Drains, which are flexible silicone tubes that are connected to a reservoir known as a bulb, allow for the egress of fluid which could accumulate between the skin-fat layer and the underlying muscle. They have been used in abdominoplasties (tummy tucks) for decades for the purpose of minimizing the incidence of fluid accumulation, known as seromas. Most commonly, two drains are placed for a full tummy tuck whereas only one is used for a mini tummy tuck.

There are some plastic surgeons who don’t use any drains – touting a suturing technique that they feel makes their usage unnecessary. This approach hasn’t convinced most plastic surgeons yet and so it is presently employed by a minority.

The drains are typically placed either in the vicinity of or within the abdominal incision itself and remain in place until 24 hour drainage totals decrease below a particular numeric level. The amount used as the metric does vary among physicians. Many use a number of 20cc or less over a 24 hour period for 1 – 2 days; others consider up to 30cc or even more within a 24 hour time frame. There are even some plastic surgeons who largely ignore the drainage quantity and, instead, use the element of time – removing them after a fixed period such as a few days or at one week.

How long can you expect that the drains will be left in for?

Unfortunately, the duration of time that the drains will remain in place after a tummy tuck is extremely variable among individuals and can’t necessarily be predicted prior to surgery unless, of course, a fixed period of time is used. I use relatively strict criteria before the drain tubes are sequentially removed in my patients and this clearly seems to minimize the risk for the development of a seroma. Most of my patients will have both of their drainage tubes removed by two to three weeks; many in less than a week and a half. It is the very rare patient whose drains remain in place for more than four weeks.

The down side for either taking out the drains too soon or failure of the approach that doesn’t use drains is the undesirable accumulation of fluid deep to the skin (seroma). This problem needs to be treated either by repeated (that is, on multiple occasions) aspirations of the fluid which entails the sticking of a needle into the tissues in order to remove the fluid or even the re-insertion of another drain. On rare occasions, surgery may be required to address what can become a fixed and deforming accumulation of fluid.

For more information on a tummy tuck or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A very common question that women have regarding activities following a tummy tuck is: “When can I do everything that I want to do?” This also can be asked as “When will I not have any restrictions of my activities?” Interestingly, if you ask around, you will obtain quite a diversity of recommendations. The answer can be very important as you want uneventful healing and no complications. The guidelines that I have for my patients are based not only on science but also on years of experience as to what truly works and what is safe.

My patients are instructed to begin ambulation immediately following their abdominoplasty for many reasons with the most important one being to try to minimize the risk of blood clots developing in the legs which can then also migrate to the lungs resulting in what is called a pulmonary embolus, a condition that can occasionally be fatal. Usually, you can expect to feel fairly tired and weak for at least a week or more, sometimes even up to several months. This gradually improves with time, much faster in some than others.

You can resume normal, non-strenuous and non-vigorous activities as tolerated. That means casual walking but not running, driving when you feel comfortable and are not on narcotic pain medication and no lifting greater than around 10 – 15 pounds. At around three to four weeks you can walk fast but not run a treadmill and also ride a bicycle, preferably a stationary one.

At eight weeks following your tummy tuck, you are allowed to engage in all your normal activities as tolerated and without restrictions unless otherwise advised. This includes weight lifting, sit-ups, full aerobic exercising, horseback riding and most sports. If you have any questions about certain esoteric or extremely strenuous activities, please ask.

For more information on tummy tuck surgery or on any other plastic surgical procedures that I perform, or to schedule your free consultation with me, please call my office at 480-451-3000. You can request whichever location is more convenient for you – Scottsdale or Glendale.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Dr. Turkeltaub on Rise of Tummy Tuck Procedures in Arizona

144,929 tummy tuck procedures were performed in 2010, making it the fourth most popular cosmetic enhancement procedure, according to the latest statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Dr. Steven H. Turkeltaub, a board-certified plastic surgeon in Arizona, discusses the 13.3% increase compared to 2009, as well as the fact that a majority of Americans now approve of cosmetic enhancement.

More than 9.3 million cosmetic enhancement procedures were performed in 2010, which is a 9% increase from 2009 according to the most recent data from the American Society for Aesthetic Plastic Surgery (ASAPS). One of several reasons for this increase is an even greater acceptance of cosmetic surgery, which has become increasingly mainstream, says board-certified plastic surgeon Dr. Steven Turkeltaub. He adds that a slightly improved economy following a deep recession with pent up demand has played a significant role in this increase as well.

According to the ASAPS study, more than half of all Americans now approve of cosmetic enhancement. The tummy tuck, also called an abdominoplasty, is a popular procedure at Dr. Turkeltaub’s Arizona plastic surgery practice, a fact which is also reflected in the ASAPS report. The abdominoplasty was performed 144,929 times in 2010, which amounts to a 13.3% increase over 2009. Dr. Turkeltaub says one reason for the increase in this particular surgery could be the growing popularity of the mommy makeover procedure. The mommy makeover is a combination of procedures that can include not only a tummy tuck, but also a breast augmentation with or without a breast lift, a breast reduction, liposuction, and a variety of nonsurgical treatments.

