"The True Form Tummy Tuck® - A New Approach To Abdominoplasty"

This chapter originally appeared in the book, Best-In-Class Surgeons – Procedures and Outcomes in Plastic Surgery (2019)

The sensual beauty of a svelte abdomen is a sought-after feature that has catapulted abdominoplasty, also known as a ‘tummy tuck,’ into becoming one of the world’s most popular aesthetic procedures. Between 2005 and 2015, the number of abdominoplasties performed by board-certified plastic surgeons increased by over 100% in the United States, moving it into the top 5 most requested cosmetic procedures in the country. Leading the charge for its demand are women opting for plastic surgery to reclaim the physiques they had prior to pregnancy and childbirth. Pregnancy, though a cherished event for many, commonly leaves behind residual effects that diet and exercise can’t repair: stretched out skin and navels, weakened abdominal wall muscle tissue,’ abdominal hernias, and stubborn fat that creates bulkier than desired proportions. Weight loss and aging, too, often take a toll on the abdomen, making tummy tuck surgery an appealing choice for women and men seeking to transform their bodies’ contours beyond the results a fitness regime can realistically deliver.

Traditional abdominoplasty techniques have focused on removing excess skin and pulling the abdomen taut. But Dr. Christopher Patronella, a board-certified plastic surgeon based in Houston, Texas who is widely considered to be one of the USA’s foremost specialists in this area of cosmetic surgery, observed early on in his career that these textbook surgical methods left the abdomen with an artificial board-like appearance, devoid of the three-dimensional details that can be seen on an attractive, youthful abdomen. His patients confirmed this, expressing during their initial consultations with him a desire to avoid the uniformly flat abdominal results they had viewed online and in person. Many specified this post tummy tuck goal: to feel comfortable wearing a two-piece swimsuit with carefree abandon, having confidence that their results would appear completely natural, revealing no signs of plastic surgery.

With the objective to create more alluring, authentic-looking abdominoplasty results, Dr. Patronella, over the course of 15 years, gradually incorporated technical refinements to perfect tummy tuck results. His efforts culminated in his proprietary “True Form Tummy Tuck” procedure. Comprised of 10 key elements, the combined techniques redefine the native anatomical contours of the abdomen and avoid some of the most common pitfalls that can be seen in abdominoplasty outcomes, including an overly high scar and a surgical-looking navel, unnatural transitions between the abdomen and its adjacent regions, and an inconsistent skin tone between the upper and lower abdomen.

To further improve patients’ aesthetic results, Dr. Patronella implemented a Scar Recovery Program. With this regimen, which begins six weeks after their tummy tuck procedure and lasts for 6 to 12 months, patients apply a series of topical products selected by Dr. Patronella to mitigate the appearance of the abdominoplasty scar. To produce optimal results, patients frequently combine the Scar Recovery Program with a series of scar-diminishing laser treatments in Dr. Patronella’s medical spa.

In his initial endeavor to perfect tummy tuck results, Dr. Patronella used the Progressive Tension Suture (PTS), originally developed by Drs. Pollock and Pollock to reduce seroma formation, pockets of fluid buildup visible on the surface of the skin, and excessive tension upon the incision line. Dr. Patronella adapted this technique into a tool to create anatomy-defining stitches that outline the attractive abdominal contours he sought to reproduce via surgery. In the ensuing 5 years after his inclusion of PTS in his abdominoplasty procedures, Dr. Patronella integrated numerous additional technical modifications.

The results of his efforts have met with consistently enthusiastic reviews from his patients, with many proclaiming their abdomens look “even better” after abdominoplasty than they did prior to having children. Over the course of nearly 20 years from 2000 to 2019, Dr. Patronella has performed more than 1600 abdominoplasties. In a survey of his tummy tuck patients, 97% reported a high satisfaction with the natural-looking appearance of their results.

In addition to the exceptional beauty and authenticity of their results, patients appreciate the advances Dr. Patronella has implemented to give them a more comfortable recovery experience. During the abdominoplasty procedure, Dr. Patronella injects a long-acting anesthetic called Exparel directly into the muscle tissue which is the source of most pain during the recovery period. In published studies Dr. Patronella and his group conducted, Exparel, which lasts for three days, was shown to reduce patients’ pain by approximately 50%. As a result, they typically require less oral pain medication, and they can resume their normal daily activities more easily. “It makes those first few days after surgery so much easier,” said Dr. Patronella.

