SmartLipo or Tummy Tuck Surgery? A Tummy Tuck Patient Case Study

Dr. Patronella performed corrective surgery to improve the poor results this patient received from a SmartLipo procedure, which left her with contour irregularities. He restored a smoother appearance to her abdomen through tummy tuck surgery.


By Dr. Chris Patronella

When skillfully performed on an appropriate candidate,  SmartLipo, like many other liposuction methods, is good technology that can be very useful in body contouring procedures. However, liposuction predictably has yielded less-than-ideal results for the patients I’ve seen who had mild to moderate skin looseness for a simple reason: when you remove fat from an area that has loose skin, the skin will not shrink back smoothly and evenly. Most of these patients eventually have opted for tummy tuck surgery to restore a smoother, more natural-looking youthful appearance to their abdomens.

One such patient, Kelly, consulted with me for revision surgery to improve the unsatisfactory results from a SmartLipo procedure she received elsewhere as part of a mommy makeover to rejuvenate the appearance of her abdomen after having two children. Though she was pleased with the results of her breast augmentation and breast lift procedure, her abdominal results were a stunning disappointment that left her with more noticeable aesthetic concerns than she had prior to surgery.

Like many women who’ve had children, Kelly had loose abdominal skin and weakness of the underlying muscle wall as a result of the stretching that takes place to accommodate the growing infant during pregnancy. These characteristics are best corrected through tummy tuck surgery. Because Kelly had good skin elasticity with skin looseness primarily beneath the belly button previous to having her initial surgery, I most likely would have chosen to perform a mini tummy tuck on her, a less extensive tummy tuck procedure that is appropriate for about 10 percent of my abdominoplasty patients.

In revision cases such as Kelly’s, it is often difficult to restore a fully smooth appearance to the abdomen because patients have a layer of scar tissue beneath the skin’s surface and little to no fat left as a result of the laser liposuction treatment they received.  Fortunately, improvement often is possible through corrective surgery. For Kelly, I performed tummy tuck surgery in conjunction with liposuction to sculpt the slimmer hip proportions she desired.

Though it’s a poor substitute for tummy tuck surgery, liposuction often serves as an excellent complement to enhance abdominoplasty results. In about 80 percent of my tummy tuck patients, I incorporate liposuction to accentuate the waist and/or to improve lower body proportions to help the abdomen’s appearance blend with adjacent areas for the most natural look.

Kelly was thrilled with her new look. Like many of the the revision patients I see in consultations, she was greatly discouraged by the poor results she received from her original surgery and fearful of going through a secondary procedure. Though revision surgery presents unique challenges to both the patient and surgeon, the resulting aesthetic transformation and restoration in these patients’ confidence makes it one of the most rewarding procedures I perform.



By Sherri Roberts Lopez

The recovery from tummy tuck surgery just became more comfortable thanks to Exparel—a new long-acting local anesthetic that Houston plastic surgeon Dr. Chris Patronella is pleased to provide to his tummy tuck patients. When injected into the abdominal muscle wall—the area that is the most common source of discomfort following abdominoplasty because of the muscle wall repair that takes place—Exparel delivers relief for 72 hours or more before the body absorbs the anesthetic.

tummy tuck recovery medication

The long-acting anesthetic Exparel provides more effective pain control after tummy tuck surgery than the pain pump, says Dr. Patronella.

Patronella says the anesthetic, which was approved by the U.S. Food and Drug Administration in October 2011, is a welcome breakthrough in pain management, eliminating the need for patients to tote around a pain pump the first week after surgery while also providing them with more effective pain control since it is injected directly into the muscle wall tissue, as opposed to medication being infused over the tissue, as it is through a pain pump.

“I’m finding that the use of Exparel makes the overall recovery experience more pleasant for my patients, ” said Patronella. “They are able to get up and around more quickly after tummy tuck surgery, thereby speeding their recovery, particularly during the first three to four days, which is typically the most uncomfortable stretch of the 10 to 14 day recovery period.” Additionally, the surgeon noted the anesthetic reduces the frequency and amount of pain medication that patients typically require, lessening drowsiness, constipation, nausea, and other unpleasant side effects that can sometimes occur with their use.

Patronella participated in a clinical study to evaluate Exparel’s safety based upon follow-up exams with 94 women who received the anesthetic in conjunction with breast augmentation surgery. He and his colleagues’ research was published in the Aesthetic Surgery Journal—the official publication of the American Society for Aesthetic Plastic Surgery—in February 2012.

By Plastic Surgeon Chris Patronella, MD, FACS

One of the most common misconceptions I encounter concerning the tummy tuck and other cosmetic plastic surgery procedures is that major changes can be made through small incisions. Minor improvements can be achieved through small incisions but not major.

In my practice, more than 90 percent of my tummy tuck patients require a hip-to-hip incision to achieve the necessary improvements that my patients seek and that I seek. When this is the case, neither liposuction or a mini tummy tuck will deliver good results, though these procedures were recommended to many of the patients I see who desire tummy tuck revision surgery to correct the inadequate results they received. Abdominoplasty performed through a small incision has left them with an upper abdomen that bulges and a lower abdomen that is flat, the result of an incision that was too small to achieve the comprehensive level of correction that is typically required to tighten loose skin and muscles both above and below the belly button.

