 Hi everyone, Dr. Saul here in Beverly Hills. Today I'm going to lecture you guys on mini tummy tuck and tummy tuck, otherwise by another fancy word abdominal plastic. So tummy tuck and abdominal plastic are interchangeable and they're just fancy words used by your surgeon to talk about excess skin excision. That's all it is. It's excess skin excision. No more, no less. So let's go to tummy tucks. Why do we need them? During pregnancy, you get sagging skin, your muscles open up, so you need to put them back together, weight loss. Different things causes the abdominal skin and the muscle to stretch out and that's when tummy tuck abdominal plastic comes into play. So before we go talk about mini tummy tuck or full tummy tuck, there are actually five different ways we could describe tummy tucks. There's the mini abdominal plastic. The thing I want to point out is I have this question asked a lot from me. Look at the mini abdominal plastic incision. It goes from side to side. Look at that. It's almost as the full tummy tuck. This is one cartoon or pictorial which actually addresses how long the incision is. A lot of patients come in and think mini tummy tucks means a mini scar. That's not correct. That's the whole point of our lecture is that a mini abdominal plastic incision is almost as long as a full abdominal plastic. There's also something called the umbilical float. Umbilical float is when they cut the umbilicus and float it down. I don't like that. Never use it. It throws off the proportionality of the abdomen. For big patients which have a lot of weight loss, we do what's called the floor deli. You can see it's right here floor deli excision of uh skin. This is people that have also excess not only on the vertical but on the horizontal so it needs to be brought in in each way. It's also called the inverted T and then the ultimate one is the belt lipectomy which it goes all the way around circular. So another pictorial to show the types of tummy tuck. This is a wrong pictorial. They showed it that they started that the incision goes all the way top and they start fixing the muscle above the belly button. By definition, when you're talking a mini abdominal plastic, you do not go above the umbilicus. So only thing that gets fixed is below the belly button. Number two is look at the incision they made. This is a wrong pictorial. The incision is longer and I'll explain to you why. This is a full abdominal plastic. We go all the way from the top to bottom due to internal corset. Extended abdominal plastic is for people that have extended skin. We'll go over that and this is for a body lift which goes all the way around. You can see from front to back which is also called the belt lipectomy. Another pictorial I found on the internet which is again wrong. Look at what it says short scar mini mini standard extended. When you're talking about these mini ones, you're talking about such a small skin removal that's not even worth it. Remember when we're talking about mini or standard or extended, we're also talking about the vertical not just the horizontal depending on how high we go. So here's one key definition I want you guys to understand. When we talk about mini against full tummy tuck, it depends on if anything is done to the belly button. You can see this the different scope of things. If you're doing the mini, you're just removing this little piece of skin right here. You see that? Nothing needs to be done to the belly button. But if you're doing the full tummy tuck, the thing that has to be done is the belly button gets isolated. The skin is brought down and the belly button is brought out through the new skin. So let's go over it again. Full tummy tuck. It involves the upper lower abdomen contouring, trimming excess tissue and tightening the abdominal muscle with the internal corset. Mini tummy tuck. Even this cartoon got the incision right at least. You could see the incisions are almost the same. It's for lower abdomen below the belly button and removal of tissue. Again, another incision that was depicted wrong in the internet. They put this little red line as a mini abdominal plastic. That means that you could literally remove this much skin. A real mini abdominal plastic is this. This is a C-section scar. Not a mini abdominal plastic. So one more way to look at it is a full tummy tuck and a mini tummy tuck. For the full, you could see that the muscle is, the skin is lifted all the way to the sternal notch and we clean it out and we pull it down and we tighten the muscle. And here's the scar. For the mini, you could see the skin elevation is only to the belly button. There's the belly button. There it is. And you could see the skin excision is very minute and it's way below the belly button. And we could only fix the separation below the belly button. You can't go above. And the scar is depicted wrong. This is the true scar. So again, mini tuck versus, I just, I just went through and took out these pictures because I always get this consults of, oh, I just want a little scar. Let's do a mini tuck. That's not the definition. So a mini tuck, do you see how much skin you could remove? It's such a small little bit and only the internal corset is done in the lower quarter of the incision. And this is the skin removal. That's a C-section, not a mini tuck. For a real tuck, you could see that the belly button is isolated and you could see the skin excision with the fat attached to it. And then the muscle is brought together and the scar is closed and the belly button is closed. So here is again, you could see the isolation, the removal, the muscle together and the closure. So what's the separation of the muscle? Remember when people gain weight or have a child, the abdominal cavity where, where in the uterus where the kid, where the baby is growing, behind you you have the sacral bone. So there's no expansion