The most important step in delivering a great tummy tuck is tightening the abdominal skin just enough. Not too loose. Not too tight. The problem with "too loose" is obvious. The tummy isn't as flat and as tight as you'd want it to be. The bigger problem is tummy tucks that are too tight. Skin that is pulled too tight never looks right. It's rigid like the top of a snare drum. What's worse, the excess tension pulls on the healing scar making it wider and thicker. These problems can be impossible to fix.
Why do some tummy tucks end up too tight? I think it's because they're based on a formula that no longer works. In a traditional tummy tuck, the plastic surgeon removes all the skin and fat from just above the pubic hair to just above the belly button. That's great if you're an average woman - average age, average build, average size, average number of children, average weight gain in pregnancy. You get the idea. Chances are you're not all those things but the standard tummy tuck pattern assumes you are.
For example, many of my patients are active and fit and remain so through their pregnancies. These women gain less weight than is typical during pregnancy so their abdominal skin doesn't get stretched as much. Removing the standard amount of skin from these women will leave an abdomen that looks much too tight.
So how do you figure out the right amount of skin to take? As we've seen, there's no simple formula. What works for me is testing and customization. When it's time to close the tummy tuck, I pull the skin until it's moderately tight and trim some off. Then I assess the results. In places where it's not tight enough, I trim a little more. And I repeat this process until the tension is just right everywhere. This produces a custom pattern of skin removal matched to the unique anatomy each woman. Customizing the skin removal gets the tension right and creates a natural-looking tummy tuck.