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All about the popular Drainless Tummy Tuck with Dr. Brian Reagan

by | Sep 7, 2021 | Articles

We recently went LIVE with Board-Certified plastic surgeon Dr. Brian Reagan of CosmetiCare and discussed his signature technique, the popular drainless tummy tuck! The drainless tummy tuck is becoming more and more popular with patients because of the speedy recovery time (most patients are standing 1 day post) and stunning results! For more details on the difference between a regular tummy tuck and drainless tummy tuck click here. Click the video below to learn more about this wow-factor technique and to see some of his jaw dropping surgical results! 

And because we know you’ll love what you see, mention this blog and receive $500 off your own drain-less tummy tuck procedure! 

Video Transcript:

Brian Reagan plastic surgeon at CosmetiCare. Welcome to our Instagram live and today we’re talking about something that is really important to me and that’s drain-less tummy tucks.

So the question is that we get a lot from patients is how do I do this? But really I want to step back and tell you why I do this. And of all of the things that we do at CosmetiCare, we do all types of aesthetic plastic surgery. We work on the face, we work on the body, we work on the breasts, we do fat grafting, we do Brazilian butt lifts, we do it all. We have many talented plastic surgeons here. But this is kind of a unique pursuit of mine. And the question is why before I tell you how why is I’m constantly trying to evaluate my approaches and my techniques to do it better and either want to do the technique better where I want to do it in a way that leads to a better recovery. And that’s where drain-less tummy tucks come in. I have been practicing for over 20 years and I have to tell you that I’ve only been doing this for about 10 years. That means before I did this I did it the old fashioned way and it’s not that there’s anything wrong with the old fashioned way but I really felt like it could be done better and I’m going to tell you why.

So a mommy makeover is typically treating the changes that happened with mom from pregnancy. So it’s usually something to the abdomen and it’s something to the breast that’s a mommy makeover and we do a lot of them here at CosmetiCare. One of the concerns that patients have with a mommy makeover is recovery. They think it’s this really big operation and I’m telling you it is a significant operation. But historically the recovery was brutal. It was two weeks of the patient bent over with tremendous pain. And so it was a lot of pain. And that scared a lot of patients. Number two scarring was often bad and that scared a lot of patients. And so I just felt like it could be done better. But I also felt like the recovery could be better and that’s when I started looking into different techniques and in fact I trained at the  University of Texas Southwestern. And as I was finishing my training in 2000 and I’m going to put a plug in, it’s probably the best training programin the country or certainly one of the top three. There was a father and son team there in Dallas and the father is the one that initially described this technique of a drain-less tummy tucks and it took me 10 years to finally come around but I came around and it’s the only way I do things now. So I felt like a drain-less approach was easier for the patient, quicker recovery, less painful with better scars. So why wouldn’tyou do that? So what does it entail? So that’s the why.

The how on a drain-less tummy tuck is we use these things called progressive tension sutures. Why do we use drains in the first place? Because we create this space and we feel like we need to drain this space or the fluid would build up. And that’s sort of been the thinking in plastic surgery. Progressive tension sutures are internal sutures that tack the abdominal wall down. So why are we doing a tummy tuck? Two things- We tighten the muscles because those get stretched or rectus diastase as it’s called during pregnancy. And then we get rid of the loose skin. Well we still tighten those muscles like we did before. But now instead of just pulling that skin down, making the cut and sewing it together, we’re now tacking that abdominal flap down. We’re pulling it down and tacking it down so there’s absolutely no tension on that scar. In addition the patients are able to stand straight up and I encourage you we’re gonna show you some cases, encourage you to go to oursocial media and you’ll see it for yourself. So because we tack it down, you don’t need drains. Because you tack it down, patients can stand straight up. They’re not bent over. I almost always thin out. It’s called lipoabdominoplasty. I thin out the flap so that you’re nice and contoured and I’ll do liposuction at the back of the flanks of the bra line. I believe in looking at the patient 360° and I’ll do the tummy tuck. There’llbe no drains. If there’s a foley in. I usually put a foley catheter in the time of surgery. We take that out and literally the patient’s standing straight up after surgery and you’ll see pictures of them the next day. And all of these will be one day out one day. So the progressive tension sutures allow me to tighten everything. I thin it out. It allows patients to stand straight up.

Why is that important? Because after a tummy tuck, you want to be able to move. You want to be able to breathe. That makes it not only quicker for recovery but safer for the patient they’re moving. They’re not sitting around getting blood clots. Okay, so it’s better. It’s better. It’s better in every way. So, I think the people who don’t do it will say two things. Well I put drains in and I get fluid out of those drains. So how are you able to not use drains and not get fluid? The second will be well you’re probably not taking as much skin out. I’ll answer the 2nd one first- We are. I am tightening that down so that you can just look at post-op results and compare ours. My patients will have as much contouring with as much skin removed as any patient I’ve seen out there because I thin out the flap with liposuction they’re nice and thin. The progressive tension sutures allow me to tack and create what almost looks like a six pack. You’re going to see some of that here. And of course we do the liposuction of the sides. So the fact is is it’s as good or not better. There’s no tension on the scars. The flaps not pulling up on that scar. So the scars are better and the recovery is less painful and quicker. 

