MD Hans-Hermann Wörl can now look back on 25 years of professional experience and has settled in 2002 with a beautiful practice in the Munich Isarauen.
His spectrum includes all facial procedures: from the classic facelift to mini-lift, mid-face and neck lift, forehead lift, eyebrow and eyelid surgery, to Botox treatments and fillers.
The range of services for the body includes breast surgery as well as abdominoplasty, liposuction, hand and microsurgery as well as varicose veins and spider veins.
In 2004, MD Hans-Hermann Wörl due to the number and the wide range of his interventions by the State Medical Association was given the right of further education for the subject "Plastic and Aesthetic Surgery" - which is equal to a great award!
Abdomen loses its elasticity because of many factors that include pregnancy, weight fluctuations, aging and individual anatomical peculiarities. After abdominalplasty, patients feel younger and slimmer which positively influences personal and professional spheres. Depending on the initial state of the front abdomen, abdominalplasty in Germany can be combined with abdominal liposuction.
During abdominal plastic surgery, abdominal skin and adipose tissue are stretched. After examining the patient, his doctor selects one abdominal plastic technique to reach optimal results. Depending on the initial state of the abdomen, the doctor can decide whether umbilicus should be moved, and anterior abdominal wall should be stabilized. In special cases, stretch marks after pregnancy and scars caysed by caesarean section or appendectomy can be removed during abdominalplasty. German doctors try to avoid leaving visible scars moving them along bikini line.
- Abdominal plastic is performed under general anesthesia;
- Duration of procedure 1-2,5 hours;
- Hospitalization period – 1 day;
- Early recovery period – 6 days;
- Full recovery after 6 weeks.
Fill abdominal lifting (abdominoplasty) is one of the most complicated surgeries. It’s aimed at restoral of proportions of belly and low-lateral sections of the thorax. Basic signs of a “correct” belly are an elastic abdominal wall with smooth contours a bit protruding below the navel and slightly concaved above the navel. There’s a small furrow between the edges of the rectus abdominis muscle, rigid muscles near the area of the pelvis, and lateral abdominal surfaces that form a smooth line of waist.
Abdominoplasty is indicated in the following cases:
- Aponeuroses stretching and separation of rectus abdominis muscle with ski stretching. Sometimes, they are also accompanied by hernia of the umbilical ring and so-called dominant line.
- Excess of subcutaneous tissue that cannot be eliminated with physical exercise, healthy eating, liposuction and other combined methods.
- Serious post-surgical scars on the abdomen, hernias in the pelvis after surgery.
- Poor elasticity and lack of collagen that makes liposuction pointless.
- Skin excess (flabbiness) and ptosis of the soft tissues on the front abdominal wall that forms a fold in the lower abdomen, or an ‘apron’ of skin and fat, scar atrophy (multiple white stretches - striate atrophy of skin).
Pretty often, such operations are made in patients with tissue ptosis that can be defined when a patient is in a vertical position. According to the level of ptosis, four types of it are classified:
- Minor skin stretching (without folds) in the lower abdomen; in such case, multiple striate is the indication for a surgery;
- Flabbiness of tissues above the navel combines with a minor skin-fat fold in the lower abdomen;
- An "apron" up to 10 cm thick that’s located on the edge between the front abdominal wall and the lateral sections;
- Fat-skin apron exceeds the thickness of 10 cm, goes to lateral abdomen sides and hangs down.
The volume of abdominoplasty and choice of the surgery depends on the level of ptosis and separation (diastasis) of the rectus abdominis muscle, as well as the presence of hernias.
The main point of surgery in both men and women is a correction of tissues to restore aesthetics of the navel, waist, and abdomen, and make it flatter. For this purpose, a surgeon cuts out navel, pelvic or epigastric hernias, eliminates the separation of the rectus abdominis muscle, removed excessive skin with subcutaneous tissues, forms the correct navel form, and restores a natural abdomen position.
Preparation for the surgery includes:
- a surgeon defines the level of tissue ptosis, finds hernias and asks about concomitant diseases;
- laboratory tests (blood and urine tests, definition of blood coagulation, electrolytes tests, blood group and Rhesus factor, RW, hepatitis antibodies, HIV), fluorography and ECG;
- consultation with therapist and anesthesiologist;
- 2 weeks prior to the surgery, patients should cease smoking and take hormonal medications, non-steroid anti-inflammatory drugs and the products lowering blood coagulation level;
- the night and morning before the operation, a patient shouldn’t eat and drink.
Surgical access for abdominalplasty is made along bikini like: incision starts from pubis and goes to hip bone in the zone of inguinal fold. After that, the skin is separated from muscles and is moved to the chest. Weakened muscles and fascia are stitched to reach the desired effects of abdominal plastic surgery.
When muscles are strengthened, excessive skin of anterior abdominal wall is fixed when it’s returned to the optimal position. This is how the main effect of abdominal plastic is reached. An incision is made on belly-button projection, then it’s stitches in the area of primary cut.
Abdominoplasty is contraindicated when a patient has:
- Acute or chronic diseases.
- Diabetes, diseases of the thyroid body (thyrotoxicosis or hypothyroidism).
- Heart diseases (abnormal rhythm, cardiac defects with stenosis, atherosclerotic cardiovascular disease).
- Systematic diseases of connective tissue.
- Poor blood coagulation.
- Pulmonary diseases, lung or heart failure.
- Unstable psychological state.
Even if there are no contraindications, abdominoplasty isn’t appropriate when a patient plans a pregnancy or weight loss with intense diets, because, in the long run, it can lead to secondary stretching of tissues, low elasticity, and tissue tension.
