Abdominal Revision Liposuction

As I have described in my ExpertLiposuction website, when I liposuction the abdominal region, I either focus on the central abdomen or I approach the patient circumferentially including the upper/lower abdomen, the lateral waist, hip/flank unit and many times the midback. In the patient who needs their waistline inched in it is important to approach them circumferentially otherwise one will flatten the abdomen but it may look wider. In addition, when I do the abdomen circumferentially in my male patients, I am careful not to pinch in the waistline too high as it will feminize their physique. It is important to create more of a V-shape in men. I feel it is virtually impossible to accomplish a great result with circumferential liposuction of the abdomen under general anesthesia. Think about it – the patient is unconscious, intubated and essentially lying in one position with loose muscle tone.

When I liposculpt the waist circumferentially, I have the patient assume a position on their side with their body held straight and rigid. I then approach the waistline from small incisions above and below. If one tries to go around the waist with straight sculpting instruments sideways, they will never get around the curved area and stay in the fat layer (where they only belong) without jabbing the muscle or skin (where they never belong!).

When doing the central abdomen in many people, I also make a conscious effort to approach the upper and lower abdomen as a unit. All too often the lower abdomen is liposuctioned but the upper abdomen ignored or not taken up high enough (almost to the lower ribs). The result is that the lower abdomen flattens and the skin retracts but the upper abdomen then hangs over more in relation.

The abdomen can also be very prone to irregularities due to commonly compromised skin tone (especially in women who have children). One must always temper how aggressive they are with the elasticity of the skin. As it decreases, the surgeon should be more conservative in their fat removal and have extreme respect for how they treat the skin. The skin will tighten, but the surgeon must also think in terms of creating an even sheet of connective tissue under the skin to tighten evenly and not poke the skin causing dimples.Lastly, improperly placed incisions or even too few will lead to a poor result. While it always sounds good to have fewer incisions, if they are small and placed in the proper orientation, they usually heal imperceptibly. A common liposuction mistake is to approach the whole abdomen through a single belly button incision, as it will never give a good result. To begin with, one can’t access fat around the belly button. From this incision a doughnut of fat is often left. I never use belly button incisions and prefer to approach the abdomen from above and below more laterally (placing an incision within the area to be sculpted is strategically silly).

However if there only remains loose irregular skin, I either refer the patient for an abdominoplasty procedure or possibly consider nonsurgical skin tightening with Thermage.