And I’ll show you some examples. So my patients are standing straight up and they’re off narcoticsoften after a few days, three days. No narcotics. That’s amazing. Now, the question is, if people who use drains see fluid, how come I don’t get fluid. And the answer is because I think the fluid is coming from the tissues when you don’t tack them down. The tissues are rubbingacross each other. And I think that’s creating some of the fluid. So by tacking it down, the tissues are opposed and they stick and we don’t get much fluid or if at all. So I just think it’s a better way. I’m not the only one who does it this way. I know some colleagues that do this way too and if you do it the other way, it’s not wrong. But I think this is a better option, and that’s why I do it. I’m going to show you some examples. And these are also on our social media. These are all patients that are one day out, and for you patients that are watching this,who had it done the other way, the old way, you’ll be surprised this patient is the next day. And these aren’t mini tummy tucks. There’s a lot of things I do to get a great result. I try to make a very natural looking belly button. It’s crazy if you see a result. That’s awesome. But the belly button looks like a punched out hole, gives it away. I keep the scar low, I thin them out here. And this was her abdomen before, she’s got a vertical scar she got a lot of laxity, this is her the next day. I don’t show their faces, but they’re smiling. The next day again, she had a vertical scar. She’s got a lot of what we call lipodystrophy or fat. So I did liposuction in that area, that is her the next day, notice the little crease in the middle starting to kind of look like a little six pack, straight up, scars are low symmetric, no dog ears, liposuction on the flanks. Okay, the nextday, and I show her before the scars are low symmetric meaning not one end goes up there, each half is symmetric. Okay, By using progressive tension sutures. We’re taking the tension off the scar. A lot of African American patients or patients with darker skin are afraid that their scars will look bad because the scar is long and I tell them no with this technique I think scars are better and you can barely see her scar here. But she at this point now she’s about four weeks out, scars are looking good. And this was a large abdominoplasty and I thinned out with liposuction this area. This patient went to work the next day. Now I don’t I don’t recommend that, I don’t encourage that. But she felt good enough that she went and she did a lot. She did you look at her abdomen there and there was quite a bit of laxity. We did liposuction, thinned her out. This is her the next day. She looks so good and she felt so good that she said she went in, she also hadfat put in her buttocks, BBL Brazilian butt lift and she just said she stood at her desk, she just felt like it. She went to work for an hour or two and she just felt good, but that’s what’s possible. Again post-op day number one standing straight up. What does that mean? That means that by one week they are pretty recovered. They’re typically off narcotics by three days. You have to look this good at day one. If you’re going to be done at one week, what does that mean for the patient? Less pain, less narcotics, moving around, safer, back to their normal activities quicker. Which is important. A lot of these, a lot of our patients are working moms, they can’t take 2,3,4 weeks off. Yeah, it’s anotherone day right after large abdomen. Just looking great. One day. If you see my finger on our social media, if you see my finger like a number one, that’s because we’re one day out and the patients are standing straight up. Okay. So that’s my approach drain-less tummy tucks. I do lipo, abdominoplasty. So I do liposuction. I often do it on the flanks, the back, the bra line, we’ll do a breast augmentation, breast lift, breast reduction, we’ll do that all at the same time. We do give you pain medication post operatively and usually you take it for 2 to 3 days. Moving around is critical. It’s better for everybody. And we’ve been super happy. I’ve been really happy with the results and the patients experience and recovery. And for me that’s what it’s about. That’s what achieving another level as a surgeon, as an inquisitive surgeon is I’ve been at it for 20 years. So at this point, what I’m trying to do is take all that time and all that training. And the things I do. I try to do it at the highest level. And so it’s been great. It’s been a great journey. Thank you for joining us on Instagram live. And if anybody has any questions were taking questions and you will reach out to us on instagram right? Got my marketing ladies here. So hopefully I’ve answered most of the questions. A couple of things- So how does the process work? Well we do both zoom and in person consultations. If we do a zoom then I will see you at a pre-op. If you’re out of town you can come and we’ll help set you up with accommodations. I typically like you to stick around for 10 days but for sure one week. But the great thing is is after three days usually you can walk if you stay nearby you can walk around and enjoy not a lot, but you can you can walk around. We have our own surgical facilities here fully certified. So it makes it really convenient and we’ve got a great staff. So you’re in great hands, we will take just wonderful care of you here at CosmetiCare.

