Liposuction is one of the most popular of all cosmetic procedures due to the ubiquity of excess fat. Of all liposuction procedures, the stomach or abdominal area is the most common area of treatment. While highly effective at removing abdominal fat, irregularities after abdominal liposuction are not rare.
Second to that of the inner thighs, the abdomen has a high incidence of the most common liposuction complication…contour irregularities. Because the abdomen is a flat surface, unlike most body areas treated by liposuction, how smooth it looks after can be easily and critically judged. Ironically while the abdomen may be much fuller than one wants prior to surgery it is almost always fairly smooth.
The outer contour of an abdominal liposuction result is a direct reflection of the evenness of fat removal underneath the skin. While many new technologies have emerged for performing liposuction, they have not necessarily resulted in a lower incidence of contour problems. This is because the technique for performing liposuction is more important than the device.
No matter what liposuction method is used, the tracks or tunnels that are made under the skin by different types of cannulas in the fat layer is ultimately important for the final contour. This liposuction tunneling concept dates back over 20 years ago and is no mystery. This has lead to the use of smaller cannulas for fat removal and this has definitely decreased irregularity problems. Like small balls lined up in cross-section, the overlying smoothness across the top of the balls is less irregular than if the balls were much larger.
But small cannula size alone is not enough to guarantee no contour irregularities…and it is probably not the most important. Superceding cannula size is the precision of the underlying tunnels that are made. This is the in and out pattern of the liposuction cannula that most people associate with the procedure. While this movement may look random, it is not like Brownian motion or a Levy flight pattern. Rather it should be a deliberate and evenly distributed method of cross-tunneling.
Cross-tunneling, when possible, during liposuction is still one of the most important concepts in liposuction to avoid abdominal irregularities. By cutting tunnels in the fat from multiple directions in any given area, fat is removed in a more even fashion. This is especially important in the abdomen where the cross-tunneling method can be most effectively used. This is done by entering from inside the bellybutton and then having two other entrances in the sides down by the waistline. This permits near 90 degree cross-tunneling to be done for any abdominal area. There is a 360 degree radiation of tunnels from the central bellybutton and 90 degrees of tunnel radiation from each side of the waistline. The intersection of these radiating patterns gives a better chance of not missing any abdominal areas and being redundant from different directions in treating them.
Despite technologic advancements in liposuction, the risk of abdominal irregularities is still best reduced by the manual method in which it is carried out. Even with the most deliberate and precise liposuction technique, abdominal irregularities may still occur due to the blind fashion by which liposuction is done.
Dr. Barry Eppley
Indianapolis Indiana