posteriorly. On the lateral, you have your pelvic bone. There's no expansion laterally. The only way you can expand which soft tissue is the abdomen. And depending on what type of pelvis they have, usually females have four different types of pelvis, depending how deep or narrow your pelvis is. The only way you can accommodate the pregnancy is by separation of the muscle. Usually before pregnancy or weight gain, the muscle is as such. That's why we call it a six pack, eight pack. They're nicely together. The linear elbow is very thin altogether up and down. But what happens during pregnancy or weight gain, because it's just, it's very thin, it can expand. Look at the linear elbow expansion all the way up and down. On this patient, it's only the lower half. So it's open below nasal, navel diastasis. Then this one is open above. And this one is completely open, not, not only vertically but horizontally too. So there's different kinds of diastasis. This is a patient laying down. You could see this is the linear elbow I was talking to you guys about. This is a patient laying down. The linear elbow, you could see it's very, it's only like probably a centimeter or so normally. And you could see this is the rectus muscle, this is the rectus muscle, and it's wrapped into fascia. So this patient is laying down. During pregnancy or weight gain, look at how long the linear elbow becomes, as opposed to this one centimeter, it stretches out. So you don't have the, the straight wall, you have more domed shape abdomen. So what we do during surgery is that we placate it and make this smaller. We don't cut it, but we fold it on top of each other. So what's the internal core set and everything I keep talking about? So this is the normal rectus, no gap. Everything is nice and tight. Look what happens when pregnancy or weight gain to accommodate the pregnancy or to accommodate excess fat, the muscle is separated. You see the gap, the rectus abdominis muscle separates. Now two things happen. Not only does this separate, but it also pulls out this way. You could see how she has a very narrow waistline here, but with this loosening up, it, it pulls out the waistline and becomes more of a rectangle rather than an hourglass. So what do we do? This is a nice depiction I found that it shows how we bring the muscles together. Basically this is a suture tie. We bring the edge of the fascia of the muscle to the edge and we close it up, up and down. I call it the internal core set. So this is what it looks like at the end. It goes all the way up and down. I usually do this twice in the case. I put interrupted like this and then I run it as a backup with another suture. So I do this, I do this step twice to make sure that if the patient has a strong cough or it's lit something heavy, the suture doesn't just pop out. Viewer discretion. If you're, get gory, step aside. So look, this is a, you could see a diastasis right here. You see how it's popping? Not necessarily can you see that on everyone, but your plastic surgeon should examine you and tell you if you have it. She has an open diastasis here and look at the internal core set. You could see the sutures all nicely from above, from the sternum all the way down. It's all placated and it's like a drum. You can probably bounce a quarter off of that. So again, full tummy tuck addresses upper and lower and correct muscle separation. Lini only addresses below the belly button. I don't believe in the smaller incision, you do have shorter recovery. Again, in a cartoon, their depictions are more correct than the actual other pictures they show that the cartoon shows you that the incision goes all the way across. It is minimally invasive for a mini tuck, but the incision, people want a shorter scar. Mini tummy tuck does not necessarily mean smaller scar. A test for you guys. Do you guys think this is a full tummy tuck or a mini tummy tuck on the internet? Actually, they had put this as a mini tuck, but obviously if you've been listening, you know it's not, because you could see the incision around the belly button. So I want you guys to see, look at that excess skin. If I'm going to take off this excess skin, if I make a short incision this big, how am I supposed to get the rest of the skin out? So in order for me to be able to do this correctly, my incision, even if it's a mini tuck would be from here to here so I could get all the excess skin, but I could tell this is a full tummy tuck because look at the skin quality here and look at how stretched out it is. So actually this is a full tummy tuck. They had marked it incorrectly on the internet as a mini tuck. Another cartoon depiction of a mini tuck, which makes me laugh because look at how much, look at what they, they tried to portray as a mini tuck. That's the incision. That's a C scar. That's not a mini tuck incision. How much skin can you remove from that? Here's a couple of mini, mini tucks that I found on the internet to share with you guys. It's not mine, but I found them on the internet just sharing them. Look at this. This is a mini tuck because first of all, there's no incision around the belly button, so it's the natural belly button and they only address the skin down between the belly button and the pubic area. The rest of the abdomen, they did not touch. Here's another one. They own, the belly button is the same. They only did the lower between here and here. So this is another mini tuck. So this is a farce. This is not correct. So a full tummy tuck candidate, you can see how the abdomen is domed shape. Do you see that? And here's another patient that has a mini tuck candidate, but you can see the top is flat. The dome is only on the bottom. This, obviously it's a full tummy tuck because you guys know the secret now. All you need to do is look at the belly button. If the belly button has been cut, then it's a full tummy tuck. If