Liposuction for Upper Belly Fat

While liposuction is designed to sculpt the body, it’s also occasionally used for a specific area of fat. Liposuction for upper belly fat is a cosmetic procedure performed on obese patients who are suffering from large deposits of fatty tissue located primarily around their stomach area. With liposuction surgery, it is possible to significantly reduce excess fat, leaving you with tighter-looking skin and added definition in your abdominal muscles.

Liposuction of the stomach is a procedure that permanently removes fat cells from the abdominal region. Not only do those cells not return, but they also do not shift around, and your body does not alter the locations where it stores fat. Following a stomach liposuction procedure, your body will have approximately seventy percent fewer fat cells in the abdominal region than it did before.

Liposuction for Upper Belly Fat

The abdomen is the area of the body treated most often by liposuction. It is a high-priority area for both men and women. In terms of surgical anatomy, cosmetic results, patient comfort during and after liposuction, and potential complications, the abdomen is also one of the most challenging of all the areas treated by tumescent liposuction.

The clinical anatomic definition of abdomen is the body’s lower cavity, from the diaphragm downward, which contains the stomach, bowels, and other organs of nutrition; sometimes this includes the pelvic cavity. Abdomen may also refer to the belly’s outer surface.

Anatomic Considerations

There are several ways to categorize abdominal fat that are relevant to liposuction. For example, the surface anatomy of the abdominal wall can be subdivided into the following areas:

Upper abdomen, or epigastric areaLower abdomenPeriumbilical areaMidabdomen, or waist area

The last area includes the periumbilical area and the area lateral to the umbilicus that overlaps the area between the upper and lower abdomen.

In terms of its overall shape, subcutaneous abdominal fat can be broken down into different types of fat tissue, such as Camper’s fascia, sub-Scarpa’s fat, and periumbilical fat. Abdominal fat is either subcutaneous (located deep to skin and superficial to abdominal wall musculature) or visceral (located on the intestines and the omentum).

In very lean individuals the subcutaneous fascia is essentially a layered sheet of fibrous tissue containing minimal amounts of fat. With increasing adiposity, yellow fat begins to appear and accumulate within the lamellar connective tissue sheets of the fascia.

In some persons, visceral or omental fat may be relatively more voluminous than the subcutaneous fat. The proportion of visceral fat relative to subcutaneous fat tends to increase with age. This is an important distinction when evaluating a patient for possible abdominal liposuction. Even with substantial fat liposuctioned from an older woman’s abdomen, she may be dissatisfied with the results if she has a protuberant lower abdomen due to muscle laxity and visceral fat.

On the other hand, a “beer-bellied” male may have much more subcutaneous fat than suspected after an initial cursory examination. A taut abdomen, apparently of omental fat, may reveal significant subcutaneous lower abdominal fat when the patient is examined in a supine position with the back and hips slightly flexed.

The rectus abdominis muscles underlie the midabdominal fat. The anterior portion of the external oblique muscles underlies the lateral abdomen.

Surface Anatomy

As noted, the surface of the abdomen can be subdivided into lower abdomen and upper abdomen (epigastrium). Occasionnally the surgeon must refer to the midabdomen, the area encompassing the breadth of the abdomen and a few centimeters above and below the umbilicus. Some patients who have little fat in the upper epigastrium may require liposuction of only the lower abdomen and midabdomen. Other patients, such as women with previous abdominoplasty, may require liposuction of only the midabdomen and upper abdomen.

The surface anatomy of the lower abdomen is dominated by the rounded abdominal “belly.” In thin females the skin and subcutaneous tissues of the belly generally are soft and supple to the touch. The visible curvature of a lean female abdomen is gently convex or flattened, essentially reflecting the subjacent musculature of the anterior lower abdominal wall.

Waistline Features. In some relatively obese females the upper and lower abdominal areas are separated by the waistline sulcus. This transverse furrow between the upper and the lower abdominal fat pads extends across the abdomen at or just above the umbilical level. Although not usually seen on thin persons, this valley of surfeit is a common superficial anatomic feature of the gourmand (Figures 31-1 and 31-2).

The waistline sulcus coincides with localized increased fibrousness of the adipose tissue. This area of excess fibrousness, present in virtually all patients, is referred to as the waistline fibrosis (Figures 31-3 and 31-4). Congruent with the proximal extent of Scarpa’s fascia, the waistline fibrosis is a dense combination of collagenous septa and fibrous bands adherent superficially to skin and deeply to the linea alba, anterior rectus muscle sheath, and external oblique muscle.

The extent and density of this transverse abdominal area of fibrosis vary from patient to patient. This fibrotic area requires extra effort to achieve an adequate degree of liposuction.