Dr. Turkeltaub says Americans simply want to look as young as they feel and a tummy tucks is one of the procedures in the right person that can provide these results. If the economy begins to show more significant improvements, Dr. Turkeltaub says he expects the number of patients seeking a tummy tuck along with other cosmetic plastic surgery procedures to continue to increase substantially.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub earned his medical degree from Boston University and the School of Medicine. He completed his general surgery residency at the University of Miami/Jackson Memorial Hospital and the Northwestern Medical Center, followed by his plastic surgery residency at the University of Massachusetts Medical Center. Dr. Turkeltaub is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, and the Arizona Medical Association. Continuing medical education is also extremely important to Dr. Turkeltaub because it allows him to stay on the cutting-edge of plastic surgery.

The Arizona Center for Aesthetic Plastic Surgery is located at 10290 N. 92nd St. Ste. 207 in Scottsdale, AZ 85258, and can be reached at (480) 451-3000, or found online at either turkeltaub.com or the Plastic Surgery Arizona – Dr. Steven Turkeltaub Facebook page.

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“I am really unhappy with the appearance of my tummy and want to have a tummy tuck now. I am not planning on having any more children at least in the immediate future. If I do decide to have more children later on, will my having a tummy tuck present a problem?”

A corollary to this which I have also been asked is:

“If I have a tummy tuck now, will it affect my ability to become pregnant in the future if I change my mind?”

Let me answer the latter question first. A previous tummy tuck will have absolutely no affect on your ability to become pregnant. This procedure addresses the excess and lax skin as well as the stretched out underlying muscle layer, providing you with a much more attractive and rejuvenated appearing abdomen. There is no involvement of your vagina, uterus or ovaries.

Then again, the fact that you are even more attractive and alluring following your surgery may increase your likelihood of becoming pregnant if that is your goal!

Regarding the first question, a previous abdominoplasty should have no impact on a future pregnancy including on the health and development of your baby. Your abdomen will stretch out again during the pregnancy and then tighten, at least to some extent, in the post-partum period with the final appearance affected by multiple factors.

Ultimately if you decide that you would like to improve the appearance of your abdomen again, various options can be considered at that time including either a secondary tummy tuck or even a mini tummy tuck.

If you would like more information regarding a tummy tuck in Scottsdale or on any other plastic surgery procedure that I perform or if you would like to schedule a free consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Should an abdominoplasty still be performed?

Will there be a noticeable difference?

When contemplating a patient’s request for a tummy tuck when her/his weight substantially exceeds the ideal body weight, two of the crucial considerations are safety and whether or not a significant improvement can be realized with the surgery. For such a patient, I will have a detailed discussion about the possibilities of making additional but serious attempts to lose at least some of the excess weight. To be successful, one must both reduce caloric intake as well as greatly increase the level of physical activity including working out.

If a person is at a reasonably low surgical risk and I am sure that she/he will see a quite significant and positive improvement from an abdominoplasty, then I will recommend it to improve the appearance of their abdomen.

The following patient who underwent a tummy tuck exemplifies this. Though not anywhere her ideal weight, she was able to realize a marked improvement not only in the appearance of her abdomen but also in her general presentation and self-esteem. She was quite ecstatic and appreciative of the outcome.

Before tummy tuck - frontal view

After tummy tuck - frontal view

Before tummy tuck - side view

After tummy tuck - side view

Before tummy tuck - oblique view

After tummy tuck - oblique view

For more information on tummy tuck surgery in Scottsdale or for any other plastic surgery procedure that I perform, you can call my office at 480-451-3000. A complimentary consultation can be scheduled at that time as well.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Obesity, therefore, has few positives associated with it unless one uses a little creativity…

In a bizarre story, two women recently deployed their prodigious layers of fat and large pendulous breasts for evil purposes – to steal clothing from a store. They attempted to hide several pairs of boots, gloves and other items under their breasts and in body fat folds in a failed shoplifting attempt. The purported total value of the items sequestered was around $2600 – an amazing amount particularly since this occurred in a (discount) T.J Maxx store and not a Neiman-Marcus or Nordstrom.

I do see many people who have lost a significant amount of weight, often 100 pounds or more. Some have achieved their success by diligent dieting and exercise. Others pursue weight loss procedures such as lap banding or gastric bypass surgery. Nevertheless, what they are left with are massive amounts of excess skin that is circumferential and often hangs down in layers. This less than attractive sight is often not what they had expected to be left with following their successful weight loss.

Fortunately, there are a variety of plastic surgery procedures that can effectively address this post massive weight loss appearance problem and which I offer to my patients. They can be performed in a variety of combinations depending on each person’s particular needs and desires. Some of the more common of these surgical procedures include a tummy tuck, belt lipectomy (circumferential removal of skin from the abdomen and back), inner and outer thigh lifts, breast reduction, and arm lifts (brachioplasty).

