Purpose:
The use of liposuction combined with abdominoplasty has been a controversial technique. Liposuction can dramatically improve the aesthetic result of an abdominoplasty, though the combination of techniques has been associated with an increased rate of venous thromboembolism (VTE) and wound healing complications. Through improvements in VTE prophylaxis, refinements in liposuction techniques, and an understanding of anatomy, this cumulative risk has decreased, though the negative stigmata persist. The purpose of this study is to describe the evolution of abdominal body contouring through the review of a single surgeon’s 20 year experience with abdominoplasty. Evaluation of this experience will highlight the significant contributions which have led to the improvement in the safety and efficacy of this technique.

 Method:
A retrospective review of patients undergoing abdominoplasty procedures was performed. Patient demographic information and procedural information including post-operative course and complications were recorded. Pre-operative and post-operative photographs were scored by blinded evaluators for aesthetic result and scar quality.

 Results:
Three hundred patients (N=300) undergoing abdominoplasty from 1987 to 2007 were included in the study. The use of a “superwet” liposuction technique in combination with abdominoplasty significantly decreased intra-operative blood loss (p<0.04), length of hospital stay (p<0.05), and blood transfusion requirement (p<0.01). Liposuction volume and region had no significant effect on abdominoplasty outcome, though refinements in operative technique, including abdominal and flank ultrasonic-assisted liposuction, high superior tension, and limited abdominal undermining did improve the post-operative aesthetic score. Venous thromboembolic (VTE) events significantly decreased with aggressive VTE prophylaxis (P<0.01).

 Conclusion:
The technical evolution of a single surgeon’s 20 year experience demonstrates liposuction can be safely and effectively combined with abdominoplasty. Pre-operative trunk analysis, intra-operative surgical refinements including super wet liposuction technique and peri-operative VTE prophylaxis significantly improve the outcome of abdominoplasty.