To a great degree, marketing leads people to believe that dramatic improvements can be accomplished with short and less invasive procedures. But often, only a small percentage of patients are true candidates for these types of procedures.

One of the hardest things to do is to disappoint a patient with a recommendation that is different from what they’d hoped to hear, but you can’t always follow their desires.It is the responsibility of a plastic surgeon to apply an artistic eye to a person’s body shape and then educate this individual as to what is necessary to create the right look.

Plastic surgeon
Dr. Chris Patronella

While surgical expertise tops the list of the most important factors to consider in choosing a plastic surgeon, a physician’s warmth, ability to put you at ease, and truly listen to your concerns are equally valuable qualities that can make all the difference between having a surgical experience that is uplifting and richly rewarding versus one that is merely average or perfunctory in nature. For Valerie, it was the recommendation of her daughter’s pediatrician and the care the young girl subsequently received from Dr.Patronella that led Valerie to choose the surgeon to improve her own aesthetic concerns.

After her eighth-grade daughter developed a blood cyst under her eye as a result of sports activities, Valerie took her daughter to a doctor, whose well-meaning attempt to treat the cyst unfortunately left her daughter frightened and traumatized—particularly because of the excessive bleeding it produced. Her pediatrician then advised Valerie to take her daughter to plastic surgeon Dr. Chris Patronella for care.

Recalling the day of that first visit, Valerie said, “Dr. Patronella looked at my daughter, put his hand on her shoulder, and said, ‘I’m going to fix it, and it’s going to be fine.’ You could see the worry and anxiety melt out of her face.” The experience deeply impressed the relieved young mother, who noted, “That’s what you want when you go to the doctor—the reassurance that everything is going to be okay.”

At the age of 53, Valerie visited Dr. Patronella once again, but this time it was for herself.  Motivated by the desire to diminish the facial jowls she’d begun to notice every time she looked in the mirror, she elected to have a facelift and eyelid surgery, a move, she said, that “took 10 years off of me.”

Four years later she returned to see what Dr. Patronella could do about the tummy roll that refused to go away despite her efforts to achieve that end through exercise.  When pants with waistbands that fit below the waist became more in vogue, she was dismayed to find there was no hiding the muffin top like she’d been able to with higher waistband styles, leaving her feeling self-conscious about wearing the more fashionable attire that filled clothing stores.

During her consultation, Dr. Patronella recommended that, in addition to a tummy tuck, she consider having liposuction to smooth out the excess fat in her back, creating a look that would better harmonize with the firm, toned abdominal look she’d attain through abdominoplasty.

“Dr. Patronella has a good eye,” commented Valerie, who appreciated that the surgeon looked at her body as a whole, providing a broader perspective beyond her own, which was focused on her more limited frontal view.

As a vegetarian who exercises regularly, the mother of two grown children gained a youthful new look that better reflected the vitality and fitness she felt inside.  Said Valerie, “This is the way I remember myself in my 20s and 30s. I just feel more myself again. This surgery helped me to be the vision I had of myself in my head.”


It can be challenging for busy moms to find time to pursue their personal interests and dreams. But a growing number are doing just that, choosing to restore firmness and shapeliness to the areas of the body that typically are the hardest hit by pregnancy—the abdomen and breasts—through mommy makeover surgery.

According to—the online plastic surgery information and patient review site—searches for the popular surgery, which is most commonly a combination of  a tummy tuck, breast enhancement, and liposuction, were up 28 percent from last year. Furthermore, 98 percent of women who reviewed mommy makeover surgery on the website declared the procedure was “worth it.”

As delighted as they are with their new appearances, many of Dr. Patronella’s mommy makeover patients initially wrestled with doubts in weighing the decision to undergo elective surgery, questioning the importance, safety, and seeming “vanity” of making such an investment in themselves.

Without exception, they will tell you that the motivation to make a change was for themselves alone. It speaks to a quiet, yet vital aspect of their feminine identity that can easily languish amidst the hectic pace of their multi-tasking roles. Though surgery in itself does not create the confidence and joie de vivre that often  is sparked within them, the satisfaction and joy they feel about the reflection they see in the mirror—shapely breasts and a firm, smooth abdomen in place of  sagging, shrunken breasts; a tummy pooch and muffin top—invariably ripples through to other areas of their lives.

In a RealSelf poll, mommy makeover recipients  said they experienced a boost in their

  • Self-confidence
  • Attractiveness
  • Satisfaction with their sex lives

Maybe that’s why the most common phrase we hear patients express is, “I should have done this long ago,”  when they see physical concerns that inhibited them for years transformed within a single day.

Dr. Patronella and his staff understand the mixture of doubt, hope, fear, and excitement that our prospective patients may feel when they first walk through our door for a consultation. As women who have children, significant others, and busy lives themselves, his patient care team is intimately acquainted with the different roles you fulfill, the pressures you face, and your desire for a change. You can be sure that every step of the way, they will provide you with support, guidance, and attentive care to ensure you have an unforgettably positive and rewarding experience.

—Sherri Roberts Lopez









As Dr. Patronella's patient coordinator for nearly 20 years, Eva Cadena will work with you to ensure that your experience is professional, courteous, and rewarding in every way. Please call her with any questions you may have.

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