針對產後鬆弛的小腹，腹部拉皮是最完整的解決方案。
Expert of Abdominoplasty (Tummy Tuck) in Taiwan
Expert of Abdominoplasty (Tummy Tuck) in Taiwan
腹部拉皮手術的目的在改善腹部鬆弛，以達到腹部緊實的效果；有腹部鬆弛困擾的人，其實並不少，常見的原因如多次懷孕生產、肥胖、老化、減重(手術)後、與長期的腹內高壓(如脹氣)等。而鬆弛的部分，則可能是皮膚的鬆弛或是皮膚與深腹筋膜同時鬆弛，單純的皮膚鬆弛則視鬆弛的部位可接受全腹拉皮(full abominoplasty)或迷你腹部拉皮(mini abdominoplasty)，此兩者主要的差別是全腹拉皮會將所有腹部鬆掉的皮膚切掉並將肚臍重新縫合，而迷你腹部拉皮則只拉下腹部鬆弛的皮膚而不將肚臍重新縫合。若懷疑有深部筋膜的鬆弛(又稱為腹直肌分離 rectus diastasis)，可以安排電腦斷層或超音波檢查，通常可見到兩側的腹直肌分開達2-3公分以上，嚴重者甚至達8公分以上，則需同時以不可吸收縫線將分離的腹直肌折疊縫合(又稱腹直肌緊實術)，可以有效改善鬆弛的腹部。
全腹拉皮含腹直肌緊實術的手術步驟如下 Steps of Full Abdominoplasty (Tummy Tuck) :
1.透過客製化的設計，切除多餘的皮膚 (resection of excessive skin)；
2.腹直肌筋膜折疊縫合 (plication of fascia)；
3.肚臍重新縫合 (umbilicoplasty)；
4.皮膚縫合，將腹部拉皮疤痕藏於比基尼線(wound closure, scar hidden at bikini line)；
5.加強腰部抽脂 (liposuction of flanks using SAFELipo)。
在腰部抽脂的部分，吳至偉醫師所採用的是SAFELipo手術法，可有效率的抽脂，減少手術時間，並較傳統抽脂有較少的出血與恢復時間。下面五個案例為接受全腹拉皮，腹直肌折疊的案例，案例四與五則另外接受了提乳手術。
全腹拉皮含腹直肌緊實術的手術步驟如下 Steps of Full Abdominoplasty (Tummy Tuck) :
1.透過客製化的設計，切除多餘的皮膚 (resection of excessive skin)；
2.腹直肌筋膜折疊縫合 (plication of fascia)；
3.肚臍重新縫合 (umbilicoplasty)；
4.皮膚縫合，將腹部拉皮疤痕藏於比基尼線(wound closure, scar hidden at bikini line)；
5.加強腰部抽脂 (liposuction of flanks using SAFELipo)。
在腰部抽脂的部分，吳至偉醫師所採用的是SAFELipo手術法，可有效率的抽脂，減少手術時間，並較傳統抽脂有較少的出血與恢復時間。下面五個案例為接受全腹拉皮，腹直肌折疊的案例，案例四與五則另外接受了提乳手術。
產後的腹部鬆弛常造成腹壁筋膜鬆弛貨併發腹部皮膚嚴重的皺摺與紋路，這兩個問是在腹部整形手術時都可以極大幅度的改善，將多餘的皮膚切除後，再將腹壁筋膜拉緊，將皮膚下拉至比基尼線，再重新將肚臍開口於新的位置，如此一來，整個腹部就年輕緊實許多，再也不用擔心穿泳裝時的尷尬了。(台北腹部拉皮權威吳至偉醫師)
腹部皮膚與筋膜鬆弛明顯，脂肪不多，腹部拉皮手術推薦方式為全腹腹部拉皮+腹直肌折疊縫合(台北腹部拉皮權威吳至偉醫師)
腹部皮膚與筋膜鬆弛明顯，脂肪不多，腹部拉皮手術推薦方式為全腹腹部拉皮+腹直肌折疊縫合(台北腹部拉皮權威吳至偉醫師)
2019年9月最新腹部拉皮案例，腹部鬆弛明顯併有脂肪堆積，腹部拉皮手術推薦方式為全腹拉皮+腰腹抽脂+筋膜折疊緊實，左為術前，右為術後(台北腹部拉皮權威吳至偉醫師)
腹部皮膚與筋膜鬆弛明顯，腹部拉皮手術推薦方式為全腹腹部拉皮+腹直肌折疊縫合+SAFELipo抽脂
(Full abdominoplasty + rectus plication+liposuction of flanks)(台北腹部拉皮權威吳至偉醫師)
腹部下半部皮膚鬆弛與全腹筋膜鬆弛，腹部拉皮手術推薦方式為迷你腹部拉皮同時做全腹筋膜緊實(Mini-abdominoplasty，台北腹部拉皮權威吳至偉醫師)
腹部皮膚與筋膜鬆弛明顯，脂肪堆積，腹部拉皮手術推薦方式為全腹腹部拉皮+腹直肌折疊縫合+縮胸提乳手術+SAFELipo抽脂
(Full abdominoplasty + rectus plication+breast lift+liposuction of flanks)(台北腹部拉皮權威吳至偉醫師)
全腹腹部拉皮+腹直肌折疊縫合+縮胸提乳手術+SAFELipo抽脂
(Full abdominoplasty + rectus plication+breast lift+liposuction of flanks)(台北腹部拉皮權威吳至偉醫師)
Dr. Chih-Wei Wu is a board-certified plastic surgeon in Taiwan and specialize in breast and body contouring surgery. The purpose of Tummy Tuck (Abdominoplasty) is to improve the loosening of the abdomen and to achieve a tight belly. It is not uncommon to see patients with abdominal loosening; common causes include pregnancy, obesity, aging, massive weight loss, post-bariatric surgery, and long-term abdominal distension due to abdominal illness. The loosening part of the belly can be skin loosening with or without fascia loosening. Two major procedures exist for tummy tuck, the full abdominoplasty and the mini abdominoplasty. A full abdominoplasty removes all the excessive skin of the entire belly with transposition of the belly button (umbilicus) and a mini abdominoplasty removes the excessive skin of the lower belly without transposition of the belly button. Additional procedures in tummy tuck include plication of the dehisced fascia (rectus diastasis) and liposuction for the upper belly and flanks. Dr. Wu use SAFElipo (safelipo.com) technique for liposuction which is an efficient and safe method for liposuction.