These plastic surgery procedures not only can help patients obtain a much more attractive appearance and body contour but can also allow them to be much more active with little or no physical restrictions (as had been related to their weight or excess skin previously). My patients have indicated that they have had a marked improvement in self-esteem following surgery and a much more positive attitude and outlook.

If you would like to obtain information on plastic surgery procedures that can help address the excess skin that you have been left with following massive weight loss such as for a tummy tuck, belt lipectomy, breast reduction, or an arm lift, please call my office at 480-451-3000. We would also be happy to schedule a complimentary consultation for you if you desire.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Can religiously performing sit-ups or abdominal crunches miraculously tighten your abdominal wall, reduce the circumference and protrusion and address the lax skin?

Of course not!

The rectus abdominis muscles will become thicker and firmer but the muscle laxity and separation of this layer will not be reduced. Furthermore, there will be absolutely no impact on the excessive amount of stretched out skin.

Surgery in the form of a tummy tuck will be necessary in order to tighten and contour the underlying muscle layer as well as the overlying lax skin. The aesthetic results from this plastic surgery procedure can be quite dramatic and rewarding.

Abdomen before surgery - frontal view

After an abdominoplasty

Before surgery - oblique view

After an abdominoplasty

Before surgery - side view

After an abdominoplasty

If you would like additional information on a tummy tuck (abdominoplasty) or any other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What is the etiology of this protrusion and how can it be treated? The bulging is caused by laxity and separation of the underlying muscle layers that are most often the consequence of pregnancy, considerable weight loss, aging or a combination of these factors. Most commonly, the increased separation between the rectus abdominis muscles, particularly in women who were pregnant, is responsible for the majority of the bulging. At times the separation can be so significant and the tissues so thin that a ventral hernia develops further exacerbating the deformity. Unfortunately, all the sit-ups in the world will not bring these muscles closer together again – only surgery will.

The solution involves the surgical retightening of the muscles of the abdominal wall in a horizontal direction to variable degrees in order to obtain more feminine contours in women or masculine ones in men. An analogy can be made with tailoring clothes by using hems and pleats so that they fit better. With the skin tightened to firmly drape over the sculpted muscle layer, an alluring appearance can be the result.

Abdomen before surgery - frontal view

After tummy tuck surgery - frontal view

Abdomen before surgery- oblique view

After tummy tuck surgery - oblique view

If you would like more information on an abdominoplasty, liposuction or any other plastic surgery procedure that I perform or to schedule a free cosmetic consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Following pregnancy, many women lose some firmness, shape and volume of their breasts which may also become droopy and develop stretch marks. These changes can be further exacerbated by breast feeding with the duration and number of children affecting the outcome. A few women actually have a net increase in breast size though the shape and positioning usually suffer. Procedures that can effectively address these changes include a breast augmentation, breast lift with or without a breast enlargement and a breast reduction.

Permanent changes in the appearance of the abdomen following pregnancy are quite variable among women and are affected by a multitude of factors. The often is some residual degree of laxity of the skin and the underlying muscle layer along with changes in the distribution of fat. Cosmetic procedures that could improve the appearance of the abdomen include a mini tummy tuck, a standard tummy tuck (abdominoplasty) and liposuction. Liposuction can also be performed elsewhere including the hips, thighs, knees and even back.

The combination of the appropriate cosmetic procedures of the breast and abdomen with or without liposuction performed at one surgical setting constitutes the “Mommy Makeover”. Of course, other procedures such as eyelid surgery can be done at the same time if warranted and indicated. This rejuvenation of one’s body back to a more desirable shape can do wonders for your psyche, self-confidence and sense of attractiveness.

If you would like additional information on breast augmentation, breast lifts, liposuction, tummy tucks (abdominoplasty) other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office in Scottsdale at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Success, finally! Celebration? Maybe not quite yet. Despite the massive weight loss that was so difficult to achieve, what many people didn’t anticipate was the permanent consequences on their bodies of first gaining then losing this sizable poundage. The figure that they envisioned following all this effort is not what they are seeing in the mirror. Instead of being slimmed down, contoured and generally smaller, most are left with unsightly deformities consisting of an excess of lax, irregularly contoured stretched skin that frequently cascades in rolls creating hygienic issues and an aesthetic nightmare.

Which areas are affected? From the face on down, the sequelae from massive weight loss may be seen. There is considerable variability among individuals as to the severity and areas that are most affected. Common areas include the abdomen, buttocks, circumferential trunk, inner and outer thighs, breasts, arms and even face and neck.

Fortunately, cosmetic procedures have been designed and refined that can address essentially any and all deformities related to post massive weight loss deformities. Examples of these procedures include abdominoplasties, thigh lifts, belt lipectomies, breast lifts, breast augmentations, arm lifts, face lifts and back lifts. A strategy for body contouring can be uniquely tailored for your individual needs based on your deformities and goals which could be determined at the time of  consultation.

If you would like to obtain additional information on body contouring surgery such as for a tummy tuck, belt lipectomy, breast lift (mastopexy), breast augmentation, arm lift and face lift, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona