Dr Michele Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis, Missouri, 314-984-8331.

The patient is a 47 year old Missouri woman who started her journey of weight loss at 230 lbs and a size 22. On the day of her surgery, she weighed 185 lbs and was a size 16.

Dr Michele Koo performed a tummy tuck (abdominoplasty) and ultrasonic liposuction of her hips, waist, and thighs. She is shown in her after pictures at four months at 155lbs and a size 8. She couldn’t be more thrilled. The surgery performed by Dr Koo changed her life.

When the patient started dieting and losing weight, she consulted Dr Koo. The patient felt trapped and frustrated by her loose hanging skin, stretch marks and did not feel that she could continue her dieting and exercise without some type of plastic surgery procedure such as an abdominoplasty or tummy tuck and some type of liposuction. She needed help to continue to take charge of her life and her body.

Dr Koo was very encouraging and understanding and stressed the fact that the patient had already done the bulk of the hard work losing the weight and should not feel discouraged by the appearance of her trunk and belly (midriff) area. So many patients bounce up and down with their weight because they hit a plateau and can’t go any further with their appearance after working for so long exercising and restricting their diet. They feel completely exasperated that they cannot further change their tummy and get rid of the loose hanging skin.

Enter Dr Michele Koo, St Louis, Missouri, 314-984-8331, Board Certified Plastic Surgeon and a Member of the Aesthetic Society. She can and will safely take you the rest of the journey toward a flat tummy and a skinny waist. She will encourage you to continue your activity level and healthy diet without using supplements or crazy ultra restrictive diets. She might suggest a gastric bypass or a gastric banding first if you are extremely obese prior to any body contouring and liposuction procedures.

Dr Koo will be very honest with you that this is a long process and lifestyle change that she wants for you. After the tummy tuck (abdominoplasty) and liposuction, you will need time to recover over 2-4 weeks and more than likely will need even 6 weeks to full recovery of returning to strenuous work. However, Dr Koo will tighten your abdominal muscles stretched from pregnancy and remove all the excess loose hanging skin of your belly and make you look like a totally new person with the tummy tuck and liposuction.

Dr Michele Koo wants you to be well informed and the following exerpt from Heller, et al, Yale Medical Center should provide some background information. Functional abdominoplasty was first described by Kelly in 1899 and popularized for cosmetic purposes in 1967 by Pitanguy, who introduced the low transverse (i.e., bikini line) incision that could remove lower abdominal scars. Since this time, abdominoplasty procedures have rapidly gained popularity, with 102,497 being performed in 2004, an increase of 510 percent from 1992 levels and an increase of 24 percent from 2002 levels.

During this period, surgeons focused increased attention on reducing complications. Local complications such as hematoma, seroma, wound dehiscence, and skin necrosis occur in up to 32 percent of nonsmokers and as many as 52 percent of smokers. As such, greater effort has been set forth to define the vasculature of the abdomen to limit these complications. Huger described three vascular territories of the abdominal wall: zone 1 ranges from the xiphoid to the pubis between the lateral borders of the rectus abdominis and is supplied by the superior and inferior epigastric arteries; zone 2 is the trapezoidal area defined by anterosuperior iliac spine superiorly and by the groin inferiorly-its blood supply is from the superficial inferior epigastric, superficial circumflex iliac, and external pudendal arteries (superficial system) and from the deep inferior epigastric vessels (deep system); zone 3 is the area of the lateral abdomen and flanks and is supplied by the segmental lumbar, subcostal, and intercostal arteries. Traditional formal abdominoplasty with its low transverse incision and wide undermining to the costal margin sacrifices zone 1, zone 2, and to a limited extent zone 3. Furthermore, the skin of zone 1 experiences additional vascular compromise caused by tension on the suture line and thinning of the abdominal flap. Thus, many surgeons have proposed less extensive approaches to abdominoplasty in an attempt to maintain adequate vascularity, but the best aesthetic outcomes remain with the classic abdominoplasty.

