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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘abdominal liposuction’

Case Study – Extended Abdominal Liposuction

Wednesday, February 3rd, 2016


Background: Liposuction, both by number of procedures performed and body surface area, is the most common aesthetic body contouring procedure. While a large number of different face and body parts can be treated by liposuction, the treatment of abdominal and waistline fat accumulations is the most popular requested area. While initially intended to treat smaller abdominal amounts of fat, abdominal liposuction has evolved to become a larger surface area treatment wrapping around the sides in the back.

Extending abdominal liposuction into the back has been shown to be very safe in properly trained and experienced hands. With fat removed in a near circumferential manner around the lower torso, it is no surprise that major body shape improvements can be seen. How much abdominal flattening and back roll reduction can be achieved is highly influenced by the amount and quality of the overlying skin. Back skin always has a greater amount of contractile ability due to its greater dermal thickness. Abdominal skin  often has less ability to shrink down smoothly due to loss of elasticity from pregnancies and weight loss.

As liposuction has evolved over the past 35 years in the U.S., numerous types of technologies have been applied to how liposuction has been performed. All of these technologies are largely about how the fat is broken up so that it can be suctioned out. While it is easy to get caught up as a potential patient in the different energies and marketing names of these liposuction types, nothing is more important than the skill and experience of the surgeon performing the procedure.

Case Study: This 46  year-old African-American female desired to liposuction to further what she has been able to achieve by diet, exercise and weight loss on her own. She had hit the proverbial wall in any further body shrinkage of her stomach, waistline and back.

african-american abdominal liposuction result front view Dr Barry Eppley IndianapolisUnder general anesthesia and using pre-liposuction tumescent infiltration, power-assisted liposuction of the entire abdomen, pubis, flanks and back rolls was performed. Using a 4mm cannula, a total of 3,800cc of fat aspirate was obtained. Essentially lipsuction as performed until the aspirate became more red than yellow.

african-american abdominal liposuction result oblique view Dr Barry Eppley IndianapolisHer postoperative swelling was considerable, as expected, and it really took her a full three months to have a complete recovery. Until the treated areas are no longer tender, feel soft and the sensation in the overlying skin is back to normal, all swelling has not resolved and the skin maximally contracted back down.

african-american abdominal liposuction result side view Dr Barry Eppley IndianapolisInterestingly at her three month postoperative evaluation, she felt she had no significant change in the fullness of her abdomen or a reduction in her back rolls. Comparing her before and after surgery pictures showed that her perception was not accurate.

african-american Back and Flank Liposuction result back view Dr Barry Eppley IndianapolisAlso of interest was the apparent change in the appearance of her buttocks. While no fat injections were done into her buttocks, the significant reduction in the waistline above her buttock made it seem that she had.


  1. Liposuction of the torso (abdomen, waistline and back) is the most commonly performed body contouring procedure.
  2. When liposuction is done in a near circumferential manner around the waist, a dramatic reduction can be achieved in the shape of the torso.

3. Liposuction does not always eliminate all stomach or back rolls if too much excessive skin exists.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Abdominal Etching Liposuction

Saturday, November 21st, 2015


Background: A well shaped and toned abdomen is a goal of both men and women of all ages alike. While some have it naturally, particularly at a young age, most have to work to maintain or create it through some regular diet and exercise.  A trim waistline and a flat abdomen is a reasonable and attainable goal for many people and would make most happy. But there are a few others that have more loftier desires for their abdominal shape, an abdomen that has visually evident muscular outlines.

Abdominal Muscle Anatomy Dr Barry EppleyThe so-called six pack or eight pack abdomen is one that has a midline vertical linea alba between the rectus muscles as well as their horizontal inscription lines evident. These are most commonly seen in young teenage boys and dedicated athletes and body builders. The one common denominator that they share is a very low percentage of body fat which results in such a thin subcutaneous layer of fat that the outlines of the abdominal muscles are seen.

But some patients, usually men, desire to have a well defined abdomen even if they can not create it by a low percentage of body fat and exercise. The artificial approach to creating this abdominal effect is known as abdominal etching or six pack abdominal surgery. This is a unique form of liposuction that removes a linear layer of fat over the vertical and horizontal muscle lines. This allows the overlying skin to indent inward along the lines of fat removal creating the muscle outlines rather than the muscle enlarging to achieve it.

