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The Ultimate Silhouettplasty™ in Honolulu, HI

It’s hard to find a woman in the world today who isn’t familiar with the possibility of regaining their pre-pregnancy body by way of aesthetic plastic surgery. Pioneering plastic surgeons have made the impossible possible. Interested patients can easily educate themselves on available procedures, best practices, and the incredible outcomes of these surgeries on sites like

Why Consider A Tummy Tuck (Abdominoplasty)?

Motherhood, for most women, is a very joyous process.  The toll pregnancy takes on a mother’s body is the cost of a growing family – and well worth it! But when a woman is done having children, her body often has a new shape and she can experience medical conditions that interfere with daily life.

Abdominoplasties (tummy tucks) were invented as a reconstructive surgery to decrease some of the most undesirable physical remnants of a pregnancy.  As the baby grows larger, so does the uterus. This leads to pressure on the abdominal skin and stretching of the skin.  The process of eating for two often increases the mother’s fatty deposits in places she never had fat before, as well as pregnancy weight gain which may not resolve after delivery.  The abdominal musculature in the midline of the abdomen, known as the rectus abdominus, separate to allow the uterus to come forward.  If this did not occur, the uterus could go straight upward, hitting the diaphragm which could cause significant problems for the mother.  Rectus abdominous separation is known as a rectus diastasis. Once separated, these abdominal muscles rarely go back together.  Abdominal organs can push forward creating various degrees of lower and sometimes upper abdominal protrusion.  These separated muscles are unable to counterbalance the back muscles, often leading to a chronic low back pain in women who have had one or more pregnancies.


When the stretched out abdominal skin attempts to contract back to its pre-pregnancy state, very often the elastin fibers have been stretched beyond their elastic potential and the loose skin of the abdomen hangs downward.  This, unfortunately, also allows the vulva containing the external female organs to sink out of its natural position into a lower position towards the inner thighs.  The vulva mal positioning can lead to stress incontinence (you laugh, you pee, you cough, you pee), and also a less favorable position of clitoral friction during intercourse.

Together with liposuction, tummy tucks corrected many of these post-pregnancy conditions. The first generation tummy tucks tightened the skin, repaired the separated musculature, and removed some of the newly deposited fat in the love handle or muffin top area.  The incredibly talented and forward thinking plastic surgeons of Brazil added upper abdominal liposuction to this reconstructive procedure.  This type of liposuction had to be conservative since the combined tummy tuck/liposuction came dangerously close to compromising the blood supply to the entire abdomen.  Abdominal skin gets its blood supply from the muscles below in a vertical fashion: from the muscles straight up to the skin.  These blood vessels are known as muscular cutaneous perforators. After an abdominoplasty, most of these vessels are cut. The new blood supply to the abdominal skin comes from the periphery in a horizontal fashion throughout the entire abdominal region.  This new horizontal abdominal blood supply appears to be intact and functional within the first 90 days after the abdominoplasty.

What Led Us to The Ultimate Silhouettplasty™?  

In the second decade of the 21st century, abdominoplasties have gained popularity as an aesthetic surgery and not just a reconstructive procedure. This phenomenon is aided, in part, by websites like RealSelf where prospective patients can see the possibilities for amazing body transformations and discuss these procedures with actual patients and surgeons. In an aesthetic tummy tuck, the muscles are repaired tightly both above and below the belly button so that a flat abdomen is possible.  Skilled surgeons take extra care in crafting aesthetically pleasing belly buttons on flat abdomens. In the best of all possible worlds, the final abdominoplasty scar is very thin, fine, and well hidden under most bikini bottoms.  As a routine part of their abdominoplasties, most plastic surgeons will liposuction the lumbar roll, otherwise known as muffin tops or love handles.  Dog-ears occur when the skin at either end of an abdominoplasty incision do not lay flat.  These little outpouches, unfortunately, can occur even with the most skilled plastic surgeon.

The presence or absence of dog ears very often has to do with the amount of residual subcutaneous fat is still present at the end of an abdominoplasty.  The waistline ultimately created in a tummy tuck with liposuction of the lumbar roll is related to the amount of residual fat as well as any scar tissue from the liposuctioning of this area.  No matter how long the patient wears a girdle or how much post-operative massage or ultrasound (the kind physical therapists use for sore muscles) is performed, some scar tissue remains which results in a thicker waistline than might be ultimately achievable.

In a perfect world, a slender patient and a highly talented and motivated Board Certified plastic surgeon can achieve spectacular results after one procedure. But what about everyone else?  With Ultimate Silhouettplasty™, a second procedure is added at 90 days.  This is aggressive liposuction of the remaining abdominal fat which includes fat in the tissue previously above the belly button and also residual fat and scar tissue at the waist. Ultimate Silhouettplasty™ leads to a thinner and more delicate draping of the abdominal skin over a woman’s torso.  This second stage liposuction surgery of the abdomen could not be done safely with the original procedure because the new horizontal blood supply to the skin did not exist.

The improvement of the blood supply to the abdominal skin is known as a “delay phenomenon” in plastic surgical terms. The original abdominoplasty withdrew much of the abdominal skin vasculature, and in so doing taught the skin and subcutaneous tissue to live on a new blood supply. As the new blood supply is well established at 90 days, it would not be compromised by this second liposuction.

Why do a second stage to a successful abdominoplasty procedure? For many women, although the results from a primary abdominoplasty are good, they had hoped for more.  Ultimate Silhouettplasty™ allows the average woman with excess fat deposits and an average waistline to achieve incredible results equal to or better than the most beautiful primary abdominoplasty outcomes. This second procedure also allows the plastic surgeon to eliminate minor dog ears that may have occurred, and turn an acceptable abdominoplasty into a significantly better silhouette.

A New Approach to Tummy Tucks and Mommy Makeovers

Both plastic surgeons and patients would be happier if all procedures were a one-time event, but they are not.  They are a process.  It took 9 months to create the post pregnancy body so it is unlikely to be fully repaired in one 4-hour procedure.  The tummy tuck itself has a relatively long recovery period, but the second procedure (abdominal liposuction) should have the patient back in the gym within 6 days, and for many, back to work in 3-4 days.  Good plastic surgery and good plastic surgeons understand how the body heals and the optimal time gaps required between procedures to safely and beautifully achieve the ultimate results. For some women, the standard 21st century tummy tuck may be all they desire, but more and more women are asking for the ultimate result, the Ultimate Silhouettplasty.

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