Furthermore, Dr. Patronella does not require, unlike many plastic surgeons, patients to wear the cumbersome, oft painful drain tubes in the initial weeks following surgery. With older abdominoplasty methods, drains have been necessary to prevent the development of fluid accumulations known as seromas. The aforementioned Progressive Tension Sutures that Dr. Patronella employs have the added benefit of eliminating the need for drains because they close the spaces where seromas could potentially form. “My patients feel better, they have less pain, and an easier recovery,” Dr. Patronella noted.

What are the key components of an abdominoplasty consultation?

To determine if a person is a good candidate for the True Form Tummy Tuck, Dr. Patronella evaluates 4 components: the degree of laxity throughout the abdominal region; excess subcutaneous fat (i.e.: the layer of fat directly beneath the skin); possible diastasis or herniating fat (in which fat protrudes between the rectus abdominis muscle – between one’s ‘abs’), and, lastly, intra-abdominal fat between the organs in the torso. If a significant level of intra-abdominal fat is present, Dr. Patronella advises the patient they must lose weight prior to surgery in order to optimize their safety during the operation and their aesthetic outcome.

The degree and location of skin laxity, diastasis and excess fat determines the type of abdominoplasty Dr. Patronella recommends: mini, modified, or full. Some patients request liposuction alone to improve the abdomen’s appearance, but this option is typically best for individuals who have relatively good skin tone and a moderate amount of excess fat. In cases where more substantial skin laxity, fat, and diastasis are present, liposuction alone, in fact, would likely increase skin laxity. This is one of the leading reasons patients consult with Dr. Patronella for revision body contouring surgery: to correct the poor aesthetic results that liposuction, performed in lieu of a tummy tuck, yielded.

True Form Tummy Tuck Objectives

Each of Dr. Patronella’s improvements to the ‘traditional’ abdominoplasty procedure loosely correspond to one or more of 9 aesthetic goals that the majority of prospective and actual patients consider to be important when assessing the success of an operation:

• Low scar positioning This facilitates concealment in a modest undergarment or swimsuit, achieving the goal of many patients: to wear a bikini with greater confidence.
• Balanced repair of muscle wall separation Repairing the separation of the muscles in both the upper and lower abdomen creates a more congruent appearance.
• Variance of abdominal fat thickness This replicates the depth nuances that a naturally-beautiful abdomen possesses.
• Consistent skin tone throughout the abdominal region – Repair of skin laxity and diastasis in both the upper and lower abdomen creates a more congruent aesthetic. If correction of these elements is concentrated on the lower abdomen and neglected in the upper region, a taut lower abdomen will often result, providing a stark contrast with the looser skin and unrepaired diastasis of the upper abdomen.
• 3-D contouring Soft definition along the sides and upper middle of the abdomen is a signature feature of an exquisite abdomen.
• Accompanying rejuvenating treatment of the mons pubis Lax skin and excess fat is removed from the hair-bearing pubic region of the lower abdomen to create a smooth transition between this region and the area above it.
• Smooth transitioning at the incision line By thinning fat either above or below the scar site, Dr. Patronella removes the potential for disparity of skin thickness between these two areas.
• Attentive treatment of the entire torso unit To ensure overall aesthetic harmony, the proportions and skin tone of regions adjacent to the abdomen, particularly the hip and waist, are blended to complement the abdomen’s appearance. This prevents artificial-looking contrasts such as a well-toned, contoured abdomen next to a thick waistline or bulging mons pubis.
• A deeply-contoured, vertical belly-button (umbilicus). Small though it is, the navel is a key feature that can make the difference between natural-looking results and those that appear surgically-created. Because the belly button is often left stretched out by pregnancy, its firmness and depth are restored.

What are the 10 technical refinements that Dr. Patronella has made to the abdominoplasty procedure? 