The operation isn’t appropriate when a patient has a lot of adipose tissue – there can be post-surgery complications, such as purulence and formation of seroma (collection of intertissue liquid in the surgery area). In this case, liposuction should be performed, after which abdominoplasty can be made within 6 months.
Together with classic abdominalplasty, German reconstructive surgery clinics use advanced methods of abdomen lifting.
- Classis abdominoplasty
- Vertical and lateral abdominoplasty
- Mini abdominalplasty
- Endoscopic abdominalplasty
- Backward abdominalplasty
- Dual-track abdominalplasty
- Transumbilical abdominalplasty
This approach is more traumatic than the previous ones, such surgery lasts longer (up to 4-5 hours), requires a longer recovery period, and the chance of complications is higher. Classic abdominoplasty is indicated only for patients with ptosis of III and IV degree combines with separation of the rectus abdominis muscle and hernias.
This operation is made under combines endotracheal anesthesia and/or regional anesthesia (or analgesia) taking several steps:
- Cut on the lower abdomen and mobilization (separation) of skin graft with adipose tissues to rib arches, xyphoid process, and lateral abdominal sections.
- Cut around the navel and separation of it.
- Elimination of a hernia and separation of muscles on the area of the white line.
- Cutting of excessive skin and adipose tissue.Иссечение избыточной кожи и жировой клетчатки.
- The lifting of tissues of the upper abdominal zone in the direction of the pubic, movement of the navel and fixation in a new place.
Vertical and lateral abdominoplasty
In the first case, a surgeon makes a complementary vertical cut. This variant is indicated in case of the vertical scar left after the previous operations for surgical diseases, in case of serious obesity, thinning and striate in the central area, serious separation of the rectus abdominis muscle, or if there’s a need to cut a larger area of tissues.
In the second case – skin grafts are cut and lifted in the lateral sections mostly, which allows diminishing the area of separation and forming the waistline. When the lateral approach is applied, the risk of complications is lower (in comparison with the classic approach) due to a lower volume of tissue separation, the speed and quality of scarring are higher due to lowered tension.
Recovery after the classic abdominoplasty and its kinds implies 2-week examination by the surgeon, care of the post-surgical stitches, wearing compression garments during 2, 3, 4 and more months. Minor physical activity and a hot bath are allowed within 1-1.5 months, and usual physical activities are allowed in 3-4 months.
Mini abdominalplasty is recommended for patients with minor amount of excessive skin tissue. During operation, excessive skin is removed. Since cut soft tissues are located in the lower part of abdomen, belly button is not moved, and the procedure is made with a smaller cut. Besides, mini abdominalplasty causes less stress for patient’s body due to minor surgical invasion: abdominal skin layer separation is not required in this case.
The main advantage of mini abdominalplasty is lower injury rate. It means that patient will recover quicker, and post-surgery period will be easier for a person.
Endoscopic abdominalplasty means that only weakened muscles of anterior abdominal wall will be lifted: it is usually performed in patients with pretty firm skin. Endoscopic abdominalplasty is performed via small incisions with endoscopic instruments which poses lower stress for patient’s body, makes up for faster recovery and great cosmetic effect. After endoscopic abdominalplasty in Germany, scars become unnoticeable within a few months. Besides, they’re located in bikini zone. Together with liposuction, this type of surgery renders better aesthetic result and corrects patient’s body considerably.
In German plastic surgery clinics, backward abdominalplasty is performed to lift several groups of muscles and remove excessive subcutaneous fat. A surgeon accesses the area in the underbust fold which makes scars invisible for the others.
Dual-track abdominalplasty combines mini abdominalplasty and backward abdominalplasty. During such operation, muscles of anterior abdominal walls are strengthened via incisions in bikini zone, and abdomen skin is lifted with access via the underbust fold to reach the best results.
Transumbilical abdominalplasty is performed to strengthen abdomen muscles, and is recommended for patients with firm skin. This operation is performed with endoscopic instruments via belly button. The basic stage of incision presupposed stitching of straight abdominal muscles above and below belly button. Transumbilical abdominalplasty allows reaching stunning results: you get firm abdomen without scars.
Right after abdominalplasty, abdomen is restricted with a special belt that should be worn day and night within the following 6 weeks. Bandages should be changed regularly, and the state of wound should be checked after surgery. Within two days after abdominal plastics, a person should not shower and wet the stitches. Bathing and swimming are prohibited until a person recovers fully.
As for physical loads, abdominal muscles can be tensed within 2-3 month only, when patient’s body fully recovers. During the first days after abdominal plastics, a patient should walk more and perform exercises for physical therapy. It promotes faster recovery and prevents formation of blood clots in the vessels of lower limbs.
You can always get an ample consultation in German plastic and aesthetic surgeries. Specialists will readily answer your questions and make an individual plan for abdominalplasty.
After abdominoplasty, complications are possible. They can be local or general.
First, there may be complications connected with anesthesia. During the first post-surgical period there can be pneumonia and breathlessness, especially when a lot of tissues have been cut to reduce abdomen size, thromboembolism of pulmonary artery, especially in case of varicose veins in the lower limbs. These complications are rare, but possible even when a person works with professional surgeons and anesthesiologists.
Local complications of abdominoplasty:
- Blood tumor in a bleeding vessel, formation of seroma and purulence – that requires cutting stitches and removing the mass inside.
- 2.Purulence and necrosis of the wound edges. It can happen due to the abnormal blood supply of tissues; in such case, necrotized tissues are cut out, and new stitches are made.
It’s also hard to eliminate the probability of absence of positive results.
There are alternatives to abdominoplasty – diets, physical exercises, electric muscle stimulation, vacuum-rolling massage combined with injection lipolysis, and different kinds of thermal lifting. However, these methods can be used when ptosis, hernias, and separation of muscles are absent.