Monique Ramsey (00:02):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. Today I'm excited to talk about something brand new. Well, it's probably not new for the doctor, but new to me and maybe new to you. And that is the BellaButton. And so I have Dr. Hector Salazar, our plastic surgeon and mommy makeover slash tummy tuck expert. Welcome, Dr. Salazar.

Dr. Salazar (00:28):
How's it going? Monique, thanks so much for having me again, and that it's always a pleasure. Have a nice conversation with you and reach our audience. And it always generates so generates questions, generates patient boost their curiosity. And also we like it because it's an opportunity to provide some education as well to our patients.

Monique Ramsey (00:46):
Yeah, so I think the first question a lot of people have when they're thinking about a tummy tuck is, what's my belly button going to look like? Because nobody wants that belly button that screams from down the beach, oh, that's a tummy tuck. So let's talk about that and I'll have you start by giving us an overview of maybe a tried and true tummy tuck and maybe what makes the BellaButton special.

Dr. Salazar (01:11):
Oh, absolutely. And no, as you're correctly saying that is the belly button is a concern for patients after surgery. How is my belly button going to look and is it going to look natural? Is it going to be, as you're saying, a giveaway that I had surgery? And that is something that we realize we recognize and we give it the importance that it deserves. Why? Well, as you know, in an abdominoplasty, you're going to have two main incisions, the incision that it's going to go at the bottom, and the second one is around the belly button. Right? So those are going to be the two incisions. What happens during a tummy tuck is you make that incision at the bottom, you go through the skin, the fat reach, the level of the muscles, and start dissecting, meaning lifting up until you reach the level of the belly button. People might not know that the belly button has a stalk, so it's not only floating on the skin, but it's connected to the fascia, to the layer that covers the muscles. Because why? I mean, that's exactly how we used to get nutrition when we were in our mommy's belly, right?

(02:24):
So it has a stalk. So it's not that when we are lifting all the tissue, we go through the stalk and transect the belly button. No, no, no, no. What we do is, as a matter of fact, we make an incision around the own patient's native belly button, and then we, let's say cone it down, and then we continue lifting everything up. So the belly button still attached. So the belly button that a person will have after a tummy tuck is their own belly button. It's not a new one, it's their own. But then what happens is, as you know with a tummy tuck, we stretch the skin, remove all that extra skin sometimes with stretch marks and all that. Also the fat that comes with that skin, all that goes away, cinches the figure of a patient. But then in theory, if you can imagine, we have removed all that skin, including the little buttonhole that where we took out the belly button.

(03:20):
So we pulled everything down, and now in theory, there is no window for a belly button so the patient wouldn't have a belly button. So what happens is when you pull down and now you adjust where that skin is going to go, so you have to find the perfect spot for the belly button of the patient that's hiding now, to come out through a new window that you're going to give the patient. So as you're doing that, you can redefine how that belly button overall is going to look, and you can do it for good or you can ruin it, right? I mean, you want to have as natural of a belly button as much as you can have, so it's not a giveaway. And that's where our approach comes in and that's where we dedicate a good amount of time. So with our technique, what we aim to do is to provide for the patient a very natural outcome belly button. And in order for us to do that, we follow several steps in the operating room and dedicate a good amount of time to create this. And what the patient can expect actually is to have exactly the opposite of what we said. It's not going to be a perfect circle. It's not going to have the sutures in the outside. The patient's not going to have a white line all the way around. It's telling everybody, oh, look, I had a tummy tuck.

Monique Ramsey (04:47):
And now did you come up with this little trickery, surgical trickery yourself? What was the inspiration?

Dr. Salazar (04:57):
Well, the inspiration literally comes from the need that, I mean, you do a consultation on abdominoplasty and the question comes out frequently or the concern from patients come up frequently. And as you know, as plastic surgeons, we have certain pedigrees and we are trained in different places and we are touched by several different surgeons and little by little, you start coming up and forming your own style and your own technique. And we realize little by little that we were dedicating more and more and more time during an abdominoplasty to do a meticulously reconstructed new window for the belly button. And also, so there are several steps that we follow. So one is that we are going to make some small surgical incisions to the native belly button, so it's not a perfect circle. In addition to that, what we do is we create a pull in belly button.

(05:54):
You don't want an outie, right? What you want to have is you want to have as much as a pull in, umbilicus belly button, and I'm going to get into minutia, but we have certain techniques of which we use to pull it in. And then what we do is when we create the window for the belly button, it's never a circle. We made also different cuts. So that belly button comes out and comes out through a window that it will never turn into a circle. In addition to that, there are several sutures that we put as we are repairing it, several stitches. And the way we like to do it is we like to do the stitches not in the outside. I mean, you can imagine like a baseball, right? No, not like that.

(06:38):
The sutures are done in a way that actually those stitches do not are in the outside, and we use sutures that we have to remove, so the body does not need to absorb them. The reason this might sound contrary to what a patient would expect because you want like, oh, all my sutures to be dissolving. I mean, everybody asks for that. So in this case, what happens is that we don't want the body to be dissolving those stitches because that means that there's going to be a large inflammatory reaction for your body to be able to dissolve some of those stitches. And this is an area where we want to pay a lot of attention. So you know what? Let's not ask your body to be working and dissolving those stitches. Let us take them out, and then the scar will be much, much better, and it'll be hiding even better.

