Liposuction or Abdominoplasty: That is the Question

The female abdomen is a very special anatomical area; not only is it the focus of body contour in fashion photos, it is the place of procreation, reproduction and the continuation of the family tree. Women exercise, measure and evaluate their abdomen regularly upon dressing and shopping for new clothes. It is not surprising that the shape of the abdomen is addressed during almost half of all new patient consultations with the plastic surgeon. Changes may occur with pregnancy, with weight gain and loss, and with any abdominal surgery, which may disrupt the muscular balance and alignment.

Most women store fat in the abdominal wall, which is the space between the skin and the muscles. This fat is particularly unattractive because it effects the waist to hip ratio. Some of us, particularly men, store fat within the abdomen in a structure called the omentum or around the abdominal organs, themselves. The omentum is a fatty apron, which protects and encloses the bowels. Fat in the abdominal wall is amenable to liposuction or liposculpture, but the internal fat is not correctable with plastic surgery. The plastic surgeon must make the distinction between the two fatty placements as a very important diagnostic requirement prior to body contouring surgery. In that regard, post-operative expectations can more realistically be determined and achieved.

When liposuction or liposculpture alone is being considered, the skin of the abdomen must be healthy, with good elasticity. When stretch marks are prevalent, there is indication that the skin has been badly damaged. It will not contract and respond favorably to liposuction alone. However, when the proper indications are met, and the skin is relatively healthy, the results can be very satisfying, sparing the extensive surgery of a tummy tuck or abdominoplasty.

After the female abdominal wall has been stretched through pregnancy or opened during surgery, very often, the musculature does not adequately support the internal structures, or the back, and a protuberance (pooch) is noted. In the time following the child-bearing years, often the patient can benefit from muscle repair by permanently attaching the two, central, rectus muscle bellies together. Thereby a flattening of the abdomen is achieved and the waist is reduced in circumference. After these muscles are surgically repaired, the excess skin is removed, resulting in a scar around the umbilicus and in the lower abdomen, often from right hip bone to left hip bone. This surgical process is termed an abdominoplasty and results in a permanent repair of the floppy belly. Most patients will benefit from a good diet and exercise program before and six weeks after abdominal surgery. The better toned, the muscle, the more favorable the repair.

Of course, diet and exercise alone, can greatly improve the abdominal contour, but in those patients whose muscles are severely stretched or have been detached, exercise will not fix the problem. In fact, sometimes, the muscle connections can tear, resulting in a hernia, or weakness, which allows the bowel to protrude through the abdominal wall. Once this defect forms, a surgical repair is necessary to correct the problem. If the repair is performed by a general surgeon, often an abdominoplasty can be offered in conjunction. Regardless of the approach, the best results are found in the person who is fit and properly nourished prior to surgery. The results should last a life time!

MARCIA V. ORMSBY, MD

Liposuction Corrections

This patient is a 49 year old, healthy female, who came to me three years following liposuction of her thighs, performed by a nearby plastic surgeon. Despite a long wait and reassurance by the operating surgeon, she was left with these scarred, irregularly surfaced thighs. The dimpling of the skin was so severe that she could not wear skirts or shorts, comfortably. After a complete workup in the office, I was able to perform Laser correction of the scarring and a thigh lift, removing the excess skin and smoothing the surface. The surgery was challenging, because of the scars that I encountered during the surgery, but careful Laser release resulted in a near perfect correction of her problem, as you can see in her photos.

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Liposuction is a safe, predictable procedure

In nearly 25 years of practice, I have not ever seen this patient’s scarring resultant to liposuction. The correction was very successful, but the problem is completely avoidable with careful, primary attention to technique and appropriate selection of instrumentation. All surgery is meticulously planned to prevent untoward outcomes with strict attention to detail and post-operative care. However, if any results are unsatisfactory, there are modalities to correct these problems.

