Abdominolipoplasty: a system of classification and treatment for combined abdominoplasty and suction-assisted lipectomy

Marriage abdominoplasty expands the mini-abdominoplasty concept

The marriage of aggressive superwet liposculpture of the abdomen and adjacent anatomic regions with a modification of well-established open surgical techniques to address skin excess and perform muscle plication was used to treat 29 patients presenting for aesthetic abdominal contouring over the past 3 1/2 years. The charts of 57 patients who had aesthetic contouring procedures on the abdomen performed from December of 1994 to July of 1998 were retrospectively reviewed. Fifteen patients underwent suction lipectomy alone, 13 patients were treated with conventional abdominoplasty, and 29 underwent "marriage abdominoplasty." The 29 patients who underwent marriage abdominoplasty presented with deformities marked by excess lower abdominal skin and adipose tissue, with or without muscle laxity (Psillakis types II, III, and IV). Seventeen procedures were performed under local anesthesia with deep conscious sedation on an outpatient surgical basis. In 12 patients, the operation accompanied a hysterectomy, urologic procedure, or additional aesthetic surgical procedure(s) and was done under general anesthesia. Suction aspirates ranged between 540 and 2600 cc (mean, 1160 cc) and were accompanied by lower abdominal skin excision in every case, which was performed predominantly through short and medium-length incisions (mean, 15 cm). Rectus abdominis muscle plication was performed where necessary, using vertical plication of the infraumbilical rectus muscles in 27 patients (93 percent) and full-length plication in two patients (7 percent). All patients demonstrated significantly improved contours and have seemed to manifest less pain when compared with patients treated by full traditional abdominoplasty. Postoperative complications have included upper abdominal skin waviness (2), annoying paresthesias and discomfort persisting for 6 months (1), seroma (1), and marginal skin necrosis with an open wound (1). The latter problem occurred in the only patient who was treated with a revision procedure. Thus, the complication rate was 17 percent (5 of 29 patients). The marriage of aggressive superwet liposculpture of the entire abdomen with standard open surgical techniques used to treat skin excesses and allow abdominal muscle plication where necessary offers the advantage of reduced surgery when compared with full abdominoplasty, while consistently achieving significant contour improvement. This concept is applicable to the majority of patients presenting for the treatment of abdominal deformities and has markedly expanded the application of the mini-abdominoplasty concept.

Scarless infraumbilical abdominal lifting

If liposuction considerably improves abdominal contours, notably in the infraumbilical area, the results are reduced, or imperfect, for stretched abdomens, or with older persons, whose derma contains less elastic fibers. In this last case, a tightening by cutaneous and adipose suprapubic resections is most usually necessary. This tightening becomes possible due to fixation to the pubis of the fibrous and fibrous vasculars tracts connecting the fascia to the superficial fat. After initial proportional liposuction, shift expansion of the upper half of the superficial dermoadipose level of the infraumbilical abdomen and retraction of its lower half result in a harmonious, strengthened, and tightened abdominal surface, without remaining visible scars.

When does your liposuction patient require an abdominoplasty?

BACKGROUND

Abdominal surgery has evolved from one operation applied to all patients requesting contouring, to a group of procedures based on individual variations in anatomy. Currently, the authors favor four (Types I-IV) different procedures. Liposuction alone (Type I) is performed in the majority of patients. In the remainder (procedures Type II-IV) liposuction combined with modifications of open, traditional abdominoplasty are utilized. These additional methods are appropriate in patients that necessitate rectus muscle reinforcement or skin reduction procedures in order to adequately contour the abdomen.

OBJECTIVE

This report describes the indications for abdominal contour surgery, beyond just liposuction.

METHODS

A consecutive series of over 300 abdominal contour patients were reviewed and analyzed, with recommendations based on individual variations in their soft tissue anatomy.

RESULTS

We demonstrate that the majority of patients benefit from a "closed" procedure (liposuction or ultrasonic assisted liposuction) but that patients with muscle flaccidity or laxity in their skin may require an open procedure.

CONCLUSION

Abdominal contour surgery should be considered a group of operations (abdominolipoplasty system of classification and treatment) based on individual varieties in anatomy.

Limited abdominoplasty techniques applied to complete abdominal repair

The techniques of umbilical stalk separation, closure of the umbilical site in the midline, and short upturned incision lines define the operation described as limited abdominoplasty. The operation has evolved over the past 17 years into a procedure which is applicable in the majority of patients who have suffered distortion of the entire abdominal wall, with panniculus formation and fatty deposition. The use of liposuction is an essential part of "limited" abdominoplasty and of "complete" abdominoplasty. To protect the flap, techniques once applied only in the lesser procedures are now used for patients requiring a repair of the abdominal wall from the xiphoid to the pubis. These techniques also include advancement of the incision line to the "French line" position for aesthetic reasons. A description of the technical maneuvers required as well as the objectives for correction of the deformity in patients of all abdominoplasty types is presented. Patient selection is no longer an absolute criterion for the type of abdominoplasty repair that is selected.