In some cases where patients have a minimal pouch in the lower belly, the standard has been the “Mini tummy tuck.” An incision similar to that used for a “C Section” is used to tighten the muscles below the belly button. At the same time a small amount of skin is taken out above the mons pubis. The procedure works well, but does not address the muscles above the belly button.
On the other hand, for the past several years I had been doing the regular Abdominoplasty using the “Lockwood technique”. Using this technique the skin above the belly button is freed up only along a central tunnel 3-4 inches wide instead of doing it all the way to the rib margins. This has the advantage of leaving more of the skin attached to the abdominal wall, which in turn allows the skin to be tighter, have a better blood supply, and it diminishes the rate of postoperative complications such as fluid collections under the skin. Doing the procedure this way one gets used to operating along a narrow tunnel with limited room, and I started using different instruments to facilitate the process.
Then one day a man came requesting a correction of a bulge above his belly button. He had a muscle separation above the belly button which is more common in men. He was recently divorced, did not want scars, and requested Liposuction to get rid of the bulge. I explained to him that Lipo would not solve his problem and demonstrated to him the separation of his muscles. Would he be interested in a procedure to tighten the muscles that was not described anywhere but that I could complete using techniques I was comfortable with? He agreed, and I did the procedure by making an incision around the belly button for access to the deeper tissues. It went so well I immediately felt bad for all those patients on whom I had done a traditional incision to treat this problem. So if I could do this going above the belly button, why not do it for muscle separations below the belly button?
Well, once you know you can do something well, you start recommending it to more and more patients. I recommend it now to anybody who has a separation of the muscles without skin folds or excess skin. If somebody is working out a lot yet when they relax the abdomen it still pouches out, they probably have separation of the muscles (Rectus Diastasis). I like the procedure a lot because it appeals to the Plastic Surgeons dream goals – Get a lot accomplished without any visible trace of your work.