 saw here in Beverly Hills. Welcome. We have our beautiful patient here. She looks great already, but we're going to make her look fantabulous. She's lost weight and she's here for a tummy tuck. So I know she's lost weight because when I put my hand in there I can see she has a lot of skin. So what we're going to do is tummy tuck is a skin removal procedure. So what we're doing basically is we're going to remove all this skin with a low writing incision that's low and comes high so it elevates part of her leg. Watch. You see that? It elevates part of her leg. Then we're also doing lipo because she has some fat here and we want her to cinch her waist in more. So lipo is for the fat. For the scar we're going to do a tummy tuck. She has a vertical scar. Many countries they use a vertical scar rather than a horizontal for C sections. When we do this, we will remove this for her so she can really wear a crown top or bikini without having this vertical scar. So it's going to be a nice case. She's a great patient, nice patient, very lovely. She's done a lot of the work of losing weight. We're going to contour her and take off the excess skin. It's going to be a fun day. Stay tuned. So we did some lipo contouring already. As always we isolate the belly button where it is because it's on a stock. So you can't really move the belly button to leave it where it is. It comes out through a different part of the skin. So here we are starting our beautiful case on this young lady. Then we're going to do a low riding incision starting from here. Here's our incision. You can see it's angulated so there's good tension placed so it brings up her private area. And then we start with the bovi. The bovi or the handheld cotterizer. It cuts the tissue and coagulates the blood vessels all at the same time working magic. So this is the fascia of the muscle right here. This white stuff, it's the rectus fascia and all this is scarring from her previous c-section. It was done overseas so it was a instead of being a horizontal it was a vertical one. So you see all this scar tissue it's caused. It makes the surgery a little bit more difficult but here Dr. Saul is up for the challenge. So we cleaned up the underneath the skin all the way up to the belly button. So now we're going to open her up because we know we could take the skin out. So here we are dividing it. This was her previous scar. It's going to be all removed. We're going straight up to the belly button. There it is. Okay so you guys watch this. See how the muscle contracts? That's your six pack muscle right there. That the fascia is what covers the muscle. Every muscle in the body has a covering of a fascia except a couple. We won't go to the exceptions but 99% have fascia. So we leave the fascia on because that's the strength of the muscle. And what you see me marking off is what I'm going to implicate on top of each other. I'm going to go from here to here figure of eight and put these together. You could see up here look at that's the diastasis. You could see when I pull it up you could see the separation. There's the edge of the muscle. Here's the edge of the muscle. Here's the edge. Here's the edge. Before childbearing these were together. Now they've separated. Let's show you a sample of what we're going to do. We're going to go in from the side. Get the edge of the muscle. Go through here. Get the other edge. What we call this is a figure of eight stitch because it looks like a number eight. And we're not getting the muscle. It's this white sheet is so strong that all we're putting together is the sheet. We don't need the muscle. If we suture the muscle it'll rip right through the muscle. So you can see how it looks like a number eight. There it is. So what we do is we tie it and watch as it folds on top of each other. Now we're going to do one up there. Let's do one up there. So again the edge of the muscle we could see here. So we pick up the edge, the fascia. We approximate it to the other one. We get the other edge and just remember you don't want muscle because muscle to counter it doesn't have any strength. It'll rip through. So we just want the fascia. Not only do I do this I do a two-layer closure. We'll see in this video. Here's a look at how much it gets folded inside of you. We call that embrication because the tissue gets folded upon it. Look at all this. There it goes back together. So you could see how we're going to put all this back together and make her stomach tighter. So you could see again it looks like a number eight. It imaginates the tissue. And all we do is we this is a permanent suture. So it stays there the whole time. It doesn't change anything under inside. You could still get pregnant. I don't recommend getting a tummy tuck if you're thinking about getting pregnant. But it does sure help increase the rate of pregnancy. So this is the belly button. A lot of people ask does the belly button get cut off and replace? No. Because the belly button is attached to a stalk. You need to keep the fat around it and the blood flow comes from underneath. It never gets removed, detached. Some people do a floating belly button but I don't like it. I always have it attached to the stem and we bring it out through the skin. So it's always where it's supposed to be. It doesn't get pulled down, pulled up. We just leave it right at the level. So with the first layer of suture you remember we had a gap about three centimeters. It's approximated so it's tighter. But yet I always do a two layer closure because you know what? We want to make sure our patients get the best results. So this is the second layer. You can think of this as an internal core set. Look at how tight that makes it. You always have that internal core set on. Watch. Look at it. Boom. So look how tight and nice the stomach is compared to before. Before it was very loose. Now it's nice and tight. She has two layer closure internal core set and now we're going to excise the excess skin and we're going to be close to finished. So what we did is we did a low cutting incision. We lifted everything all up the way to the sternal notch which is right here off the sternal bone. Now we have all the excess skin ready so we're going to cut off the excess skin. The muscle is nice and tight. She's all nice and dry. We're going to go to the next step. So we measured this is 21 centimeters and we're going to cut right along our line right there. Perfectly measured. Measure twice. Cut once and right on the dot. Here we go. We measured the same distance on the left side. The excess skin. We measured twice and we're cutting once. So people say how do you determine the belly button? The belly button I know exactly where it is as I showed you before. It's on a stop. It's right there underneath it. So I'm going to make a new incision and just bring it up through the incision. Usually the rule of thumb is two-thirds from the sternal bone and one-third from the lower incision. Two-thirds and one-third. But I can put my finger in here. I know where it is and I'm just going to bring it right through the skin. So I just want you guys to see this was the vertical scar. This was where her belly button was. This is her pubic area where she had some hair follicles. So this was her stomach. And here's the reveal. Look at this beautiful stomach. No stretch marks. No scars. Bikini ready. Ready to go for the summer.