Lipoabdominoplasty

Lipoabdominoplasty is the most advanced technique of Tummy Tuck performed routinely in most of the patients. It is a procedure that combines 3 D Liposculpting along with Tummy Tuck / Abdominoplasty.

When a patient comes to me asking for Tummy improvement, how do we make a decision as to which procedure would be suitable for the patient?

There are numerous procedures described in the literature and it is available in Internet with all the details of technique, risks, recovery etc. What is not clear for the patient is what procedure would be suitable for them and how do we come to a conclusion?

When you come to see me I will ask following questions:

1. What is bothering you or what would you like to improve in the tummy?
2. How old are you? – Sorry, I am in a profession that I have to ask!
3. Are you Single, married and how many pregnancies you had, if any?
4. What are your current weight and its fluctuations?
5. How is your health?

These questions will allow me to understand your needs, your body & skin changes and medical health.

I will than examine your tummy in standing and lying down positions and will assess the following

1. BMI and your body frame
2. Areas of disproportions and fat bulges
3. Amount of excess skin above the belly button, below the belly button, in the love handle areas and circumferentially.
4. Quality of skin, stretch marks, old scars etc
5. Underlying muscles- tone, diversifications, hernias
6. Intrabdominal fat content

In what circumstances would I need Lipoabdominoplasty?

1. If you have multiple pregnancies with normal deliveries or caesarean sections
2. If you have lost a lot of weight and have hanging skin above and below the belly button
3. Large bulging abdomen with hanging panniculus (fold of skin fat flab)
4. If you have diversification of rectus muscle or hernia
5. If you have excess skin flab with poor quality skin
6. If you have undergone bariatric surgery like gastric banding, sleeve gastrectomy or bypass surgery
7. If you are not planning any other pregnancy in near future

In what circumstances I should not go for lipoabdominoplasty?

1. If you have chronic uncontrolled medical conditions such as hypertension along with diabetes and cardiac dieases, renal diseases, lung diseases etc
2. If you are obese with large amount of intraabdominal fat
3. If you only have excess fat with minimal skin excess
4. If you have never been pregnant and plan pregnancy in future
5. If you have only limited skin excess below the umbilicus
6. If you are men with large “beer belly”

How do I prepare for a lipoabdominoplasty surgery?

Your surgeon will give you written instructions on planning for your surgery. You will get a booklet from Cocoona office with details of pre and post instructions that you should be aware of prior to the surgery.

1. Reduce weight as much as possible
2. Stop smoking
3. Get into a healthy lifestyle with nutrition and exercise
4. Wear an abdominal belt and do breathing exercises- because after tummy tuck with abdominal muscle tightening you may have difficulty adjusting postoperatively
5. Stop all medications that can cause thinning of blood (consult with your doctor first before stopping important medications)
6. Purchase all necessary items prior to surgery (Cocoona office will provide you the list)

How is the procedure performed?

In the hospital prior to the surgery Body marking will be performed by your surgeon. You will have an IV catheter inserted for anaesthesia medications. You will be given a stocking to wear. Inside the operating room you will be a pneumatic compression garment applied to your lower limbs to prevent clots in legs. You will be then connected to all monitors. After Induction of General anaesthesia, your surgeon will prepare and drape your abdominal area. He will than inject a cocktail of fluid with lidocaine and adrenaline (Tumescent technique). This will minimize the dose of general anaesthesia and take care of postoperative pain.

First stage involves liposculpturing with or without “VASER” ultrasonic assisted device. After liposuction of the abdomen and waist an incision is made at the lowest point in the bikini line area. It can be extended laterally towards the hip bones depending upon the amount of skin excess. Abdominal flap is elevated; belly button is disconnected so more skin can be pulled down. Rectus muscle is repaired and then excess skin is removed. Additional local anaesthesia in form of Sensorcaine/ marcaine is added under the muscle to take care of postoperative pain. Deep sutures are placed securely to approximate the wound in multiple layers. Finally running subdermal sutures are applied under the skin. Sometimes we insert drains either suction drain or silicone corrugated drain for first 24-48 hours. Then bandage is applied on the abdomen.

What is the postoperative event after the surgery?

You will then be shifted to your room after you are completely awake from the anaesthesia. After 4-6 hours you are encouraged to eat and drink and move your legs. You will be encouraged to walk as soon as you are able to do so. In the beginning you may walk with your hips flexed. You will be given IV medications to take care of any pain that you may have. Next morning your dressing is changed and drain may be removed. Many patients go home the next day. Some stay back for another night.

You will go home with very light dressing, pressure garment and some oral medications. You will able to move around in the house with some help in the beginning. After 1 week many patients leave home to attend to basic chores and follow-ups in our office. In 4 weeks time you may be able to resume work and moderate exercise.

What are the risks of surgery?

The potential risks include bleeding, haematoma, infection, excessive scarring, skin necrosis, fat necrosis, DVT etc. The incidence of complications is minimal in our centre. We have had occasional patients with small haematoma, small wound gaping and fat necrosis.

Minimising the scar of abdominoplasty is the most challenging part of this surgery. Excessive scar can occur in patients with tendency to form keloids and hypertrophic scars, type V and VI skin, excessive skin tightening, delayed wound healing etc

What is the scar management protocol?

Our protocol begins intraoperatively

1. Ensuring proper placement of incision
2. Meticulous suturing under the skin with miminal tension
3. Dry & exposed wound management 1st week to minimize inflammation and redness
4. Scar lotion in the 2 nd week
5. Silicone Sheets with compression for three months
6. Injection Triamcinolone intralesional if there is scar hypertrophy
7. CO2 fractionated laser in some patients- 10-12 sessions can reduce the scars dramatically.