Case Study: This 52 year male has lost fifty pounds and had gotten himself into a much improved shape through his own efforts of better eating and exercise. While he had made major improvements with a near flat abdomen and better waistline, he wanted to improve his abdominal result even further through a surgical approach.

Abdominal Etching Basket Cannula Dr Barry Eppley IndianapolisAbdominal Etching dressing intraop front view Dr Barry Eppley IndianapolisPrior to surgery he had markings made for the vertical midline and the vertical outer borders of the rectus muscles as well as the three paired horizontal inscription lines. Under general anesthesia, a 4mm basket cannula on a powered-assisted liposuction device was used to aggressively remove fat along all linear markings through small incisions. At the completion of the procedure linear strips of foam were placed along the etch lines and covered with a compression garment.

LW Abdominal Etching result front viewLW Abdominal Etching result oblique viewLW Abdominal Etching result side viewAt six weeks after the procedure his abdominal etch lines were becoming apparent as the skin contracts down to the reduced linear subcutaneous fat layers. Further definition in the abdominal etch lines would be expected to continue to develop up to three months after the procedure.

Middle Aged Male Abdominal Etching results Dr Barry Eppley IndianapolisAbdominal etching is a linear liposuction technique that does something liposuction is normally not intended to do…remove fat to deliberate create a focused skin indentation. Abdominal etching works best and looks the most natural in those patients who are already thin with a low percentage of total body fat.


  1. Abdominal etching strives to create the midline linea alba and the horizontal inscription lines of the abdominal muscles.
  2. Abdominal etching is a specialized form of liposuction that uses a linear line of maximal fat removal to create its effect.
  3. The best results in abdominal etching come from those who have a thinner subcutaneous fat layer over their abdomen.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Realistic Male Abdominal and Love Handle Liposuction Results

Wednesday, November 20th, 2013


Background: Liposuction is the most commonly performed body contouring procedure when judged by surface areas treated and the number of patients who undergo it. For men it is absolutely the most common aesthetic body contouring procedure and is largely done for the abdomen, waistline and chest. These are the primary areas in men that are affected by unaesthetic fat collections with the stomach and waistline ultimately being of some concern for most men as they age.

The age of men that usually seek abdominal and waistline contouring is usually younger, often being under the age of 45 years old. They may have always been bothered by a ‘bigger belly’ or may have developed fat collections on a much more svelte physique when they were younger. They are even younger men (and some women) that appear now for liposuction that are undergoing it to pass the military fitness test.

One of the very important considerations in ‘younger’ male abdominal and waistline liposuction patients is to set realistic expectations. While many men envision that they will come out with a ‘six-pack’ and a beautifully tailored waistline, this is not realistic for many men. While there are techniques for abdominal etching and ‘six-pack’ liposuction, their effectiveness requires the right patient who is often more lean and has less overall fat thickness in the abdominal subcutaneous tissues.

Case Study: This 42 year-old male wanted to get rid of his ‘jelly belly’ and love handles. He exercised and biked regularly but was unable to contour these historically problematic areas of his body. He was at a good weight for his height (5’ 9”, 158 lbs) and had no concerns about any other body areas.

Under general anesthesia, he underwent power-assisted liposuction (PAL) of his full abdomen and waistline. A total of 1,875ccs of fat aspirate was obtained. Very aggressive treatment of the flanks was done with liposuction carried out to almost the spine in the back. At the end of the procedure, linear six-pack etching was done with a fine liposuction cannula in a midline vertical line (linea alba) and three horizontal rows (inscriptions) from the umbilicus upward.

His liposuction results show marked improvement in getting rid of his frontal abdominal and side of the waistline bulges. However, he did not reveal much of the six-pack look with indistinct row lines visible.

Abdominal and waistline contouring by liposuction can achieve results that are often not obtainable by diet and exercise alone. But most realistic results from such procedures are more about a debulking or thinning effect. Obtaining a six-pack look is not possible in many men due to their thicker tissues and the amount of overall subcutaneous fat that must be removed. Preoperative expectations and limitations should be thoroughly discussed beforehand to determine if abdominal etching is worth the extra effort and expense.

Case Highlights:

1) Body contouring in men almost always involves liposuction of the abdomen and love handles.

2) For most men the expectations of abdominal and waistline liposuction should be less bulging and a contour that is closer to being flat.

3) The ability to achieve with liposuction  a six-pack or V-shaped waistline is not realistic for many men and realistic expectations should be understood before the procedure is done.