To improve contour, liposuction has been offered to abdominoplasty patients, but previously as two independent procedures separated in time by at least 6 months. Caution concerning the advisability of such an approach was based on the belief that the traumatic forces of liposuction would limit the vascularity of the flap and thereby increase complications. Matarasso studied the safety areas for lipoplasty combined with abdominoplasty and recommended limited and cautious liposuction of the epigastric and mesogastric areas (zone 1) with full type 4 abdominoplasty. With advances in superficial liposuction, Saldanha et al. performed lipoplasty of the abdomen, sparing the epigastric and mesogastric areas, followed by an abdominoplasty with rectus muscle plicature, and found a complication rate no higher than that of a formal abdominoplasty. In a study performed by Lockwood, patients who underwent high lateral tension abdominoplasty and superficial fascial system repair with and without liposuction experienced complications that did not exceed historical controls. In 2006, the most recent survey of 497 surgeons reveals that 56 percent of surgeons perform some sort of liposuction with a full abdominoplasty but also stresses the need to differentiate complication rates in patients who received liposuction with their abdominoplasty versus those who did not.

Dr Koo believes that liposuction of the abdomen to achieve the “finished look” of a smooth flat tummy can be performed simultaneously with minimal complications. She takes extra precautions with her unique surgical procedure of a refined high lateral tension abdominoplasty that achieves amazing results as seen in the featured before and after picture.

          

Whether you have undergone a gastric banding or gastric bypass and have had massive weight loss or have too much skin and fat or you feel trapped by your large fat belly and overhanging skin of your abdomen, DR MICHELE KOO, MD, FACS, BOARD CERTIFIED PLASTIC SURGEON, ST LOUIS, MISSOURI, can help you get out of your own way and get rid of all that skin and fat that you have never been able to do for yourself.

If you’ve never had a skinny waist or waist and want a flat tummy and want to get rid of all that fat around your midriff or just want to be able to wear clothes normally, you can achieve a flat stomach with an abdominoplasty and body contouring by Dr Michele Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis, MO, 314-984-8331.

Dr Michele Koo wants you to know that this is possible for you and is not just a dream. Dr Koo makes sure that her office helps you uphold your end of the bargain which is that you must eat sensibly and start on a regular walking routine. You do not need to feel frustrated if you can’t jog or lift weights or have the time or money to go to exercise classes or hire a trainer or a cook. What you must do are common sense tasks of cutting your portions that you eat and walking at least 3 times a week. You should not deny yourself the kinds of food you like to eat but you must not eat as much of it.

Eating sensibly and increasing your activity level an essential part of achieving weight loss and maintaining shape after a tummy tuck - abdominoplasty and body contouring (liposuction).  While Dr Koo does not require you to lose weight prior to your surgery, she does encourage you to start good habits prior to your surgery so that they will become second nature after the surgery thereby changing your lifestyle for the long term. You will then be able to maintain a much healthier life after the surgery when she removes all the skin and fat that you couldn’t possibly do for yourself.

Dr Koo wants you to understand some of the techniques that she uses for your body contouring. According to Dr Daniel Brauman of Cornell University, liposuction abdominoplasty-liposuction of abdominal subcutaneous tissue deep and superficial to Scarpa’s fascia, with excision of excess abdominal skin and, when indicated, plication of the anterior rectus sheath without undermining-is an effective, low-risk approach to minimizing abdominal flap undermining. The technique allows aggressive thinning and sculpting of full-thickness abdominal subcutaneous tissue and achieves a natural (not featureless) abdominal contour. It minimizes the creation of dead space, which often leads to postoperative complications, as well as preserves sensory nerve and blood supply to the abdominal skin. The operation may be performed with the patient under local anesthesia, which probably diminishes the risk for deep vein thrombosis. Moreover, additional procedures can be conducted safely and the postoperative course is short, uneventful, and without restrictions; patients return to normal activity within a week or so. New evaluation criteria for abdominoplasty are discussed in this article, the most important of which is the assessment of intraabdominal fat content and its impact on surgical outcome and the decision to perform anterior rectus sheath plication. The concept of a sliding, mobile, sensate abdominal flap, created by liposuction and sustained by multiple neurovascular mesenteries, is also offered.

Traditional abdominoplasty is associated with the potential for several problems. The procedure has been identified as a specific risk factor for deep vein thrombosis by Daane and Rockwell, Reinisch et al., and Stuzin et al. Dillerud  found that wide undermining causes skin necrosis. In addition, undermining necessitates prolonged postoperative suction drainage to avoid seroma, which is the most frequent complication of abdominoplasty. It has also been reported by van Uchelen et al. to produce sensory changes of the abdomen and thigh. Further, incisions are often long and geometrically designed, and tension may cause excessive scarring. In contrast, limited abdominal flap undermining, which has resulted in less morbidity, fewer complications, and shorter scars than the classic procedure, has been advocated for appropriate cases by Wilkinson and Swartz, Greminger, Eaves et al., Zukowski et al., Shestak, and Lockwood. 