腹部拉皮整形手術疤痕 (Scar of Abdominoplasty / Tummy Tuck)
腹部拉皮手術設計與疤痕位置
腹部拉皮手術無可避免的，會在下腹部留下一道長長的疤(上圖右)，而疤痕要好看有幾個重點：術前良好的設計，精密且無張力的縫合，術後良好的照顧。良好的設計重點在於疤痕的位置要夠低，或者是可以讓最常穿的褲子遮住；精密且無張力的縫合，則是吳至偉醫師的獨門功夫；術後良好的照顧，則包括了美容膠，脈衝光等，也是吳醫師非常仔細處理的一環。唯有這些細節都注意到了，腹部拉皮後的疤痕，才有可能達到完美的境界。
腹部拉皮整形手術流程
◎ 初診：
- 理學檢查：評估腹部皮膚鬆弛狀況。
- 超音波檢查：評估腹直肌鬆弛狀況。
- 手術討論與建議：包括各式腹部拉皮整形之方式，費用與價格。
- 術前檢查與麻醉評估。
- 術後休養的準備：休息5天。
- 術前兩週與術後兩週需禁煙；避免荷爾蒙藥物Hormone；避免阿斯匹靈Aspirin、中藥、銀杏、維他命E、維他命K、保健藥品等活血藥物。
- 手術當天空腹8小時
=> 於預訂時間報到
=>手術記號〔30分鐘〕
=> 麻醉與手術預備〔90分鐘〕
=> 腹部拉皮整形手術〔3-4小時，如同時抽脂時間會更長〕
=> 術後恢復
=> 住院一天觀察。 - 止痛藥、抗生素請服用至少7天。
- 術後穿著束腹帶4-6週〔本院所會準備〕
- 3天回診換藥，7天回診換藥，若有引流管於此時移除，一般會安排14天回診換藥，之後視情況安排回診。〔若是住國外患者希望引流管置放時間更短者，可選擇另外使用組織膠Tissel在術中時間，組織膠可減少出血，加速組織間的黏著速度，可非常有效的減少引流管置放時間，在引流管移除之後即可離台〕
- 恢復期：較明顯的疼痛約5-7天，通常兩週後再恢復工作〔但一開始的工作量要減少〕。
腹部拉皮整形手術後遺症
- 血腫 (<1%)
- 漿液腫 (<1%)
- 感染(<1%)
- 傷口癒合不良 (抽菸者易發生，其他少)
- 疤痕明顯 (少見)
- 肚臍形狀改變 (少見)
- 血栓與肺栓塞 (< 0.01%)
- 其他
Surgical Condition for Tummy Tuck
- Procedure name：abdominoplasty (full or mini)
- Candidate: adult patients with loose belly skin
- Anesthesia: general anesthesia
- Surgical duration: 3-4 hours (increased with liposuction)
- Hospitalization: 1 day
- Post-op care: abdominal binder for 6 weeks; avoid strenuous exercise for 8 weeks
- Recovery time: pain for 5-7 days, usually need to off from work for 14 days
- Price: price quote can be obtained via line, email
- Complications and risks: hematoma < 1%, seroma < 1%, infection < 1%, poor wound healing, obvious scar (uncommon), distorted belly button (uncommon), fat or pulmonary embolism (< 0.01%)
如何減少腹部拉皮整形後的風險，併發症與後遺症
Efficacy and Safety of Scarpa Fascia Preservation During Abdominoplasty: A Systematic Review and Meta-analysis.
Xiao X1, Ye L2.
Aaesthetic Plast Surg. 2017 Jun;41(3):585-590.
Abstract
INTRODUCTION:
Scarpa fascia preservation might be a promising approach to reduce seroma and other complications after abdominoplasty. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of scarpa fascia preservation in patients with abdominoplasty.
