Q: Dr. Eppley, my son was born premature and needed a tracheostomy. He then had a tracheolaryngoplasty performed at 3 years of age. This has left a large ‘hole’ in his neck. He is now 11. We have seen a plastic surgeon who seemed to think that it couldn’t be made better. Do you have any experience with this type of neck scar problem? He is quite small for his age, has a very husky voice, and the scar is not good for his self-esteem.
A: Having done numerous tracheostomy scar revisions throughout the years, I have observed that they come in numerous orientations and depths. The most difficult tracheostomy scars are those that are significantly indented such as the one your son appears to have. They require more than just a simple excision of the wide scar because there is a significant soft tissue deficiency between the skin and the underlying trachea. This tissue deficiency must be replaced to get a satisfactory outcome. I usually use a dermal-fat graft to fill in the defect after the scar edges are released and undermined. Then the skin portion of the scar is closed over the graft to get a smoother neck contour.
Q: I am interested in getting a six-pack stomach. I work out all the time and do a lot of abdominal crunches, but it is just not appearing. I am a 34-year-old man and have only 9-percent body fat. I have read about a liposuction method called abdominal etching which can make the six-pack look in one surgery. Can you tell me how it is done?
A: The abdominal etching surgery is a modified liposuction method for producing abdominal highlights. Using fine liposuction cannulas, fat is removed along predetermined highlight lines in a linear array of a central vertical line and multiple (usually three) horizontal lines. By removing linear lines of fat, this causes the stomach skin to selectively indent which then appears like the underlying abdominal muscles lines, creating the six-pack look. Abdominal etching is really best done on someone who already has a near flat abdomen and wishes for a more liposculpture approach rather than a large amount of fat removal. It is not a good idea for someone who has a large abdomen or is significantly overweight. The only long-term issue is what would happen if you gain abdominal weight. The etch lines may look peculiar on a bigger belly, more like the back of a turtle shell.