Dr. Barry Eppley

Indianapolis, Indiana

Abdominal Liposuction – Jelly Belly vs Watermelon Bellies

Tuesday, June 4th, 2013


Liposuction is one of the most popular of all plastic surgery procedures both in numbers of patients done and in body surface areas treated. Of all potential body areas in which fat can be extracted, the abdomen or stomach is the most commonly requested. Even amongst those people who would never consider having any other form of plastic surgery, the ‘big stomach’ prompts requests as to whether liposuction would be beneficial.

Liposuction is often perceived as a ‘simple’ operation in which one sticks in a tube and the fat is just sucked out. This makes for a great cartoon but, unfortunately, the reality is that liposuction is neither simple to do nor uniformly effective in all patients. The success of liposuction depends on many factors of which some of the most important are the actual location of the fat and the quality of the overlying skin.

The location of the fat must be in the subcutaneous plane (right under the skin) and the amount of elasticity of the skin must not be excessive. Fat that is under the muscle and/or overlying skin that is loose or has poor elasticity (such as stretch marks) are indicators of poor liposuction outcomes.

Thus, not every ‘fat stomach’ can be substantively improved by liposuction. The determination of a successful abdominal liposuction patient can be done by a physical examination and, in many cases, can even be done by just looking at pictures. An examination that uses the pinch (more than one inch between the fingers) and the jiggle test (shakes like jello) are simple but effective objective determinants.

Stomachs that have a high jiggle factor and a good pinch test are usually quite responsive to liposuction. I call these the ‘jelly belly’ stomachs as they feel quite soft and spongy. This means that there is a significant amount of fat between the skin and the underlying abdominal muscles, which is why it shakes so easily. As fat distribution goes, this means that the stomach bulge comes mainly from fat that is primarily located extraperitoneal (on top of the muscle) and not intraperitoneal. (under the muscle around the internal organs) This location makes it accessible by a liposuction cannula. As long as there is not excessive skin that hangs over the waistline, where a tummy tuck may be a better operation, visible abdominal reduction will be seen. The jelly belly stomach is commonly seen in women who are naturally predisposed to more extraperitoneal stomach contour issues such as weight gain and pregnancies.

Stomachs that have a negative or very low jiggle factor and a limited pinch test do not usually produce great liposuction results. In these patients, the stomach may be big but it feels firm and the skin is taut. I call these the ‘watermelon belly’ stomachs. It feels this way because much of the fat is in a intraperitoneal rather than extraperitoneal location. The accumulation of fat around the internal organs creates an internal push that bows out the abdominal muscles and contributes much to the external stomach contour seen.  Because there is little fat right under the skin, the stomach has little to no jiggle and not much of a pinch test. While liposuction can still be done in this type of stomach, the results will not be nearly as effective as the patient would have hoped. The watermelon belly is very common in men and accounts for their very firm stomachs no matter how big they are. Weight loss is a more effective method of stomach reduction than liposuction surgery in this type of stomach.

Abdominal liposuction can be very effective but patient selection is critical. Fat that is primarily located extraperitoneal with good overlying skin quality are the key predictors to the best results.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Linear Liposuction for the Abdominal Six-Pack Look

Monday, December 10th, 2012


Background: The most common area for liposuction on the body is the abdomen for both men and women. It is done very successfully for making a round belly flatter and providing some shape to an often rotund waistline. While one can never make a round abdomen into a flat and sculpted athletic one, removal of a few liters of fat aspirate can go a long way to improvement that defies what most can not achieve with diet and exercise.

Some patients, however, want more than just a flattening effect and desire a muscular-looking result. A well-defined abdomen is one that not only tapers in on the sides but shows an outward appearance of the underlying abdominal muscles. The abdominals consist of 6 muscles that extend from the ribs to the pelvis at various locations. These are the internal and external obliques, the transversalis and the rectus abdominus. While all play important muscular roles, paired rectus abdominus muscles are the most superficial and it alone accounts for the ‘six-pack’  look that many desire.

The vertically-oriented rectus muscle are joined in the midline by the confluence of their encircling fascial sheaths. There are fibrous bands that cross the rectus muscle at three specific locations, at the umbilicus, one below the xiphoid process and one between the two. These fibrous bands do not pass through the muscle but only indent inward into the encircling sheath. These tendinous insertions is what creates the ‘six-pack’ look and even an ‘eight-pack’ look can be created in people with very low body fat. The abdominal etching technique creates a similar look by removing the overlying fat along these bands, creating visible skin indentations where the underlying inscriptions lie.

