Issues | About the Journal | Subscriptions | Article Submissions

ULTRASOUND ASSISTED LIPOPLASTY AND MINI-ABDOMINOPLASTY

 Jaime Anger, MD

    Plastic Surgery – Hospital Israelita Albert Einstein – Sao Paulo – Brazil
    Address: Av. Brigadeiro Luiz Antonio, 3889
    1401-01          São Paulo  Brazil
    e-mail: E-mail para o Dr. Jaime
    Home-Page: www.cirurgiaplastica.com  

1. Introduction:

     The mini-abdominoplasty technique consisting of liposuction, muscle plication and skin removal by a small horizontal incision, could be the best approach for patients with diastasis recti, skin excess and fat deposition that are not candidates to full abdominoplasty since they don’t have enough skin for removal. Complications as lipolisis, hematoma and skin necrosis are related to flap liposuction. Technical difficulties are related to the flap dissection trough small incisions. Some technological innovations as the video-surgery improved this procedure but   liposuction is still the must controversial subject up to the vascularity damage that is also caused by the flap dissection. The most important advantage of the Ultrasound Assisted Lipoplasty is the maintenance of the vessels and other important structures. Since 1997 we use UAL in the total abdominal area in mini-abdominoplasty with success. Our goal was to review a series of patients who underwent mini-abdominoplasty and UAL.

2.Technique:

Between August 1998 and August 2000, 61 consecutive female patients undergoing mini-abdominoplasty were enrolled in this study. The procedure begun by tumescent infiltration using a formula with epinephrine 1:1.000.000, lidocaine 15mg/kg in a Ringer Lactate solution firstly in the deep plane and followed in the superficial area.  Ultrasound treatment was performed firstly in the deep plane followed by the superficial plane using a 5 mm lateral double hole cannula in the hipogastic area, followed by the epigastric area treatment using a 4 mm lateral double hole cannula and a solid probe in the superficial epigastric midline zone.  Finally in the lateral and posterior waist zone was used a 4 mm lateral double hole cannula. The evacuation phase was performed with a 8 lateral holes with round borders, 5 mm suction cannula and a 500 mmHg suction pressure. Delicate movements were done avoiding vessels destruction.

Then a suprapubic horizontal incision was performed and the abdominal flap was dissected sufficient to perform the rectus sheath plication. When supraumbelical plication was necessary, the umbilicus was released under the base resulting in the abdominal cavity exposition that was closed. The rectus adominis sheath was plicated. In the umbilical zone the suture was slight down deepening the umbilicus after its fixation. The videoscopy was used in patients without previous incisions or presenting vision difficulties in the apigastic area.  Excess Skin was ressected after muscle plication but without increasing the incision. All the patients where drained with suction tubular drainage for 48 hours. Pressure garments were used for 3 weeks.  

3. Results:

 61 patients were treated, aging from 39 to 63 years. 57 had previous incisions that were utilized. Horizontal access incisions were created on 4 patients 5 cm wide. The umbilical scar release was done in 37.  The supraumbelical rectus sheath plication wad done in 39 patients. Videoscopy was used in 11 patients, for total flap dissection in 4 cases and in 7 only in the supraumbelical zone. The total infused volume ranged from 2.000 ^to 4.000 cc. The total amount aspirated varied from 1.200 to 2.800 cc., and from 400 to 1.800 cc. of fat emulsion. The ultrasound use time ranged from 12 min e 47 sec to a maximum of 23 min e 45 sec. The complications were: 1 seroma aspirated three times, 1 superficial umbilical scar and a 2 cm dehiscence in the middle of the supraumbelical muscle plication. There was no skin necrosis either skin dehiscence. Two reoperations were performed, the first one for periumbelical fat excess and the other one to correct the muscle plication dehiscence, done by videoscopy.

4. Conclusions:

The mini-abdominoplasty with UAL in the total abdominal area can be considered safe regarding the low level of complication and the quality of the results achieved. It is important a good infiltration and a mild evacuation phase avoiding to transform this step in a traditional liposuction.  It is important to drain all the patients to avoid hematomas and seromas.  Tumescent infiltration is necessary in UAL, but also results in a fast flap dissection with no bleeding. The absence of bleeding allows a better view when Videoscopy is needed.

The dehiscence after muscle plication in the supraumbelical zone was avoided by using a continuous double line suture, beginning just above the umbilicus point, up to the superior point and coming back in a more superficial level only knotting above the umbilicus at the place of the beginning of the suture.

            Patients with more excess skin presented a great improving after 4 months, especially those who exercised.  

5. Cases

Fig.1 - Pre-op         Fig. 2 - Post-op

Fig 3 - Pre-op        Fig.4 - Post-op

6. References:

1. Abbes M,  Bourgeon Y. Fat embolism after dermolipectomy and liposuction (Letter). Plast recons Surg 1989; 84:546.

2. Anger J. Lipotripsia Ultra-sônica Interna, “Lipoaspiração Ultra-sônica”. Ed. Esperança, São Paulo, 2000.

3. Avelar JM. Fat suction versus abdominoplasty. Aesthetic Plast Surg 1985; 9:265-75.

4. Rohrich RJ, Beran SJ. Is liposuction safe?. Plast recons Surg 1999; 104:819-22.

5. Talmor M, Hoffman LA, Lieberman M. Intestinal perforation after suction lipoplasty: A case report and review of the literature. Annals Plast Surg 1997; 38:169-172.

6.Yamanaka K, Ichikawa T, Horiuchi Y. Flap defatting with an ultrasonic surgical aspirator. Plast recons Surg 1997; 99:888-91.

7. Zukokowski ML, Ash K. Ultrasound-assisted lipoplasty learning curve. Aesthet Plast Surg 1998; 18(2):104-10.

8. Zochhi M. Ultrasonic liposculpturing. Aesthetic Plast Surg 1992; 16:287.