 Good morning everyone. I hope everyone had a great weekend. We have this lovely patient here We're going to do a tummy tuck and lipo contouring I'm really excited for her because she has a great shape and Once we do the tummy tuck and the lipo it's going to look fabulous Let's take a look at our patient today So you can see that she has some stretch marks down here You know the only way is I always say to get rid of stretch marks is by taking them out We're going to do a low writing scar which is going to be low and come up high So that way it pulls on her thighs. You see that you see how it's going to pull up So we're going to go low and then come up and it's going to put some tension and pull up her thighs our goal is to remove this Elliptical incision here. I'm marked out. I'm going to take all that out. This point is going to reach down here She has some skin laxity up here. We're going to contour this area by Taking it all the way into her bones And we're going to lipo the pubic area pubic area is very important if you have a tummy tuck you'll notice that sometimes when you do gain weight It goes to the pubic area afterward because if you don't remove the fat there They're very rich fat cells there that will be large if you gain a little bit of weight So we're going to prevent that from happening. So she's going to get a nice contoured look Very cinched in waistline. Most of the stretch marks down here will be gone We're going to do an internal corset, which is going to tighten her muscles She's going to look fantabulous. Look at her from the side. All this is going to be flattened out as she turns around We're going to cinch in her waistline and This is going to be flattened out and she's going to look fantabulous Look at how much skin I'm going to take out all the way to the black part from here to here It's going to be nice. Stay tuned So the first thing I like to do when we do the tummy tuck in lipos is to do the liposar To contour the waist and make it as small as possible So we're starting with the liposar first. I think I'm going to get a good amount of fat out of her We'll wait and see how much is in the bucket Look at how much I took out. Now she has more cinched in waist We took out about 800 or 1000 cc. Let's take a look at the fat So now at home you guys can see the difference between the left which was performed as opposed to the right that wasn't Huge difference. Okay, so we haven't even started the tummy tuck just doing the lipo contouring Once I take her look at how small her waist is going to be. This is like very thin very thin Brought them in here. She looks very good We already took out two liters of fat from the abdomen and the pubic. So we start First by isolating the belly button. Here it is going around it looking beautifully my beautiful and So handy assistant assisting me today Look at that. Wow Next we I always place the scarf where there's Hair follicles if it's up here. It's too high Your tummy tuck scar should be somewhere where you have hair follicles if I go here It makes the surgery much easier, but it's going to leave her a scar that's visible If it's down where the hair follicles are it won't show in a bikini number two is the There's a little straight line and then it hooks up. So it pulls up on your thigh So it kind of gives you a little bit of a lift It's not a thigh lift, but it does give you a little bit of a tension lift laterally So we're going to start with the low riding scar. Here's my my marks And slide right through them beautiful beautiful So this is a fascia we get to first before we get to the muscular fascia But we open it. This is the one we when we close we're trying to get that as we go deeper There's the real muscular fascia right there. You see right in here watch See how There it is speciculates the muscle So when we know the muscle is right underneath it the word of the day is Pesticulation in the right layer like we are right now. You could see how god likes plastic surgeons He developed a layer so we could go that's really bloodless and we could just go through it and get to where we want to be So i'm going to teach you guys some things here when someone has a six pack You're seeing these lines and you could see her muscles come in like this. This is the rectus abdominis muscles You could see the striations going across here. That's what creates the six pack So you have to be thin enough for this to be visible So imagine you have to be probably half a centimeter or so to see these Lines when they do it through lipocontoring. It's just causing a defect in the skin You're not seeing the actual lines Now what we're going to do is when we pull up you could see that the muscle has separated You can see how this linea alba has become about a centimeter a centimeter and a half to two centimeters So i'll bring this muscle to this muscle this muscle to this muscle and do the internal core set for her at this time And the other thing is look at the belly button. The belly button is attached. It doesn't move down It doesn't move up It'll stay at the same level because it's getting the blood supply from underneath So it can't be moved unless some doctors do a floating belly button Which they caught the stock and move it. I don't like it because it makes it Disproportioned so again the first time we do it we do figure of eight to approximated We'll do a double layer closure, but look at how this folds it inside. It's called imbrication where we We Fold it upon itself. Okay Let me hold on let me get this right All right ready So you can see how it's spread out. It is and with this it's going to become together watch push push boom Nothing is cut. It's just folded upon itself So that's very important a lot of people say oh my god I don't want a tummy tuck because you're gonna cut my muscle. No muscle is cut All I'm doing is bringing it together So we did the first layer. This is the second layer. The second layer is continuous continuous means the stitch starts And runs like a shoelace all the way down What you can see is again i'm I'm folding it one more time on top of each other. Watch this You see how it folds on top of each other so the muscle even gets tighter So you have a two layer system of closure Which makes it doubly tight So we've tied her abdominal muscle internal corset times two one interrupted one continuous It's nice and tight. You don't see any division It's nice and flat and you can see the outside of it But the inside is nice and tight and together So now we're going to go to the next step of cutting off the excess skin So we've measured and this is about 21 centimeters I measured twice so we could do replicated on the other side So we're going to cut this out and then replicate it on the other side I measured this side it's equivalent to the other side so we're going to go ahead and Cut this side To the desired markings So I check where the belly button is and I Bring it out on the skin. So here belly button is going to be right in here So I know it exactly where it's going to be It's going to be two thirds of the way from the sternum and one third from the pubic So here we are for the reveal. Here's her old belly button. You can see the circle This here was her Private ear your pubic. You can see the hair follicles. Look at how much skin we took out Almost the length of what she has left. Watch this. Here we go. The refill. Oh my god, beautiful Look at that. She looks fabulous