Early experience of aspirative lipoplasty of the abdomen

Abdominoplasty and abdominal wall rehabilitation: a comprehensive approach

Standard abdominoplasty techniques involve a low horizontal or W skin excision, muscle plication, and umbilical transposition. Newer techniques include suction-assisted lipectomy, the use of high lateral tension with fascial suspension, and external oblique muscle advancement. The author has modified these traditional procedures and added new techniques to improve the aesthetic and functional results of the abdominoplasty procedure. This modification provides a comprehensive approach to abdominal wall aesthetic improvement and rehabilitation. The comprehensive approach described includes four components: the "U-M dermolipectomy," "V umbilicoplasty," the rectus abdominis "myofascial release," and suction-assisted lipectomy. The patient is marked while standing for areas of suction lipectomy and undermining. The lower incision is designed as an open U with the lateral limbs placed inside the bikini line. The upper incision is a lazy M with the higher peaks located at the level of the flanks. Subcutaneous hydration is achieved to perform suction along the flanks, waistline, and iliac areas. Gentle suction of the flaps is also performed. The umbilicus is cored out in a heart shape. The flaps within the U-M marks are excised, and the undermining is performed to the xiphoid and costal margins. The rectus diastasis is marked, and the anterior rectus fascia is incised at the junction of the medial third with the central third of the width of the rectus sheath. Horizontal figure-eight plication sutures by using the lateral fascial edge enable easier infolding of the central tissue. The new recipient of the umbilicus is made by an incision in a V shape on the abdominal flap. The umbilicus is telescoped, and the triangular flap of the abdomen is sutured to the triangular defect of the umbilicus. Skin flap fixation to the umbilicus relieves tension in the lower portion of the flap. The upper skin flap, which is cut in an M manner, provides lateral tension and matches the length of the lower flap. A standard fascial suspension is used and closure is performed in layers. The techniques described here are intertwined procedures. Each facilitates the accomplishment of the other procedure, and they complement each other. They all attain the 12 objectives of the abdominoplasty described. These combined techniques have been used in 104 patients in a period of 11 years. Complications were minimal and easily manageable, except for one patient who required excision of a pseudobursa and retightening of the lower quadrants of the abdominal wall musculature to correct extreme lordosis. A comprehensive approach for the treatment of complex abdominal wall aesthetic and functional defects is presented. These require thoughtful integration of the four components mentioned. This approach has allowed predictable, reproducible, and aesthetically pleasing results.

Analysis of methods for reporting severe and mortal lipoplasty complications

During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.

Surgery for obesity

The medical risks of obesity increase exponentially as weight increases, and these risks are reduced by sustained weight loss. Behavior modification and dieting provide an approximately 6% loss of body weight at 1 year. Fenfluramine provides an approximately 8% weight loss at 1 year, which can be doubled to 16% when a drug such as phentermine, which works through a different biochemical mechanism, is added to it. This amount of weight loss is insufficient for many severely obese individuals. It was with these facts in mind that the National Institutes of Health Consensus Conference in 1992 recommended that obesity surgery is an appropriate treatment for patients with a body mass index greater than 40 kg/m2 who had failed in attempts at medical treatment and for patients with a body mass index greater than 35 kg/m2 with severe complications of obesity. Vertically banded gastroplasty and Roux-en-Y gastric bypass are the two operations presently recommended because of their relative safety and effectiveness. This article reviews previous procedures that have provided insight into the mechanisms by which these surgeries cause weight loss. The presently used surgeries and their results also are reviewed because until medical therapy improves substantially, surgery remains the most reasonable treatment option for most morbidly obese patients.

Abdominal etching: differential liposuction to detail abdominal musculature

Male athletes seeking improvement in the detail of their abdominal musculature have traditionally utilized vigorous exercise and a tightly controlled diet. Abdominal etching is a technique devised to enhance the appearance of the abdominal musculature by removing fat with liposuction at variable levels. The abdominal musculature is topographically visualized as the linea alba, linea semilunaris, and the transverse tendinous intersections within the rectus abdominous muscle. These landmarks are enhanced with localized superficial liposuction to deepen the natural grooves or furrows in these areas. We have performed abdominal etching on eight male patients with good to excellent results and minimal risks.

Philosophy, technical principles, selection, and indication in body contouring surgery

The experiences of almost three decades of performing various types of body contouring surgery, in both pre- and postlipoplasty periods, using many different techniques are described. Contouring surgery for such body areas as the abdomen, flanks, inner and outer thighs, and buttocks is discussed in detail.

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

Criteria for diagnosing abdominal contouring candidates and a new classification system for procedures are presented. The surgical techniques for each of four patient categories of abdominolipoplasty are reviewed: type I--suction-assisted lipectomy alone, type II--mini-abdominoplasty, type III--modified abdominoplasty, and type IV--abdominoplasty with suction-assisted lipectomy. With the combination of suction-assisted lipectomy and abdominoplasty, the majority of patients can actually be treated with a limited abdominoplasty procedure or suction lipectomy. Complications noted in a series of 75 consecutive patients operated on by one surgeon are presented. The blood supply that is relevant to a combination of suction lipectomy with abdominoplasty is outlined. Specific guidelines for these combined procedures are recommended in order to safely combine full abdominoplasties with suction-assisted lipectomies.

Liposuction. What it will and won't do

Liposuction is used most often to contour the body. Usually, it is done on an outpatient basis under general or regional anesthesia. Results are better in patients who have good skin turgor and are at or near their ideal weight. The recovery period is short and relatively pain-free. While there have been serious complications in a few cases, the procedure is safe when done by experienced physicians who are careful in selecting patients and cautious about the magnitude of the procedure they perform. Patient satisfaction is high, particularly when patients are selected carefully and are well-informed concerning the expected outcome.

Combination of facial rejuvenation and lipoplasty of the torso

Older women seeking facial rejuvenation often exhibit another sign of middle age--the accumulation of subcutaneous fat in the torso. In the author's practice a total body evaluation approach is used. It is often suggested that the patient combine facial rejuvenation with lipoplasty of the torso if the patient is a good surgical candidate and the procedures can be performed jointly in less than six hours. The advantages are many, including a single convalescent period, decreased costs, and very high patient satisfaction with the degree of makeover in one session.