Case Study: This 43 year-old male had lost signifincat weight and worked hard to develop a more muscular body frame. While his efforts were exemplary, he desired even more results and wanted a ‘sic-pack’ abdominal look. He felt he had done what he could and wanted to pursue a liposuction etching technique to get it.

Prior to surgery, the vertical and horizontal etching lines were marked. The vertical one is straightforward as it is in the middle. The horizontal lines must be marked with the patient sitting up and down to see where the skin creases naturally lie. It is important to not have horizontal lines that do not match the natural horizontal skin creases. In theory these should match the location of the underlying muscular inscriptions in the rectus muscles. The lower limit of the horizontal line is the umbilicus and not below in most cases.

During surgery, the midline vertical line is made from an incision inside the umbilicus. The horizontal lines are made by stab incisions in the skin in the midline. A small 3mm cannula is used to remove fat in linear motions only, pulling fat off of the fascia all the way up to the underside of the skin from each location. Linear strips of reston foam are applied at the completion of the procedure prior to the application of a circumferential abdominal binder for a dressing.

The foam dressings were removed two days later and the binder was worn for an additional week. While the abdominal lines were evident when the foam came off, it took an additional six weeks before maximal definition of the six-pack look was seen.

Case Highlights:

1)      Abdominal liposuction can be useful for more than just volume reduction, it is also a sculpting technique as well.

2)      Abdominal etching is a linear liposuction technique that over reduces fat along the inscription lines to create a ‘six-pack’ look.

3)      Abdominal etching works best and only looks natural on a patient who already has a fairly lean abdomen and wants more visible muscular outlines.

Dr. Barry Eppley

Indianapolis, Indiana

Liposuction and the Fat Homeostasis Theory

Tuesday, June 19th, 2012

One of the most common questions that patients ask these days in regards to liposuction is…will I gain weight elsewhere after this fat is removed? The basis of this question comes from one study published last year which showed some fat growth in the back and arms after abdominal liposuction in a small number of women who were measured up to one year after their surgery.


This was the first study that added some supportive evidence to the fat homeostasis theory. The hypothesis is that if you remove fat from one area of the body, fat will accumulate elsewhere in an effort to maintain a certain level of fat throughout the body. This hypothesis is far from being proven with absolute scientific certainty. But it has a certain amount of urban belief, perhaps to explain why some liposuction patients do not maintain their results.


An additional study to provide some further support to the fat homeostasis theory was recently published in the July 2012 issue of the Journal of Clinical Endocrinology and Metabolism. In this study, over thirty women who had abdominal liposuction were studied and were divided into two groups after surgery. One group was given a 4 month exercise program that began two months after surgery. The other group did not participate in exercise activities.The study found that liposuction effectively reduced extra-abdominal fat but after six months the non-exercise group showed a 10% increase in intra-abdominal fat. Conversely, the exercise group was able to effectively counter this increase in intra-abdominal fat so that it was not observed to develop.


This study concludes that abdominal liposuction may cause an increase of fat inside the abdomen as a compensatory response. But regular exercise can overcome this fat ‘reaccumulation.’ Does this prove that the body does have a thermostat for a certain amount of fat for each individual? Of that I don’t know. But what it shows is that the best protection of any patient’s investment in abdominal liposuction is to maintain a healthy diet and exercise regularly afterwards. Abdominal liposuction results will last only as long as one ensures that they do. Not changing your lifestyle habits after surgery will eventually bring a patient back to their presurgery state in many cases.


It is important to point out that this study and others has focused on the effects of abdominal liposuction, one of the main depot sites for fat accumulation in the body, What happens here should not be confused, in my opinion, with what may happen with liposuction to the thighs, knees, arms or knee. These are extremity sites with usually smaller amounts of fat in which its role is not the same as that of the abdomen. These are not primary depot sites. So changing/reducing them may not be associated with compensatory changes elsewhere. And areas of fat return are much less likely.     


Dr. Barry Eppley

Indianapolis, Indiana



Plastic Surgery’s Did You Know? Counting Tummy Rolls

Wednesday, June 6th, 2012

One of the common conundrums for many patients is whether their stomach should have liposuction or a tummy tuck to get a better and more flat shape. Liposuction removes fat, seems simpler and has a more rapid recovery. A tummy tuck removes a large amount of skin and fat, is more complex to undergo and has a longer recovery. But which one does any patient need and what will work best? A simple visual test is to count the abdominal or stomach rolls between the ribs and the pubic area. If one single large roll exists, then liposuction may be adequate. If there are two or more stomach rolls, then a tummy tuck will likely be needed. The more stomach rolls you have, the more excessive skin that exists. Excess skin can only be removed by a tummy tuck. You can count the rolls or pinch them. If you can pinch more than a few inches, there is too much skin for liposuction to work well.

