I have more patients make appointments with me for liposuction of the abdomen when actually they need an abdominoplasty and vise versa. So why is treatment of the abdomen so confusing for patients? I can’t imagine because the problem is simple, it’s the skin, the abdominal wall fat, the intraabdominal fat, the muscles…. Okay, it’s not so simple. In fact it’s pretty complicated.
As we gain weight fat increases in some areas more than others, such as the abdomen. With greater weight gain we can actually gain fat inside our abdomens, which shows up mostly as upper abdominal bulging. This “intraabdominal” fat pushes against the muscles of the abdominal wall widening them in the middle and decreasing their strength. Eventually, the skin and fat begin to hang in the central abdomen and increase laterally. As the skin is stretched, poor skin tone will lead to stretch marks or strea. Eventually a significant hanging of the tissue or pannus develops. Even with weight loss this skin can remain. This abdominal fat has been associated with many diseases such as diabetes and heart disease.
Liposuction will remove the fat. An abdominoplasty will remove skin and fat from the lower abdomen and is usually combined with tightening of the muscle. Unfortunately, liposuction cannot be combined with a standard abdominoplasty. This is because liposuction would disrupt the blood supply to the remaining skin of the abdomen potentially leading to disaster. When there is only a small, central pannus combined with excess fat over the abdominal wall, liposuction can be combined with a mini-abdominoplasty. In this procedure there is less dissection of the tissue and minimal risk to the blood supply.
So what do you do when there is moderate to significant fat and a moderate to significant pannus? In order to get a “home run” result I recommend two surgeries. In the first surgery I will extensively liposuction the entire affected areas. This will result is some skin tightening and may be enough for some patients. If not, after 4-6 months we will return to the operating room to do a complete abdominoplasty with muscle tightening.
Contour correction of the abdomen can be simple to quite complicated. A thorough discussion is necessary to appreciate each patient’s issues.
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