Liposuction abdominoplasty is a safe and highly effective alternative to traditional abdominoplasty in appropriate patients. Dr Koo feels that the procedure has consistently and significantly reduced many of the problems that have been associated with classic abdominoplasty. Other related concepts are also offered: The successful outcome of abdominal wall surgery appears to depend on the preoperative evaluation of the intraabdominal fat content, and a sliding abdominal flap, created by liposuction, is mobile and has unique advantages in comparison with undermining.

Dr Koo almost always repairs the lax abdomen by repairing the split between the abdominus recti muscles that can be a result of weight gain, pregnancy, or simply present congenitally (at birth).  She will determine if your anatomy will allow her to be able to tighten the abdominal musculature and help tighten the rib cage even more.

Liposuction creates sliding flaps by dissecting free their fibrous/neurovascular mesenteries.  Abdominal flap mobility is obtained by fat removal, the transection of the cutaneous ligaments, and the stretching of the neurovascular mesenteries. The concept of a sliding flap, tethered by a subcutaneous pedicle, is not new; these flaps are used extensively in reconstructive surgery. Liposuction sliding flaps possess a rich blood supply, evident by the rarity of skin necrosis in the procedure; however, they are not safer than undermined traditional flaps. Clinical judgment should be exercised regarding the extent of liposuction, the thickness of the flap, and the degree of tension. Sliding flaps possess several advantages: they eliminate dead space, can be contoured, and are sensate. 

Anterior abdominal wall-tightening procedures such as rectus plication are performed to achieve a flat, nonprotuberant abdominal appearance. The intraabdominal contents consist of intraabdominal fat and organs; the fat includes both visceral fat and a substantial amount of retroperitoneal fat.  Normally, there are marked variations in the volume and position of the abdominal contents. Visceral position is affected by posture, respiratory excursions, and body build. Therefore, a postural increase in lumbar lordosis predisposes to a protruding abdomen even in a thin person.

With the exception of the anterior abdominal wall and the diaphragm/rib cage, most of the abdominal cavity has rigid and nonyielding boundaries. The superior boundary of the abdominal cavity is the diaphragm/rib cage; the inferior boundary is the pelvis. Lateral boundaries are the fleshy parts of obliqui, transverses, and the ilium and iliacus. The anterior boundary is the recti and aponeuroses of obliqui and transversi abdominis, and the posterior boundary is the lumbar vertebrae, crura of the diaphragm, psoas, and quadrati lumborum.  Thus, only the anterior abdominal wall and diaphragm/rib cage-and to a much lesser extent the waist between L-3 and L-5-are pliable and can accommodate an increase in the intraabdominal volume.  Furthermore, the abdominal cavity encloses a finite intraabdominal volume. Tightening of the pliable anterior wall pushes the intraabdominal contents (volume) against the only other pliable boundary, the diaphragm.

Dr Michele D Koo, MD, FACS, St Louis, Missouri, 314-984-8331, Board Certified Plastic Surgeon, Member of the Aesthetic Society believes that weight loss after pregnancy can be achieved with sensible eating habits and increasing one’s activity level. She does not think that one should worry about the weight gain during the pregnancy as long as your OB-GYN is following your rate of weight gain and which trimester you gain the most weight.

Fat deposits and weight gain is a normal part of pregnancy and is necessary for the healthy development of normal birth weight newborn. Fat accumulates during pregnancy in the same areas that plague most women even when not pregnant. The most common female areas of fat accumulation are the abdomen, hips, waist, inner and outer thighs.  The areas of fat accumulation are genetically determined that cannot be altered with diet and exercise. These are the areas that increase in size first any time there is any weight gain regardless of pregnancy.

The fat that is accumulated with pregnancy is a rapid weight gain type of fat that increases the size of the fat cells over a short period of time. There usually is not enough weight gain of 75 lbs and up that might actually stimulate the body to trigger the cells to multiply and increase the actual number of fat cells.

Short term weight gain such as with pregnancy should actually be easier to lose than weight that has accumulated over a long period of time.  Fat that has accumulated over a long period of time of years may be a result of an increase in number of fat cells and even fat deposit in the composition of muscle and internal body fat gain.

The body’s physiology may also have been altered in terms of its insulin release and response patterns, fat storage, other endocrine functions, and possibly set points for “normal weight.” However, during the post partum period, the woman may be recovering and exhausted from a newborn and perhaps other small children and attempting to return to work, and, therefore, not really devoting time and energy into healthier eating and exercising habits.  The weight then seems to be extremely “stubborn” and resistant to exercise and weight loss, but in fact the fat is very readily reduced with the same diligent adherence to exercise and healthier eating.