Correction of the Abdominal Shelf Deformity After Tummy Tuck Surgery

Sunday, February 12th, 2012

There is no more significant surgical procedure for reshaping one’s stomach area than that of a tummy tuck. For those women whose unsightly stomach is due to a combination of loose skin, excess fat and lax rectus muscles, a tummy tuck has the best chance to make it flat again. While the permanent physical price is that of a low horizontal scar and a small circumferential belly button scar, this is a relatively minor cosmetic trade-off for those women who are unhappy with the current state of their abdomen.

While a tummy tuck has the best chance for making one’s stomach flat, this does not mean that everyone will end up so. There are numerous factors which control how flat a stomach can become including one’s inherent body shape, the amount of intraperitoneal fat and the thickness of the upper abdominal skin flap. This last one, abdominal skin flap thickness, influences the chance of stomach flatness after a tummy tuck more than any other factor.

When a tummy tuck is done, a horizontal ellipse of skin and fat is taken from the lower abdomen. This newly created defect is eventually covered by the remaining upper abdominal skin being pulled down and stretched over it. This upper abdominal flap is composed of both skin and fat which moves downward through a combination of undermining and tissue stretch. The largest part of this tissue flap is composed of fat. Like an accordion, when the abdominal flap is pulled down to cover what was removed is does become less thick. The fat component of the flap, by necessity, must become thinner to cover a larger surface area.

The closure line of a tummy tuck brings together the upper abdominal skin flap and the inferior pubic skin flap. While in theory and in drawings the upper abdominal flap does all of the movement downward, this is not exactly so. There is some upper movement of the pubic area since it is not a fixed structure. Its skin and fat can stretch also. It simply does not move as much as it is smaller and more attached to the pubic bone and upper thigh area.

More relevantly, however, is that the skin flap thickness between the upper abdominal skin flap and the pubic flap is usually different in almost all patients. The abdominal skin flap is always thicker. While it may thin out as it is brought downward and the two skin flaps may look level across the incision line closure, it may not later. As the abdominal skin relaxes after surgery and with the patient in the standing position, the lower edge of the abdominal skin flap may appear fuller and create a ledge above the scar line. I call this the abdominal shelf deformity after a tummy tuck. It is there because of the inherent differences in the thickness of the two joined skin flaps.

While some defatting of the lower edge of the abdominal skin flap may be done during surgery to prevent a shelfing deformity, it must be done conservatively to prevent devascularizing the skin edges and developing  wound healing problems later. The same applies to thinning our the abdominal skin flap with liposuction.

The tummy tuck abdominal shelf deformity can be treated secondarily through either liposuction or skin flap resection. Liposuction can be used to thin out the thickness of the lower half of the lower abdominal skin flap. If the tummy tuck scar is thin and there is no loose skin above the incision, liposuction is the preferred treatment. If the tummy tuck scar is wide or otherwise not ideal and there is some amount of residual loose skin above the scar, then a wide scar revision approach would be better. Using a resection of the scar and an inch or two of skin and fat above it, a leveling of the two skin flaps across the new tummy tuck scar line can be achieved.

Dr. Barry Eppley

Indianapolis, Indiana   

The Rare Risk Of Intra-Abdominal Penetration in Liposuction

Thursday, May 19th, 2011

I had a patient ask me an interesting question about liposuction just the other day. Since they had seen a video, probably on YouTube, of how liposuction is done, they wanted to know how one does not poke through the outer abdominal wall and not hit one’s organs like the bowels. Having done hundreds of liposuction procedures, the question initially seemed as an unjustified concern. But then again I am certain in the over 30 year history of liposuction done around the world with tens of millions of cases that it has happened…and probably more than once.

In the spirit of that liposuction concern, I would offer the following explanations.

It is anatomically difficult to penetrate through the abdominal wall with a blunt instrument. This is well known in any type of laparoscopic surgery in which a large sharp trocar is used. General surgeons well know the force that it takes to push the trocar in as part of deliberating trying to enter the abdominal cavity. This is using an instrument designed for it, aiming it at 90 degrees to the plane of the abdominal wall. Liposuction cannulas, conversely, are blunted and are used in directions oriented 10 to 20 degrees (more parallel) to the abdominal wall.