Upper Abdomen. The upper abdominal fat compartment consists of epigastric fat pads as well as the more proximal fat overlying the costal margin, the supracostal abdominal fat pads. In the obese patient the location of specific large creases and rolls of fat is predictable. The supracostal fat and the more distal epigastric fat may appear as two prominent transverse rolls and furrows.

The fibrous septa of the upper abdomen are more numerous, thicker, and more resistant to penetration than septa and collagenous tissue of the lower abdomen. The upper abdomen is uniformly more fibrous and more sensitive to pain than the lower abdomen. It is also more prone to a permanent postliposuction appearance of irregular lumpiness. Smooth results after liposuction of the epigastrium are more easily achieved using microcannulas than larger cannulas.

Rugosity. With resolution of postoperative edema after liposuction of the upper abdomen, the epigastric skin tends to appear rugose, crepelike, or crinkled. In older patients with decreased skin elasticity, this “crepiness” (rugosity) seems to be the predictable consequence of deflating the upper abdominal subcutaneous fat compartment. Interestingly, lower abdominal skin does not seem to be susceptible to this postliposuction rugosity.

This epigastric rugosity may partly result from the different degrees of flexibility in the thoracic and lumbar spines. The greater flexibility of the thoracic spine allows compression of the upper abdominal skin, whereas the relative inflexibility of the lumbar spine inhibits compression of the lower abdominal skin. The elasticity of Scarpa’s fascia might prevent rugosity after liposuction of the lower abdomen.

Pregnancy. Previous pregnancy predisposes to diastasis recti abdominis, a condition in which the muscles of the anterior abdominal wall become stretched. This imparts a greater degree of roundness and protuberance to the lower abdomen.

Pannus. A large abdominal panniculus (pannus) usually retracts greatly after adequate tumescent liposuction. Retraction of an excessively large panniculus, however, may be limited or inadequate. Panniculus adiposus, a term used to designate subcutaneous fat, is the adipose tissue between the skin and the enveloping aponeurosis. A pannus of abdominal fat usually refers to an apron of sagging skin and fat on the lower abdomen.

Treatment Considerations. The traditional surgical approach to eliminating an apron of abdominal fat was abdominoplasty (dermolipectomy). The modern approach is first to treat the area using microcannular tumescent liposuction.

In most instances of abdominal obesity, tumescent liposuction provides acceptable or superior aesthetic results, with fewer risks than the traditional “tummy tuck.” If a subsequent dermolipectomy with rectus muscle sheath plication is required, it can be accomplished several months later as a delayed secondary procedure totally by local anesthesia. The surgical risk, recovery time, and postoperative disability are significantly reduced by dividing one abdominoplasty, often requiring general anesthesia, into two procedures, both accomplished totally by local anesthesia.

Abdominal liposuction is not ideal for every patient. Liposuction may not provide significant cosmetic improvement for a prospective patient whose principal concern is the elimination of abdominal stretch marks. Similarly, liposuction results may be inadequate for a patient with excessive skin laxity and little subcutaneous fat.

Liposuction Before and After Belly

Gross Anatomy of Subcutaneous Fat

The depth of subcutaneous abdominal fat is subdivided into three layers in the upper abdomen and four layers in the lower abdomen. As in most areas of the body treated by liposuction, three layers of fat extend over the entire abdominal expanse: the apical layer, the mantle layer, and the deep fat compartment layer.

Apical fat is the most superficial layer of fat. Intimately attached to the deep surface of the reticular dermis, the apical layer of dermal fat contains vascular and lymphatic networks important to the skin’s normal appearance and physiologic function. Using a liposuction cannula to rasp the apical fat can cause irreparable injury and inflammation to the subdermal vascular plexus, resulting in erythema ab liporaspiration or dermal necrosis.

Mantle fat is a layer of vertically oriented palisading columnar fat pearls that form a blanket of fat attached to the dermis. Dissection or magnetic resonance imaging (MRI) often reveals a thin fibrous sheet of collagenous tissue that separates the mantle layer from the deeper compartment of subcutaneous fat.

An excessively large deep fat compartment layer is responsible for the cosmetically unattractive area of focal fat excesses. This compartment is the site of the greatest accumulation of fat in cosmetic lipodystrophy and in obesity. Most of the fat removed by liposuction is derived from the deep compartment of fat.

Camper’s fascia is formally defined as the superficial layer of the superficial fascia of the abdomen. For the purposes of liposuction, a more useful definition is the subcutaneous abdominal fat having the following boundaries:

The superficial boundary is the apical fat.The deep boundary in the lower abdomen is Scarpa’s fascia.The deep boundary in the upper abdomen is the aponeurosis of the abdominal wall muscles.

