Before the incision is fully closed, Dr. Diaz examines the sides of the incision to prevent "dog ear" formation. A "dog ear" is an excess amount of folded skin that can be present at the sides of the tummy tuck incision. When this occurs, it is unsightly and bothersome. Dr. Diaz designs the incision to prevent this from forming. He ensures that when the incision is closed, it will heal as a smooth and fine line.
Drains are then usually inserted and brought out each side of the waist. The purpose of the drain is to prevent the accumulation of fluid in the abdomen. Drains are not always needed, especially if progressive tension sutures are used to secure the abdominal skin and fat to the underlying muscles.
The incisions of the lower abdomen are then closed in three layers. The first, and deepest, level attaches tissue called "fascia." This is a strong tissue that is found in the deeper layers of the skin and fat, just above the abdominal muscles. Strong and long lasting sutures are used for this repair, since a bulk of the tension and pressure during the healing process will be transmitted across this layer.
The second layer is called the deep dermis. This is the bottom level of the skin, where there is an abundance of collagen fibers for strength. Care is taken to close this tissue with multiple absorbable stitches across the entire length of the incision. Once this level is closed, it brings the skin edges very close together, thus allowing for a very precise closure of the third and most superficial layer of the skin.
The final layer to be closed is called the superficial dermis and it represents the upper most edge of the skin edge. A fine suture is used to delicately bring the skin together so that the edges finally meet. Once this layer is closed, the incision appears like one fine line. Closure is then completed.
Once this is done, attention is then directed to creating a new opening for the belly button.