Location of Abdominal FatLocation of abdominal fat is an important factor in predicting the success of abdominal liposuction. Abdominal fat occurs in two different levels: superficial and deep. Superficial abdominal fat is located just below the skin and above the abdominal muscles. The deep abdominal fat is located inside the abdominal cavity on the intestines. Some people have more deep (intestinal) fat than subcutaneous fat. Subcutaneous fat can be removed by liposuction. Intestinal fat cannot be removed by liposuction because it would be too dangerous. Fat on the intestines can only be diminished by weight loss through diet and exercise. Thus liposuction cannot remove all of the abdominal fat. Most patients have more subcutaneous fat than intestinal fat. Thus, most patients will see a good cosmetic improvement with abdominal liposuction.
The Old-Fashioned Tummy-TuckTumescent liposuction of the abdomen is so effective that few patients require the more dangerous tummy-tuck, also known as an abdominoplasty. Patients who are obese and have a pendulous lower abdomen, often find that tumescent liposuction will give a better cosmetic result than a tummy-tuck. The traditional tummy-tuck involves several surgical steps. First, the subcutaneous fat is removed by liposuction or excision with a scalpel; next, the surgeon excises a large piece of skin from the lower abdomen just above the pubic area; then, the abdominal muscles are tightened using sutures; and finally, the large wound where the skin was excised is closed with staples or sutures. The two most important reasons to have a tummy tuck are 1) extensive laxity or spreading of the abdominal rectus muscles as a result of pregnancy, 2) excessive loose skin and excessive stretch marks. Just because a surgeon recommends a tummy-tuck does not mean that a tummy tuck is necessary. Some surgeons are unaware of the excellent results that can be produced by liposuction without resorting to the more dangerous and the more expensive tummy-tuck. Compared to liposuction, tummy tucks are associated with a much higher risk of serious complications, including fatal pulmonary embolism (blood clots in the lung). If a patient decides that a tummy-tuck is needed, it is usually much safer to separate the traditional tummy-tuck into two separate surgical procedures. Abdominal liposuction should be the done initially. Then, one should wait a couple months and evaluate the cosmetic results of liposuction before deciding to proceed to the skin-excision part of the tummy-tuck. The surprising aspect of using this two-stage approach to abdominoplasty is the high degree of satisfaction that patients find from liposuction alone. In fact, the vast majority of patients are so pleased with the results of liposuction alone that they decide not to pursue the second stage skin resection.
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