It takes careful evaluation to set goals

During your evaluation, we will consider options for a realistic attainment of your goals, taking note of your time and lifestyle. Your surgery is performed in our fully-accredited surgery center. Since your life is busy and your time especially sacred, many times, combined surgeries are offered to reduce healing time and costs. You will enjoy a ‘house call’ following your surgery, so that I can determine your optimal healing conditions and correct any problems that may be interfering with a smooth, safe, pain free recovery.

Options for Liposuction surgery include:

• liposuction alone, always using the tumescent technique and small cannulaes
• lifting of the surrounding skin
• liposuction with ‘Smart Lipo’ or Laser Liposuction

The surgical removal of fat is a practice that has been implemented for several decades. The techniques have changed dramatically over the years, improving the safety and quality of the results. The equipment has evolved and been refined over the years, providing smaller instruments and better control over the suctioning process. The tumescent technique was introduced to significantly decrease the skin depressions and to mobilize the fat for removal. This process of tumescence involves the infiltration of a bio-compatible fluid into the fat layer, thereby mobilizing the cells for removal, reducing blood loss, and improving upon the final results with smoother skin contours.

It should be stressed that liposuction, by any process, involves the removal of entire fat cells. The individual fat cell is a storage unit for excess calories; we are born with a finite number of fat cells and that number remains constant throughout life. When body weight increases due to obesity, the fat cells begin to divide, creating new cells and a greater capacity for fat storage. Those new cells then fill up with fat and the cycle continues. This is why it’s so difficult for overweight individuals to loose weight. The fat cells may become smaller in dieting, but they never decrease in number, unless surgically removed. The skin stretches, often permanently, to accommodate the extra bulk, and so we begin to weigh more and look fat.

Surgery, especially liposuction, is responsible for removing these storage units and their contents, that is, the fat cells themselves. The weight of the individual is reduced, but even more noticeably, as fat does not weigh very much, the contour of the area is reduced and improved. The excess skin in the area of fat removal presents the next aesthetic challenge in body contouring surgery. Sometimes the skin shrinks in response to liposuction, but when it does not contract, the contour problem remains. One solution, naturally, is to remove the excess skin, but this more extensive solution provides for large scars, considerably more surgical time, and more procedural complexity. Lately, another solution for skin shrinkage has been added to the liposuction surgical options. A laser machine, that generates a particular wave length (1064nm), specifically targeted to the undersurface of the skin, has been developed by Cynosure, which causes the excess skin to contract. Through a series of clinical trials and research, ‘Smartlipo’ has been FDA approved for clinical use. This machine involves the use of a fiber, enclosed in a tube with an exposed tip. This fiber is introduced into the skin though the existing incisions (which were made for the liposuction procedure), and delivers a series of pulses to the dermis. The Smartlipo device causes the skin to contract to more favorably, enclosing the new and improved contour following fat removal. The laser liposuction technique is designed to target damaged, stretch-marked skin, greatly improving the final, healed appearance. This process is similar to dropping a raw egg into a hot skillet – notice how the egg contracts.

There are many ways to accomplish the same task. Consider safety first and be certain that the results warrant the time and expense of the procedure. These issues can be confusing and complicated to understand without medical training, which is why they should be discussed with your surgeon, whomever you choose. Review a variety of photographs, pre-operative and post-operative results. Additionally, you may be offered the opportunity to talk with patients who have had the particular procedure you are considering, to understand the healing process and expected outcomes. The discomfort involved and the time for recovery and healing are specific to your procedure and cannot be generalized here; choose a doctor who will help you understand all of these important issues, as we make a practice of doing at Annapolis Aesthetic Surgery.

In closing, when diet and exercise alone cannot restore the form that you would like to achieve with your body, if you are in good health and have reasonable expectations, then consider a skillfully, safely and artfully preformed surgical procedure to assist you in your transformation.

Our surgical center, Annapolis Aesthetic Surgery, was one of the first in Maryland to offer Smartlipo, and have been offering this service for just under three years.