Liposuction abdominoplasty is a procedure, which consists of: liposuction of the entire thickness of the abdominal subcutaneous tissue, an excision without undermining of excess abdominal skin and when indicated, a rectus sheath plication is performed as well. Liposuction abdominoplasty should replace traditional abdominoplasty, since it eliminates or reduces many of the potential shortcomings and complications, inherent to traditional abdominoplasty. Liposuction abdominoplasty is a logical progression in further limiting the extent of abdominal flap undermining. It allows aggressive, thinning and “sculpting” of the entire thickness of the abdominal subcutaneous tissue, resulting in a natural (not a featureless) appearance of the abdomen. It minimizes the creation of “dead space”, which leads to seromas, hematomas and infections and preserves the sensory nerve supply of the abdominal skin. The resultant scar is usually shorter, thinner and curvilinear rather than geometrically designed. Surgery may be performed under local anesthesia, additional procedures can be safely performed, the potential for deep vein thrombosis and abdominal perforations is lessened and the post operative course is short, without restrictions, with a return to strenuous activities within a week or so.

This paper describes new evaluation criteria for abdominoplasty, the most important of which is the evaluation of the finite volume of the abdominal contents and its effect on the decision to perform rectus sheath plication. Additionally, the concept of a mobile, sensate abdominal flap created by liposuction and sustained by multiple neurovascular mesenteries will be offered. Finally, a brief discussion will raise the issue of local versus general anesthesia in abdominoplasty.

The traditional abdominoplasty procedure entails undermining an abdominal flap by dividing the midline neurovascular perforators. Removal of the entire infra umbilical skin especially in patients with minor skin excess, creates tension and contributes to unacceptable scarring. Moreover, “unnatural” geometric incisions such as the W incision may be necessary and the aesthetic results can be disappointing and not meet patient expectations. The abdominoplasty procedure is known to be a special risk factor for deep vein thrombosis and pulmonary embolism. Additionally, abdominal perforations and skin necrosis, were reported on, in the largest series ever, 487 patients, published by Dillerud. Dillerud found wide undermining to cause skin necrosis. Undermining necessitates prolonged post-operative suction drainage and it is also the cause for the most frequent complication of abdominoplasty: seroma. Seromas may result in pseudocyst formation and they are especially frequent when liposuction is combined with a traditional abdominoplasty. Wide undermining of the abdominal flap has been reported to cause significant post-abdominoplasty, sensory disorders of the abdomen (71%) and thigh (9.5%), by Van Uchelen et al, who also demonstrated a recurrence of diastasis recti in 40% of their patients.

32 consecutive patients underwent liposuction abdominoplasty procedures from 1997 to 2001, representing approximately 7% of 450 major liposuction cases performed during that period of time. 9 patients were 50 years old or older and 10 patients weighed more than 190 lb. In 11 patients (34%), the skin excision was extensive enough to qualify as a panniculectomy. A rectus sheath plication was indicated and performed in only 5 (15%) of these patients. The clinical material, demonstrates that the added evaluation of the intra abdominal volume greatly reduces the number of those, who are expected to benefit from a rectus sheath plication. It also demonstrates that liposuction abdominoplasty is a safe and effective procedure, which satisfies patients’ expectations and is essentially devoid of complications and problems. Finally, an argument is made in favor of local anesthesia with sedation in the performance of liposuction abdominoplasties.