Abdominal liposuction is one of the most common procedures peformed in plastic surgery. The general shape of the body is profoundly affected by the way we precieve the abdomen and for many people the two terms are synonymous. To remove excess fat in the abdomen is primary focus of most people who are overweight or who have a "belly paunch".

Although there are differences of opinion about what the ideal shape of the abdomen should be, there is a definite concesus that excessive fat is not part of what makes the abodmen look good. With abdominal liposuction you can get rid of this fat permanently.

Abdominal liposuction

Before	After

What is abdominal liposuction?

Stomach or Abdominal liposuction is the removal of fat from the abdominal wall. Anatomically the abdomen is defined as the region between the lower border of the rib cage and the pubic bone. Liposuction of the abdomen is one of the most popular procedures performed in plastic surgery. It is an area that is commonly affected by diet and exercise. As a result, it is one of the first areas that both men and women try to correct. The fat cells of the lower abdomen and periumbilical area are one of the most common areas to store fat. The affects of pregnancy are also seen in this area more than other parts of the body. Stretch marks may develop and the skin may never retract after the baby has been delivered. The shape of abdomen both in clothes and out of clothes is one of the hallmarks of youth and being in good physical condition. Liposuction of the abdomen is procedure that removes the fat permanently from these areas.

Permanent Fat Removal from the Stomach area

The only expedient way to remove fat permanently from the abdomen is by liposuction. With liposuction the plastic surgeon can remove the excess fat from the deep and superficial layers of the skin and subcutaneous tissues. The fat removed never returns. However it is impossible to remove all fat cells. Liposuction is not a replacement for dieting and exercising. Depending on the extent of fatty excess it may be possible to suction the entire abdomen. According to guidelines set by the American Society of Plastic Surgeons 5 liters of fat removal is the upper limit of fat removal in one day. If more fat needs to be removed, it is safer to return to the operating room at a later date. One of the ways to treat people who have more than 5 liters of fat is to do part of the abdomen and return later to do another area. In this way one has treated the area in question thoroughly and knows that the return of fat to this areas is unlikely. In order to find out exactly how much fat can be removed you need to consult a plastic surgeon. Many plastic surgeons have their own criteria for fat removal. These criteria may include your age, overall health, the quality of your skin, and the amount of fat you have.

Tumescent Liposuction -What is it and how is it done?

Almost all liposuction is done by tumescent technique. Essentially the area to be treated is filled with water. In this fluid there are medications that help reduce blood loss and pain. The reason that is possible to remove large amounts of fat with little or no risk is because of this tumescent solution. Otherwise, the blood loss from this operation would be too much and you would have to have blood transfusion. Today, it is possible do some liposuction procedures under local anesthesia. You must consult your plastic surgeon to see if you are candidate to have local anesthesia for your liposuction.

Indications:
Who is a good candidate for abdominal liposuction?

The best candidates for liposuction of the abdomen are those with localized fat in the deep layer of the subcutaneous tissue. The person may have accumulation of fat in just one area of the abdomen (usually in the lower part), or have a generalized deposit. As the thickness becomes more, the skin rolls over and causes layers of abdominal skin fat to appear when the person sits down. After a while even if the person looses weight the skin does not contract back to its normal state.

Ideal candidates for suctioning also have good contractile skin. When such a person has liposuction, the skin contracts completely and no excision will be necessary at a later date. The scars of liposuction are extremely small. An average scar may be only 3-4 mm in length (an eighth of an inch). So after surgery you will have no visible scars on your abdomen.

Good surgical candidats must be healthy and have realistic goals.

Contraindications:
Who is not a good candidate for surgery?

If you have a large amount of fat you may not be a good candidate for liposuction. Generalized obesity is a relative contraindication to liposuction. Liposuction in this situation is unlikely to give a good result. If liposuction is performed, it is most like to be done in order to deal with a specific problem. For example removing some fat from an area that is causing an unusual bulge that makes it difficult to wear certain clothes or to move a body part.

The procedure
How is abdominal liposuction done?

Traditional liposuction is performed with tumescent technique. The abdomen is infiltrated with a solution containing lidocaine and epinephrine. These medications cut back on the bleeding and pain experienced during and after surgery. Small incisions are made in areas that are hidden by natural folds the body. The belly button and the pubic area are common entry points for liposuction. Additional entry points many be necessary depending on the particular case. The abdomen is suctioned with small blunt cannulas. The removal of fat is a mechanical process. The vacuum suction removes the fat in between the blood vessels, nerves, and other tissues under the skin. However when ultrasonic liposuction is used, the fat cells are first broken down and emulsified before being removed with a regular suction device. The incisions in regular liposuction are about 1/8th of inch long. Ultrasonic liposuction incisions are slightly larger. Once the fat is removed the skin incisions are closed or left open depending on the preference of the surgeon. You may have a drain placed in the area of suctioning. The area is covered with sterile pads and a compression garment. Some surgeons prefer not to use compression garments.

Will I have extra skin after liposuction?

This depends on the quality of the skin and the amount of fat suctioned. If the skin tone is good, it is very likely that it will completely contract. If the skin quality is not good, it is likely to have excess skin. However if large amounts of fat have been removed, even if the skin tone was good, there is a possibility that there will be some excess skin. It is difficult to predict how much skin redundancy there will be after liposuction.

After several months when the skin has completely contracted, it will be evident if there is any excessive skin that needs to be removed. Normally, in the lower stomach the excess would be seen as a roll of skin just above the pubic area. If the skin excess occurs in the upper part of the stomach, it is seen as roll of skin above the belly button.

Once it is obvious that skin excess is present, the treatment is to remove it by excision. If there is just a minor amount of excess skin in the lower abdomen, it may be possible to remove it locally. If the excess skin is above the abdomen or extensive, it may be necessary to do a tummy tuck. In this situation the skin of the abdomen is lifted up to the rib cage and the excess is trimmed from below. To read more about this procedure see the section on Abdominoplasty (Tummy Tuck Surgery).