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The common nickname for this procedure, "tummy tuck", which removes excess sagging skin from the abdomen, belies the fact that it is major surgery normally done under general anesthesia.

Patients with sagging tissue due to aging, pregnancies, multiple abdominal operations, or significant weight loss are generally good candidates for body contour procedures. Surgery can benefit the occasional patient with an isolated excessive deposit of fat below the lower abdominal skin, in the thighs or elsewhere.

The typical case of generalized obesity, however, is not amenable to surgical correction of contour deformity. A fold of tissue, especially fatty tissue, around the abdomen implies serious obesity, although advancing years and skin laxity undoubtedly tend to compound the problem.

Obesity, however, presents its own health risks - notably that of heart disease - and is a complex condition for which cosmetic surgery is not necessarily the correct answer.

Once you and your surgeon decide cosmetic surgery is right for you, the surgeon must still ascertain whether in your particular case it is necessary to deal with just an excess of skin in folds, or with an excess of skin plus fat deposits beneath.

Most of the fat forms a thick yellow, oily layer that separates the skin from the abdominal muscles and may be many inches deep. Removal may demand extensive surgery, making concealment of surgical scars more difficult, and increasing the chances of such complications as blood loss - which may temporarily affect your overall health, bleeding into the tissues (hematoma) causing conspicuous marks, or infection. The goal of the surgery is to remove a section of skin, or of skin-plus-fat, in such a way as to be able to pull together the remaining outside edges and stitch them together without undue tension, while still preserving normal bodily features as much as possible.

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Approaches to performing the abdominoplasty depend on whether you have been dieting, or have been pregnant, and now have an "apron" of loose, sagging skin in folds over your lower abdomen, or, if fat has accumulated under the skin of the central abdomen.

After surgery you will feel some pain, which can be controlled with painkilling drugs. To reduce tension on stitches and minimize strain on abdominal skin, you will probably be kept in bed, lying with your knees up, for as long as two weeks or while adhesive tape is in position.The long-term effect is, ideally, that with the excess fat and skin removed, you are now in the shape you want to be. If obesity was the cause of the problem, however, returning to your former size and weight might cause your scars to stretch and become obvious, or your skin to stretch to its former size.

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Questions to Ask Your Doctor

What are the medical reasons for having abdominoplasty?

What are the cosmetic reasons?

Do you advise surgery?

What is your experience and special qualifications for performing this procedure?

What complications should be considered?

How will the surgery be performed?

How long will the recovery period be?

What degree of success can be expected?

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