Monique Ramsey (07:27):
I love that. And it is kind of contrary. You would almost think that dissolving sutures more modern or more obscure too, or that invisible, I guess. So tell me, how did the BellaButton get its name?

Dr. Salazar (07:41):
Well, I would say that it totally comes in from the technique and the goal. So BellaButton abdominoplasty, it's an abdominoplasty with a beautiful umbilicus, with a beautiful belly button, and Bella in Italy and Italian, it means beautiful. So that's how we put it. And the way or how it came was actually as many of our patients were referring or complimenting on the fact that, oh my God, my belly button looks so good, looks so beautiful, Dr. Salazar, your belly button, the new window that you created for my belly, but looks so good, so beautiful. And that's how we put it together.

Monique Ramsey (08:23):
That's so neat. And would this be something that would work just as well for men? I know men get tummy tucks and that men could also have a BellaButton?

Dr. Salazar (08:34):
No, absolutely. Absolutely. It's something that you can, I mean, both men, women can want to have a natural belly button and that more not to be a giveaway of their abdominoplasty.

Monique Ramsey (08:47):
So now when you were talking about innies and outies, what if the patient starts with an outie? Could you give them an innie based the BellaButton, or is their anatomy too much in the way?

Dr. Salazar (08:59):
So I would say that it depends on the patient by patient basis. And the reason why I say this is imagine, there are several things to take into account. One is the patient on anatomy. The second one is any underlying condition, which could be sometimes even a hernia. For instance, if a patient has a hernia or a patient has a very prominent outie to turn that into an innie, as you're saying, sometimes you're going to reach the limit of the technique.

Monique Ramsey (09:34):
Okay, one more question. What if a patient has had a tummy tuck in the past and they want a revision? Could you do a BellaButton sort of revision to somebody who's had a previous tummy tuck?

Dr. Salazar (09:49):
You could, but you would be very limited. You could, because the technique starts right from the beginning of an abdominoplasty surgery sometimes, and I know that you know about this, that sometimes when you need to revise the tissue around the belly button and the patient already had an abdominoplasty, and you talk to the patient, you say like, well, you know what? We need to basically make the whole incision again and revise. So we can, but sometimes it would be a little impractical. So if time for recovery, if economical resources and it's not a factor, then you can redo an abdominoplasty, provide the patient with a better belly button. But sometimes that could turn to be a little impractical, but depends on how much of a revision the patient is looking for.

Monique Ramsey (10:41):
Okay. Now sometimes they're going to be having other surgeries at the same time. I'm assuming that doesn't change, right? If they wanted to have a breast lift at the same time or they want to have liposuction, that doesn't impact this procedure.

Dr. Salazar (10:56):
Correct. No, it does not.

Monique Ramsey (10:57):
So one more question before we wrap up, is this belly button technique, I'm assuming once you do it, you're not going to go back to the old way. Is this the way you do your abdominoplasties all the time?

Dr. Salazar (11:13):
Absolutely. Absolutely. Because I think everybody deserves to have the best belly button possible. So definitely, yeah, we perform, this is our routine, if you want to call it that way, or our customary or our usual abdominoplasty includes having the BellaButton up within that procedure. So it's something that we think that all the patients that we operate should benefit from and dedicating that extra time, it's totally worth it. And I think patients are very happy. And then you can see that in all of our reviews and you can see in per procedure. And abdominoplasty also is one of the procedures that patient loved the most, so definitely is something that's only going to add up and boost the satisfaction of our already very satisfied patients.

Monique Ramsey (11:57):
Right, right. Now, if you're listening today and you're interested in maybe a BellaButton tummy tuck, I encourage you to look in the show notes. We have links to get a consultation. There's no charge for a consultation. And just to kind of see what would I be looking at in terms of cost, in terms of recovery, seeing some before and after pictures. And we're going to dig up some before and after pictures to show you the difference between a Dr. Salazar BellaButton and a regular, maybe more old school bella, not, un bella, but just to get the idea for what are we talking about. So we're going to try to give some comparisons and have those links in the show notes so that you can see what we're talking about. I think you've explained it really well conceptually, but again, it comes down to let's look at the before and afters and see the difference. So stay tuned for all those things in the show notes. And thank you again, Dr. Salazar, for coming in today.

Dr. Salazar (13:01):
No, thanks for the invitation.

Monique Ramsey (13:02):
And talking about this really fun new, like I said, new to me maybe, not new to you, but to our patients.

Dr. Salazar (13:10):
Absolutely.

Monique Ramsey (13:10):
And describing this upgrade, I would say, upgraded tummy tuck experience.

Dr. Salazar (13:16):
Absolutely. No, thanks so much, Monique, for the invitation and every time that I come here, we have, I don't know, we have so much of fun sharing our knowledge of plastic surgery, and hopefully patients appreciate that or potential patients, all your audience.

Monique Ramsey (13:31):
Thank you. Alright, we'll see you on the next one. Bye.

Announcer (13:35):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I five San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis, T-H-E-A-X-I-S .io.