Dr. Patronella combines these 10 key elements to achieve the elegant, beautiful abdominoplasty results for which he’s known:

• Strategic low position of the incision Patronella uses a precise system of measurements to calculate ideal placement of the incision. The subsequent scar closely corresponds with the waistband position of many women’s’ underwear and swimsuit bottom styles. As part of this step, the surgeon secures the tissues with sutures to help prevent migration of the scar upwards.
• Full mobilization of the abdominal flap The abdominal flap is fully mobilized. In layman’s terms, this means the layer of skin that covers the patient’s torso is completely ‘opened’, and cut free from the rest of the torso, which allows for greater precision in performing the technical refinements of the abdominoplasty. Full mobilization permits direct access to both subcutaneous and deeper peritoneal (intra-abdominal fat), which can be trimmed during the course of surgery, potentially reducing the need for liposuction in the central part of the abdomen.
• Complete diastasis repair During pregnancy, the rectus abdominus muscle wall separates to accommodate the growing baby. The medical term for this is “diastasis,” and it’s one of the main culprits behind the stubborn tummy “pooch’ many women strive to flatten after childbirth. This protrusion commonly results because the abdominus rectus muscles provide compression which helps to hold the organs in. While diet and exercise can improve muscle tone, they cannot bring the separated muscles back together. Dr. Patronella repairs the weakened muscle wall during the tummy tuck procedure, helping to eliminate the tummy bulge.
• Thinning of Sub-Scarpa’s fat. Thinning of the fat pad along the external oblique muscle deepens the waistline, producing slimmer proportions that complement the newly rejuvenated abdomen. Removing fat along the linea alba in the mid-upper abdomen and on the sides of the lower abdomen to highlight the linea semilunaris lines accentuates the natural definition found in these areas. This step lays the foundation for the application of the Progressive Tension Sutures.
• Anatomy-Defining Progressive Tension Sutures Patronella meticulously places Progressive Tension Sutures to give the abdomen soft, 3-dimensional character. As the sutures are progressively completed, the abdominal flap is advanced in a manner which creates added waist definition and reduces the potential for “dog ears,” redundant skin at the outer edges of the flap.
• Vertical closure of the umbilical defect (if required). In the event that the low incision point for the surgery results in aesthetic defects with the patient’s belly button, this can be repaired directly during the course of the main procedure.
• Mons Pubis Rejuvenation It is common for the mons to accumulate unwanted fat and skin laxity. Treatment of this area through skin and fat excision reduces its fullness, ensuring a smooth transition between the abdomen and mons.
• Customization of the abdominal skin flap. Dr. Patronella prefers to remove the excess skin of the abdominal flap after completing the above refinements in contrast to traditional abdominoplasty methods, where it is performed at the beginning of the procedure. With the latter option, greater risk exists for too much skin to be removed, which can necessitate the flap being pulled tighter than is ideal at the incision line and a scar that migrates upwards as a result. Performing this step in the sequence Dr. Patronella recommends, allows for more accurate assessment of the degree of laxity. He is able to more precisely customize the flap, shaping it along the incision line to create a perfect, tension-free fit.
• Soft tissue equalization at the incision line. Because the tissue above the incision line is typically thicker than that below it, removal of fat equalizes the difference. This eliminates the all-too-common ‘step-off’,’ where a cliff-like effect is created from thicker tissue above the incision which protrudes beyond the thinner skin beneath the incision.
• Deeply-contoured navel In plastic surgery studies analyzing the characteristics of attractive navels, a vertical orientation and inward contour were the most common denominators. To achieve this objective, Dr. Patronella implements a meticulous multi-step process. This includes first repairing any umbilical hernia that may be present. A generous removal of fat in a vertical fashion at the navel site and shortening of the umbilical stalk, if necessary, enhances the appearance of depth. Because excess abdominal skin has been removed, the navel is repositioned and secured using a technique which further deepens the belly button and conceals the sutures.

Outcomes: Professional Acclaim

Dr. Patronella’s True Form Tummy Tuck method has met with acclaim in the professional plastic surgery community. It was spotlighted in both the esteemed Aesthetic Surgery Journal and the International Society of Plastic Surgery’s periodical in a special report on some of the most exciting abdominoplasty advances around the globe. Dr. Patronella has been invited to share his innovative techniques to plastic surgeons at conferences throughout the world including in South America, Central America, Canada, and throughout the United States. His prolific contributions to advance the art and science of plastic surgery reflect the philosophy that drives him: “As plastic surgeons, we should be compelled to continually set the bar higher and provide better results.” With the plentiful information resources and photo galleries available online to prospective patients, their expectations and feedback have helped spur this challenge, “and that’s a good thing,” says Dr. Patronella. “This external challenge complements the internal competition I have with myself. I welcome it.”

“I can’t thank you enough for giving me my body back” – patient of Dr. Patronella