it was a mini, none of this would be addressed. The patient would still have stretch marks and wrinkles above the belly button because a mini tuck addresses below the belly button. Here's another mini tuck. I want you to just appreciate the extent of the incision. It's almost from hip to hip, just a little shorter because they tried to save the tattoo, but you could see the redness. It goes all the way across. Here's another mini tuck. How do I know it's a mini tuck? First thing, I look at belly button. I could tell this is the natural belly button. Look at the shape. It looks exactly the same, but look at the scar. It goes from one side to the other. That's not a mini incision. It's a mini tuck, but it's not a mini incision. Another one. This was a mini tuck. The only place that was addressed was the excess skin below the belly button to the pubic area, but look at the extent of the scar. It goes from hip to hip because he has excess skin. If you stop the incision here, he's going to have skin hanging laterally. You have to chase the end until you get all the excess skin. A full tummy tuck, remember, the incision goes high, low, high. We're removing all the excess skin. We're doing the internal corset. We're bringing out the belly button through a different hole, and that's a full tummy tuck. I'm going to go through. These are now my pictures. This is a young lady. She was 26. She came in. She said, I want a lipo. I said, why do you want lipo? She said, I don't like the skin hanging up here and this. I don't feel comfortable. And I told her, in order for me to be able to flatten you out so you feel more comfortable, we need to do a full tummy tuck. She had lost weight, about 60 pounds, but the skin stretch was still there. You could see down here and up here. But interestingly, she had some moles. Follow the moles, one here, one here, one here. From the stretch, you could see this big one came all the way down here. So all I did was, first you could tell it was a full because of the belly button. And you could see the skin above the belly button was addressed. Here she is further back. You could see that it looks very natural. Here she is from the side. You could see the hooding of the above the belly button. It's gone. Now it's a smooth and she has some etching done in the middle. And here she is from the side, from the side. And there she is. Okay, this one is an extended tummy tuck. Why do we call it extended? Because look at how far I have to go to get the lateral aspect. So her scar goes all the way where I chased to get the excess skin. Of course, I always put my scar down low. You could see her belly button, but you could see all that excess skin is gone. The stretch marks are minimized to the lower half. They're not going above the belly button anymore. There is the belly button. You see no scars here. You see all these stretch marks. They will all move down. So here she is laterally, all that excess skin. So her scar is probably till right here, which would be right there. But it's always down low below your bikini. Here's another extended tummy tuck. You could see she has, she's very small petite lady, but she has a lot of skin and we were able to take it out. And there it is. You could see her excess skin ends there. So her incision, I bet you underneath the garment goes over there. There she is. There she is on the core. Here's another patient. First of all, you could see she has excess skin up top. She has excess skin on the bottom. She has a nice belly button. She has some contouring. So this was a full tummy tuck. Here's another patient. Whenever you have the, I call it the unhappy belly button, you see the frowning belly button coming down. There's special attachments right here. What happens is that the skin is falling down and it's causing a hood on top of the belly button and it's not allowing the skin to really fall down. So once I see that, a lot of those patients are going to require a tummy tuck to give them a nice belly button, a nice contour. We did some lipocontouring laterally. She's in a string bikini. You can't see her scar. Her scar went from probably here from hip to hip, but it's down low with lateral tension. It picks up actually a little bit on the thighs. You could see her thighs look a little better. It's because the lateral tension pulls it up and you could see most of her stretch marks are gone here. Here she is lateral there and here she is from the back, just showing a little bit of the lipocontouring. This one is a mini tuck. Okay. I don't usually do it. It's very rare cases. I do mini tucks, but this one is a mini tuck. Why? First thing was the patient wanted some quick fix and number two is that she actually qualified for it because you could see her skin above the abdomen is pretty good. It's pretty tight and there's no stretch marks. And here you could see that. You could see I pulled down the belly button. You could see I excised here and a little bit of that, lowered that a little bit. So her scar is probably from somewhere here to here. I could see the tattoo right there. So in something like this, we removed that. You see how it's hanging? So it was probably something like that we removed. So it's not a C-section scar, just a little bit bigger. Here she is from the lateral position. You could appreciate it better. We just took off what's hanging in the lower. Basically that's it. Okay. We went right before the tattoo, after the tattoos. You could see the tattoo is there and we just took off the excess skin. That's all we did, just that lower half. Here she is fully. You could see she has a pretty straight upper abdomen and we just contoured the lower. There she is again. There she is. Thank you very much for participating and now I expect everyone to be able to tell every picture on Instagram what's a mini tuck and what's a regular tuck. Thank you so much.