METHODS:
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials and clinical controlled trials assessing the effect of scarpa fascia preservation versus control (without scarpa fascia) during abdominoplasty were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were seroma and hematoma/bleeding. Meta-analysis was performed using random-effect model.
RESULTS:
Four studies involving 630 patients were included in the meta-analysis. Overall, compared with the control group, scarpa fascia preservation was associated with a significant reduced seroma (OR 0.16; 95% CI 0.06-0.43; P = 0.0004), time until drain removal (std. mean difference = -0.92; 95% CI -1.31 to -0.54; P<0.00001;), drain output (std. mean difference = -0.92; 95% CI -1.38 to -0.45; P = 0.0001), and hospital stay (std. mean difference = -0.93; 95% CI -1.48 to -0.39; P = 0.0008), but it failed to alter hematoma/bleeding (OR 0.46; 95% CI 0.09-2.38; P = 0.36), infection (OR 0.38; 95% CI 0.11-1.25; P = 0.11), and suture rupture (OR 0.67; 95% CI 0.12-3.73; P = 0.65) in patients with abdominoplasty.
CONCLUSIONS:
Scarpa fascia preservation was associated with a significant decreased seroma, time until drain removal, drain output, and hospital stay, but could not change hematoma/bleeding, infection and suture rupture following abdominoplasty. Scarpa fascia preservation should be recommended during abdominoplasty.
LEVEL OF EVIDENCE II:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Xiao X1, Ye L2.
Aaesthetic Plast Surg. 2017 Jun;41(3):585-590.
Abstract
INTRODUCTION:
Scarpa fascia preservation might be a promising approach to reduce seroma and other complications after abdominoplasty. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of scarpa fascia preservation in patients with abdominoplasty.
METHODS:
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials and clinical controlled trials assessing the effect of scarpa fascia preservation versus control (without scarpa fascia) during abdominoplasty were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were seroma and hematoma/bleeding. Meta-analysis was performed using random-effect model.
RESULTS:
Four studies involving 630 patients were included in the meta-analysis. Overall, compared with the control group, scarpa fascia preservation was associated with a significant reduced seroma (OR 0.16; 95% CI 0.06-0.43; P = 0.0004), time until drain removal (std. mean difference = -0.92; 95% CI -1.31 to -0.54; P<0.00001;), drain output (std. mean difference = -0.92; 95% CI -1.38 to -0.45; P = 0.0001), and hospital stay (std. mean difference = -0.93; 95% CI -1.48 to -0.39; P = 0.0008), but it failed to alter hematoma/bleeding (OR 0.46; 95% CI 0.09-2.38; P = 0.36), infection (OR 0.38; 95% CI 0.11-1.25; P = 0.11), and suture rupture (OR 0.67; 95% CI 0.12-3.73; P = 0.65) in patients with abdominoplasty.
CONCLUSIONS:
Scarpa fascia preservation was associated with a significant decreased seroma, time until drain removal, drain output, and hospital stay, but could not change hematoma/bleeding, infection and suture rupture following abdominoplasty. Scarpa fascia preservation should be recommended during abdominoplasty.
LEVEL OF EVIDENCE II:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
這篇論文刋登於2017年六月的Aesthetic Plastic Surgery，主旨在討論腹部整形手術時，保留淺層筋膜系統(Scarpa Fascia)對於手術預後的影響，結果發現在手術時如果可以保留Scarpa Fascia在腹壁筋膜上，可以大大減少術後漿液腫的比例，而且引流管移除時間與住院時間皆可縮短。而原因是因為此層脂肪與筋膜，內含了相當多的淋巴管路 (lymphatic ducts)，可幫助淋巴的引流，減少水腫。此論文的結果與吳至偉醫師多年來的經驗相符，在手術時若能保留淺層筋膜系統，不只減少術後漿腋腫的比例，也可減少術後疼痛。
腹部拉皮整形手術案例 (Case Study of Abdominoplasty / Tummy Tuck)
全腹腹部拉皮+腹直肌折疊縫合
下腹迷你腹部拉皮+腹直肌折疊縫合+SAFELipo抽脂
非手術腹部緊實選擇 (No surgical procedures for tightening of belly skin)
如果有輕微腹部皮膚鬆弛(明顯皮膚的皺紋)，但沒有腹直肌或腹壁筋膜鬆弛時，可考慮電波拉皮(熱世紀，Thermage)的身體探頭做皮膚的緊實，或魔方除皺(Profound)系統，透過特殊設計的25度角絕緣針頭，在2mm的深部將真皮層加熱至72度C，通常可有效改善腹部皮膚鬆弛，是不需要或不敢接受腹部拉皮手術患者的替代療法。
魔方除皺(Profound)系統
可合併手術 Other Combining Procedures
腹部整形手術常與其他部位的整形手術一同進行，特別是胸部的手術，如縮胸，提乳，或隆乳手術，與腹部整形手術一起進行，可稱之為「媽咪改造手術 Mommy Makeover」，因為腹部鬆弛與胸部萎縮或下垂，常在產後的媽媽發生，因此這兩部位的拉提手術常在產後的媽媽一起進行，可以達到完整身形改造的效果。
