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Dr. Barry Eppley

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Posts Tagged ‘lipoabdominoplasty’

Tummy tuck with Abdominal Liposuction

Sunday, May 31st, 2015


A tummy tuck is a major abdominal operation that usually removes a large horizontal ellipse of lower abdominal skin and fat. While tremendously effective, many patients having the procedure have excess fat beyond the zone of the tummy tuck excision whose reduction would improve the overall abdominal contouring result. While liposuction of the flanks is commonly done with a tummy tuck, liposuction of the abdominal area above the cut out has been frowned upon because of concerns of impairing healing of the tummy tuck excision.

Tummy Tuck without Abdominal Liposuction Dr Barry Eppley IndianapolisAvoidance of any upper abdominal liposuction at the time of a tummy tuck is certainly the safest approach as there is no chance of vascular compromise by not doing so. But this can leave an upper abdominal fullness that protrudes out beyond the more inwardly located tummy tuck scar the entire lower abdominal area. Many patients interpret this postoperative finding as swelling only to discover it never goes away. This is due to a simple anatomic fact the thickness of the upper abdominal fat largely remains the same while the lower abdominal contour is better because a large segment of tissue has been removed.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, an article appeared in print entitled ‘Safely Combining Abdominoplasty with Aggressive Abdominal Liposuction Based on Perforator Vessels: Technique and a Review of 300 Cases’.  A retrospective review of 300 consecutive patients who had a tummy tuck combined with liposuction. The tummy tuck was performed saving several perforators from the deep superior epigastric artery.  The abdominal liposuction was fairly aggressive removing an average of 660cc. Their overall complication rate was 17% (52 patients) of which the vast majority of the patients suffered minor complications (the need for scar revision, seroma evacuations, and non-surgical treatment of incisional dehiscences being the most common) and 1% encountered major complications. (non-fatal pulmonary embolus, severe infection and need for blood transfusion)

Tummy Tuck with Abdominal Liposuction Dr Barry Eppley IndianapolisCombining extensive liposuction with a tummy tuck has been a somewhat controversial combination since the early 2000s. What has changed since then is a better appreciation of the blood supply to the abdomen. This study uses a tummy tuck technique that preserves perforator vessels to the central abdominal  skin flap. This then permits the central abdominal area to safely undergo liposuction with impairing perfusion to the central abdominal skin above the incision line.

In the standard lipoabdominoplasty technique the liposuction is performed first followed by the tummy tuck. The liposuction loosens up enough of the upper abdominal tissues that extensive abdominal flap undermining is not needed and all perforators are preserved. This tummy tuck technique performs the liposuction after the tummy tuck. The difference is that some upper abdominal flap undermining is done and the perforators are deliberately seen and preserved.

Dr. Barry Eppley

Indianapolis, Indiana

Satisfaction and Results from Abdominal Contouring Procedures

Sunday, April 8th, 2012

Abdominal contouring through either liposuction alone or combined with some form of a tummy tuck are very common and popular body contouring procedures. Whether it is done to help with fat removal alone from weight gain and aging, pregnancy-induced abdominal changes or abdominal deformities from massive weight loss, these procedures provide very effective changes that can be long-lasting.

While they are commonly done, does this mean that patients are usually satisfied with them? As a plastic surgeon, I would tell you that they are tremendously satisfying for patients based on observations of results and comments from patients. But such anectodal evidence may seem self-serving as it is not objectively collected and sometimes one only hears or sees what they want to be true. Patients are also concerned about complications and recovery and these can understandably give one pause when considering these abdominal shaping surgeries.

In the May 2012 issue of Plastic and Reconstructive Surgery, this exact question was studied. A published paper from a private practice in Kansas studied  the effects on the quality of life in 360 liposuction or combined lipoabdominoplasty patients. One of the objectives of the study was to compare liposuction and tummy tucks parameters from the patient’ viewpoint. These included the results, recovery, complications and psychological effects from the surgeries. The patient numbers broke down into 219 liposuction, 13 tummy tuck alone patients and 128 patients who had a combined tummy tuck and liposuction procedure.

To no surprise, liposuction patients had less pain and quicker recoveries than the tummy tuck patients. The average time off work was 6 days for liposuction and 16 days for tummy tucks. Conversely, tummy tucks with or without liposuction reported more significant results and improvement in abdominal contours than liposuction alone. Half of the liposuction patients felt that the procedure did not provide enough results. Overall nearly 86% of patients reported improved self-esteem  and nearly 70% reported an improved quality of life. Collectively, high levels of patient satisfaction were reported at near 89%.

The complication rate for any clinical series of a procedure is always of interest. In this study, it was close to 11%. Tummy tucks had more complications than liposuction with infection and delayed healing being the predominant issues.

For patients, this study has several relevant findings. Better results come from tummy tuck-based abdominal contouring procedures than just liposuction alone. Thus if in doubt between choosing between these two procedures, be aware that higher levels of disappointment occur with liposuction alone. After surgery scar concerns from having a tummy tuck is very uncommon. But to achieve this better result from a tummy tuck comes the price of more pain and recovery, having at least double the time until one can return to work. Nearly 100% of tummy tuck patients say they would undergo the operation again and would recommend it to others based on their experience.     

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

Combining Liposuction in a Tummy Tuck for Improved Safety and a Faster Recovery

Sunday, November 22nd, 2009

Liposuction and abdominoplasty are two of the most popular plastic surgery procedures. While commonly used to treat different body areas, they can be combined to improve one’s abdominal contour and shape. When done together and weaved into a single procedure, it is known as lipoabdominoplasty or liposuction abdominoplasty.

A traditional abdominoplasty or tummy tuck involves removing lower abdominal skin and fat and undermining the skin up to the lower margins of the ribs. After sewing the rectus muscles together, the remaining upper abdominal skin flap is brought down and closed under tension. By undermining this skin and placing it under such tension, a flatter abdomen is obtained but  this skin flap has less blood circulating through it. This accounts for why some small percentage of tummy tucks suffer skin death (necrosis) at the center part of the incision line underneath the new belly button. It is also why drains are almost always used afterwards, to remove fluid that accumulates in this wide open space.

In contrast, liposuction abdominoplasty does not undermine this upper skin flap to any degree and relies on the use of the liposuction cannula as the dissection tool. This saves more blood vessels to the skin than undermining with cautery while disrupting ligaments that helps the skin move downward. The skin ligaments are released by a combination of initial liposuction followed by blunt dissection with scissors and/or fingers. Because large undermined skin flaps are not created, the use of drains after surgery is often not needed.

The question is…is lipoabdominoplasty a  replacement over a traditional tummy tuck or is it more of an option for properly selected patients. Some tout it as a better tummy tuck although it is yet not widely adopted by the majority of plastic surgeons. Currently, I am using it in my Indianapolis plastic surgery practice as the latter. In some patients with tight and thin supraumbilical tissues, liposuction and blunt dissection alone is not enough to get the skin flap to adequately move downward. It does require some loose skin above the umbilicus to execute a lipoabdominoplasty.

This lipoabdominoplasty operation, however, is ideal for smokers. Smoking is well known to cause blood supply problems to stretched skin under tension. This concern is significant enough that some plastic surgeons will not do a tummy tuck in someone who smokes or has smoked recently. Because it preserves more blood supply to the skin, this operation makes the tummy tuck less risky for healing problems.

In the right patient, liposuction abdominoplasty produces similar results to conventional techniques with improved safety and a faster recovery. It is not a passing fad or a procedure of theoretical benefit but an improvement proffered by an amalgamation of two well-established plastic surgery treatment methods.

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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