written information to help you post-operatively and during recovery
Dr. Johnson performs the preoperative evaluation. This includes blood work done in our office a review of your medical history and a directed physical exam. On rare occasions some additional tests like more blood work or an EKG may be needed. Once it is determined that you are a good candidate the procedure is scheduled. The pre-operative evaluation can be done on the day of the surgery but we prefer to do it a few days ahead of time. We often do the pre-operative evaluation on the same day as your initial consultation.
You are now ready for your procedure.
What will happen during the Liposuction portion of the Awake Tummy Tuck?
We do most of our Awake Tummy Tuck procedures in the morning. When you arrive you can expect the following:
- After arrival for your Awake Tummy Tuck you will be taken to the preparation room. Dr. Johnson will meet with you before you are given any medications. At that time he can address any remaining questions you may have
- Dr. Johnson will mark you for liposuction portion of the procedure. The tummy tuck portion will be marked later.
- We will take your before procedure pictures.
- You will be given some oral medications and a typically a shot. These medicines are a sedative, a pain medication and a medicine to prevent nausea. Sometimes an IV will be started.
- Next you will be taken to the procedure room and placed on the table. You will be placed on a monitor to display your vital signs during the procedure. The surgical area will be cleaned with a solution to sterilize the skin.
- Using a small needle, the locations for the incisions for liposuction will be numbed. The ¼ inch incisions will be made using a scalpel. These incisions will later be used for your drains after the abdominoplasty.
- The entire abdominal area will be infiltrated with tumescent fluid. We do this by pumping the fluid through a cannula into the tissue. The fluid consists of:
- Normal saline water with the same amount of salt as our bodies.
- Lidocaine a local anesthetic
- Sodium bicarbonate increases the effectiveness and safety of the lidocaine.
- Epinephrine increases the effectiveness of the lidocaine and decreases bleeding and bruising.
- The fatty layer of the abdomen is then suctioned to remove the fat. In the lower abdomen, we remove more fat than a normal liposuction to facilitate the excision of excess skin. For video of abdominal liposuction using tumescent fluid click here.
You will then be ready for the abdominoplasty portion of your Awake Tummy Tuck.
What will happen during abdominoplasty portion of the Awake Tummy Tuck?
While you are still on the table and mildly sedated we will proceed with the second portion of your Awake Tummy Tuck. The abdominoplasty or tummy tuck potion proceeds in this manner:
- While continuing on the table and monitor your abdomen is once again cleaned with special soap for sterilization. This cleaning is even more thorough. The abdominal area is draped to create a sterile field for Dr. Johnson to work.
- Next Dr. Johnson will mark the areas for removing (excising) the excess skin.
- Your umbilicus or belly button is next removed and a suture placed so it can easily be found later.
- The upper incision to remove excess skin is made. A final check of the size of the skin being removed is confirmed. Then the lower skin incision is made and the excess skin is removed. We place this on a tray and photograph it.
- The upper and lower edges of the excise skin are now brought together in the center and sutured in place. All of the sutures used to close the skin are underneath the skin. This eliminates the need to remove sutures later on. This method of closing the wound also tends to produce a thin scar.
- Occasionally a patient will have enough skin removed to require special sutures called retention sutures to be placed. These sutures are on the outside and will be removed in 3-4 weeks.
- Once the center of the wound is closed Dr. Johnson will determine the correct spot for your umbilicus. Once determined a new incision is made and the umbilicus sutured into its new home.
- Next the entire wound is sutured closed. After suturing special skin glue is used to seal and protect the wound. This makes the wound essentially care free.
- Finally drains are placed below the skin and sutured into place. To see video of the abdominoplasty portion of the Awake Tummy Tuck click here.
Now you are done. After dressings are placed over the drains and you are in your compression garment to decrease swelling, you may go home.