The abdominal wall is composed of three layers, an inner and outer layer of dense fascia and a thick rectus muscle between them. To penetrate the abdominal wall, it would require passing through these three layers of which the two fascial layers are quite dense. This is not that easy. This is more likely to occur in a patient who has a known or unknown hernia where a portion of the abdominal wall is absent. It is in that scenario that such liposuction injuries have probably occurred.

That is not to say that the outer fascial lining of the muscle is not often injured or torn. It is not uncommon during abdominal liposuction to have the suction cannula get clogged or obstructed. When cleared it can be seen that it is fascial strips not fat globules. This indicates that tears in the outer fascia regularly occur when doing liposuction in the deeper subcutaneous tissues. This probably accounts for why some patients will complain of spot tenderness in some liposuction areas that can take months to completely go away. These are the spots of muscle injury and not just fat.

Violation of the intra-abdominal cavity from liposuction is often lethal if untreated. While one of the reported risks of liposuction, violation into the abdominal cavity is extremely rare. In those few cases that have been reported in the medical literature, the consequences have been rapid and lethal if not treated within days. Injury of abdominal organs (e.g., bowel injury) following penetration of the abdominal cavity by a liposuction cannula can be especially life-threatening if that injury is not immediately treated. (open laparotomy and bowel repair) Even penetration into the abdominal cavity, without injury to an organ, results in peritonitis and an acute abdomen emergency within 24 to 48 hours after injury.

Dr. Barry Eppley

Indianapolis, Indiana

Reducing Seromas in Tummy Tuck (Abdominoplasty) Surgery

Wednesday, October 27th, 2010

A tummy tuck, or abdominoplasty, is one of the most common body contouring procedures. It is unrivaled for what it can do to the waistline when there is loose skin and excess fat for which there is no other satisfactory solution. Despite the success of the procedure, it is not complication free. The most common postoperative problem in tummy tucks, in my experience, has been that of fluid collections.

Known as seromas, these fluid collections accumulate in a characteristic time period of two to three weeks after surgery. Even though drains are placed in most tummy tucks and are used up to 10 days after surgery, seromas can still develop later. Seromas occur due to internal unhealed surfaces that express mainly lymphatic fluid somewhat like that of a brushburn. Compression garments and keeping one from getting too active helps but about a third of patients will still get some amount of seroma fluid in the first month after surgery.

While not one dies so to speak from a seroma, it is an inconvenience for the patient and most certainly can be uncomfortable. They will require intermittent drainage in the office and doing it just once rarely solves it. My usual experience in tummy tuck seromas is that once they develop, it will take a month of abdominal tapping before the fluid no longer accumulates. (as the internal surfaces have healed and stopped leaking fluid)

Several techniques have been developed in the past few years to decrease these abdominal seroma problems. One such method is that of quilting sutures. These sutures are done by sewing together the underside of the skin flap to the fascia of the abdominal muscles just prior to skin closure. It can be done using individual sutures at multiple points or using a running barbed suture which is placed in a series of rows. This method does work for seroma reduction but is tedious and time consuming which does add to the cost of the operation. There is also the possibility that the quilting points may cause some visible skin indentations where the sutures are placed.

Another technique for seroma reduction is in how the tummy tuck is performed. Rather than wide undermining of the upper abdominal skin flap the whole way up to the rib margins, a combination of liposuction and more limited skin flap raising is done. This preserves more attachments in the upper half of the abdomen and therefore makes less non-adherent tissue surfaces that have to heal…what we would call in plastic surgery less ‘dead space’. The sewing of the abdominal muscles (rectus muscle fascial plication) is done through a narrow tunnel up to the xiphoid process rather than the full raising of the upper abdominal skin flap. This technique requires a liberal use of liposuction throughout the upper abdomen with less tissue undermining. This not only preserves tissue attachments but also keeps a better blood supply into the skin flap for incisional healing.

While I like the quilting suture method for seroma reduction, the concept of ‘don’t detach as much to start with’ seems even better. While it may not be ideal for some tummy tucks, I use the ‘lipoabdominoplasty’ method more and more. As has been demonstrated by many other plastic surgeons around the world, the postoperative incidence of seroma is definitely less.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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