It is my opinion that if after 1 to 2 years post partum, a woman has not lost all of her pregnancy weight, she will not be able to do it. More importantly, even if she achieves her pre-pregnancy weight, she will not look the same unless all of the skin has tightened which becomes less and less likely with each subsequent pregnancy.

My recommendation to my patients is that, they wait 6-12 months after they have stopped breast feeding or at least 6-12 months after delivery prior to undergoing any liposuction procedure as at that point, the post partum weight is relatively stable.

It has been my experience, however, that most women after pregnancy will need some type of skin removal procedure, i.e., tummy tuck, breast lift in addition to liposuction to achieve what they are looking for. The likelihood of needing a skin resection procedure increases with a C-section and increases with the number of children a woman has had.  I discuss this at length with my patients, the pros and cons of the permanency of the scar versus the great shape that can be achieved with the addition of the skin removal.

My patient’s ultimate goal of how flat she wants her abdomen or smooth her thighs will determine whether she would be better served with liposuction alone or liposuction with skin removal. The amount of time to recover after a liposuction is not any different for post partum patients; the amount of time to recover is dependent on the amount of fat removed and the number of areas liposuctioned.

With each pregnancy there will be weight gain and skin stretching; if one is considering any kind of plastic surgery for post partum changes for unwanted fat and skin, one might want to wait until they are completely finished with having children. The most important thing that one should always know is, “that there is nothing that pregnancy or weight gain can do that Dr Michele Koo can’t fix.”

DR MICHELE D KOO, MD, FACS, ST LOUIS, MISSOURI, 314-984-8331 for individualized personal care that will change your life and let you take charge of your own destiny.

Let Dr Michele Koo, MD, FACS (314) 984-8331 of St Louis, MO change your life and remove all that excess skin, fat, and surgical scars on your abdomen and make your tummy flat and your thighs slimmer.

You have been on and off diets all your life and now after children, you can’t remove that excess skin and fat from your mid-section. Everytime you lose some weight, you look down at your tummy and become depressed and frustrated with yourself and you fall off the wagon and your weight bounces back up.

If you’re tired of not being able to stay on a healthy eating regimen and exercise plan because you’re not getting the results you want, let Dr Michele Koo, MD, FACS, St Louis, MO, Board Certified Plastic Surgeon, Member of the Aesthetic Society, change your life with a tummy tuck (abdominoplasty) or a liposuction that will keep you motivated and take you to the next step. You’ll finally see the results and rewards of all your hard work with a flat belly, a slimmer waist and thighs.

This photograph is of a mid 50 year old Missouri woman who was frustrated with her large abdomen after three children and c-sections.  No matter how much weight she lost, she was unable to get rid of her large belly.  Prior to her surgery of a tummy tuck (abdominoplasty) and ultrasonic liposuction of her upper abdomen, waist, hips, and inner and outer thighs, she reports wearing size 14 clothes.  At 4 months after her surgery, she fits into a size 6.  She is able to tuck in her shirts, wear low cut jeans, and wore a 2 piece bikini on her vacation with her husband.  At the time of her surgery, she also underwent a breast lift, completing her entire body makeover.  She has kept her weight off now 2 years after the surgery and continues her healthy lifestyle which she was never able to stay on prior to her surgery, because nothing she ever did previously worked!

Dr Koo performs ultrasonic liposuction at the same time as the tummy tuck (abdominoplasty) and contours the entire trunk and legs to make you look like a new person. She feels that this tummy tuck and liposuction combination is extremely safe and can achieve amazing results all in one surgery and one recovery time. Dr Koo also repairs the split in your rectus abdominus muscles which have become lax with age, weight gain, and possibly children and surgeries. This will cinch in your waist and entire circumference of your trunk, reducing your clothes size!

Do not be discouraged and depressed with your shape and inability to change your waist and abdomen, Dr Michele Koo, MD, will take you the rest of the way to being what you want to be with a tummy tuck, abdominoplasty, and liposuction. 

Call Dr Michele D. Koo, MD, FACS, St Louis, Missouri, Board Certified Plastic Surgeon, 314-984-8331, and talk to many others who have had this and similar tummy tuck (abdominoplasty) and liposuction surgeries and find out how that has changed their lives.