One of the first questions patients ask is whether they can have a good result with liposuction of the abdomen alone, or whether they need an abdominoplasty. Most candidates to have a good result with liposuction of the abdomen are men or women who have excellent skin elasticity, usually in their 20’s or early 30’s, and have a localized area of fat that can be removed with liposuction. So, in the office we will assess the skin elasticity, thickness of the fat layer, and check whether the abdominal muscles are stretched either from pregnancy or weight gain and loss. If there is a “roll” of loose skin when you sit down, then the skin will probably need to be tightened. I have not yet seen a technology that can reliably and smoothly tighten loose skin without taking a piece out. So the concept of the abdomioplasty is to leave the scar from removing the skin in a low enough position to be covered by most clothing styles. I will frequently have patients bring any special clothes like hip hugger jeans or bathing suits to the office so that we can place the markings where the scars will be hidden. At the time of surgery I like to create a hollow around the umbilicus (belly button) by sculpting the fat layer underneath. I also like to make a “champagne groove”, a slightly depressed groove in the midline of the abdomen above the umbilicus, which helps to accentuate the shape of a beautiful abdomen. And part of the “bulge” of the abdomen after weight loss or children is typically looseness of the muscle wall, which we will also tighten at the time of an abdominoplasty.
It’s difficult to retighten the loose muscles if you are significantly overweight, because the fat around our intestines (“omental fat”) fills up the abdomen. As I tell my patients, “you can’t put 40 lbs of potatoes in a 20 lb bag”. So typically I would like to see your BMI around 27 or less to consider an abdominoplasty. If you are much heavier, the muscles will stretch out again, there is more pain after surgery, and the chance of complications is higher.
And speaking of pain, there is a new product EXPAREL which we have been using since November of 2012. This is a newer formulation of a long acting local anesthetic that we inject at the time of surgery. It has helped to dramatically decrease the pain after abdominoplasty.