Someone asked if they had a tummy tuck 14 years ago can you do it again? So possibly it depends on how much laxity that you haveand there’s no doubt I can make it better. The belly button scar when pulled down may still be visible. And so I just have to evaluate the abdomen, but it’s possible.

Someone wants to know how much for a tummy tuck starting. So if we just did the tummy tuck and usually that includes some liposuction. Ballpark, don’t hold me to it but ballpark is around 12,500. And then if you add some more liposuction or you do breast work then we add that on.

Someone said what is the down time? Do you need to be near your goal weight? So if someone is within 5 to 10 pounds of their goal weight then I’m fine with that if someone is losing a lot of weight then I want them at that goal weight for a couple of months. And this is the reasonwhen you drop weight you’re not necessarily in a good balance of nutrition. You might be starving yourself, you might be negative caloric. So I want the body and the mind in a good steady state. And we’ll evaluate that. Often, we do work on gastric bypass patients, weight loss patients and usually we like them at their steady state for a year.

Someone asked you do you go by BMI? For the massive weight loss patients often if their BMI is a certain level then we’ll refer them for weight loss surgery. We do evaluate the BMI but I’ve done work on patients that might benefit from gastric bypass but they’re just not going to do it. And so we will evaluate those patients. 

Let’s see Theresa said she loves you. Hi Teresa!

Perfect. I think that’s good. Nobody else has any questions. 

At this point in my career I’m just trying to do things the way I think are the best and I’m really happy that I pushed forward and had the confidence with the support of the team here to do that and to offer it and not every doctor does it this way here and maybe they’re just not quite on the same place that I am on the journey. And so it’s not that they’re not going to get good results but I just think my patients arerecovering a little bit easier a little bit quicker. That makes me happy, makes them happy.

A couple more questions tummy tuck or lipo. So my philosophy in offering cosmetic surgery is I try to get where I think the patient wants to go with the least invasive technique. If I think I can get the results they’re looking for with lipo alone I’ll do it. But unfortunately if there’s toomuch laxity or there’s been children and there’s the rectus diastasis which is the weakening of the abdominal wall, lipo alone is just not gonna do it. And the great thing about this practice is that we have other tools. We have bodytite, which for some patients we can do lipo andthen the bodytite and we get a nice result. But remember with the tummy tuck, were tightening the muscles and don’t fear the scar for a tummy tuck. Don’t fear it because the scars look great. They are hidden under a bikini. And I have never heard a patient tell me afterwards boy, I wish I didn’t do this because the scars so big. I’ve never heard that the results are so great and they can wear bikini that they don’t care about the scar.

Someone asked, will a tummy tuck takeaway stretch marks? Yes, if the stretch marks are all below the belly button, then they will be gone. And then someone said do you recommend wearing a binder or anything post? Yeah. Our patients wear a binder for about two weeks orthey get into Spanx. And it helps with the results. Yes, because remember we’re doing liposuction too. So compression helps. 

Someone asked you tell your story on how or why you started this method, I think you already did earlier. Because patient recovery was long. The perception was that it was a painful long recovery and the thinking behind the drain-less approach using progressive tension sutures would one, make the recovery seem easier, it is easier, it’s less painful, better scars. So there were so many positives. The only potential negative was well what if they get fluid? So when I first started doing this, I had a very low threshold for checking for fluid and Iwould put a needle in so the patient doesn’t feel it. But I put a needle in to check for fluid and I wouldn’t get it. And I finally realized,no, we’re not getting any fluid. 

Any other questions?

And so often we’re doing this in conjunction with some liposuction of the flanks, the bra line. We’re doing breast lifts, breast reductions, implants and lifts. And it’s one of my favorite things to do because patients are so happy and thrilled and you know, I think moms out there do a wonderful job bringing kids into this world and sometimes it just affects their bodies in a way that they can’t control. And I just like seeing mom do something for herself and getting that confidence back with her body and we can help them. So it’s very rewarding. 

I have a couple more questions. How soon can you work out after a tummy tuck? So you can start working out, so you can start being active, maybe a stationary bike at two weeks, back in the gym at four weeks, no restrictions at six weeks. That’s assuming everything heals well.

Someone asked how long does the surgery take? So the total surgery time is surgeon time plus when you go to sleep and then when you wake up from anesthesia. So if we just did the tummy tuck you’re looking at about four total hours.

So this was great. And we’re going to do more of these and thank you for those patients that responded. And if you have any other questions just give us a call we’ll get you in here for a consultation. Wait we have one more question. Does it take away all fat cells? If so you can’t gain weight back in your tummy. No no. You never remove even with liposuction you never removing all of the fat cells. But the question becomesif you thin everything else here and then you gain weight. Will you gain it somewhere else? And you might, you might gain some of it back here and you might gain some of it somewhere else. All right wonderful. All right everybody thank you.

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