Camper’s fascia extends over the entire area of the abdomen. In the epigastrium, Camper’s fascia consists of the mantle layer and deep fat compartment layer. In the lower abdomen, however, an additional layer of subcutaneous fat is located deep to Camper’s fascia. This layer is separated from Camper’s fascia by a discrete sheet of fibrous tissue known as Scarpa’s fascia.

Sub-Scarpa’s fat is the deepest layer or compartment of fat in the lower abdomen. Sub-Scarpa’s fat is separated from Camper’s fascia by Scarpa’s fascia.

Fasciae. The traditional definitions of the subcutaneous fasciae of the abdomen are imprecise and somewhat confusing. Camper’s fascia contains fibrous tissue septa, all the deep compartment fat of the upper abdomen, and all the deep fat of the lower abdomen that is superficial to Scarpa’s fascia.

Scarpa’s fascia extends over the entire lower abdomen and only exists in the lower abdomen. Thin patients have little if any fat between Scarpa’s fascia and the aponeurosis of the abdominal wall muscles. Obese patients, however, have a significant collection of subcutaneous fat located deep to the plane of Scarpa’s fascia.

Anatomically, fascia (Latin fascis, bundle) is used in several different contexts. Subcutaneous fascia designates sheets of fibrous tissue that envelop the body beneath the skin. It includes subcutaneous fat; subcutaneous adipocytes seem to be derived from perivascular fibroblasts of the fascia. Subcutaneous fascia is essentially the layer of subcutaneous adipose tissue (including the collagenous fibrous septa, vasculature, and adipocytes) bounded above by the dermis and below by muscle fascia.

Muscle fascia or deep fascia refers to a visibly discrete layer of collagenous fibrous tissue that encapsulates muscles. Muscle fascia, which generally does not contain a significant amount of fat, is distinct from subcutaneous fascia.

Scarpa’s Fascia

Scarpa’s fascia is a fibrous sheet of dense membranous connective tissue within the deeper portion of the lower abdominal subcutaneous fat and is tangentially parallel to the abdominal muscle wall. Scarpa’s fascia can be identified on MRI as a thin line within the deep subcutaneous fat, extending across the lower abdomen.

The cephalad (proximal) portion of Scarpa’s fascia seems to diverge into the dense fibers of waistline fibrosis just proximal to the umbilicus. The insertion of the proximal extent of Scarpa’s fascia actually coincides with the dense waistline fibrosis. Laterally, Scarpa’s fascia inserts into the iliac crest and the anteroinferior iliac spine.

The distal fate of Scarpa’s fascia has clinical interest for the liposuction surgeon. As Scarpa’s fascia crosses the inguinal ligament and extends distally, it merges with the ligament and the deep fascia of the proximal thigh, where it forms a dense attachment. The insertion of Scarpa’s fascia 1 to 2 cm beyond the inguinal ligament forms a tightly sealed barrier that prevents distal migration of fluid.

Distally and medially, however, Scarpa’s fascia inserts into the deep perineum (Colles’ and Buck’s fasciae), extending over and enveloping the genitalia. A distal midline condensation of a portion of Scarpa’s fascia is said to become the fundiform ligament of the penis.

One purpose of Scarpa’s fascia may be the additional weight-bearing function that this elastic sheet provides in supporting the pregnant uterus.

Edema. The location of the fibrous attachments of Scarpa’s fascia explains the occasional ecchymosis and edema of the labia or the scrotum and proximal penis after abdominal liposuction. Under the influence of gravity, residual blood-tinged anesthetic solution tends to percolate and seep distally from the abdominal fat deep to Scarpa’s fascia, causing more bruising in the midline pubic area than laterally over the anterior thighs.

This bruising is not clinically significant but can be a concern if the patient is not forewarned. To some extent this distal bruising can be prevented by (1) placing several adits or incisions along the inferior margin of the abdominal liposuction area and (2) establishing multiple drainage pathways through liposuction tunnels not closed with sutures.

The extent of Scarpa’s fascia can be identified in the patient with a pelvic fracture and rupture of the membranous urethra. Within hours, leakage of urine into the space deep to Scarpa’s fascia will fill and distend the sub-Scarpa’s fat compartment with extravasated urine. Clinical examination reveals a distended expanse of the lower abdomen extending from the level of the umbilicus into the perineum, with associated scrotal or labial edema.

Pseudolipoma. A thin patient has little or no fat between Scarpa’s fascia and the deeper linea alba, the anterior rectus muscle sheath, and the external oblique muscle fascia. Obese patients always have a layer of fat deep to Scarpa’s fascia. The relative amount of fat in the sub-Scarpa’s fat compartment tends to be greatest medially and gradually diminishes laterally and distally. Abdominal posttraumatic pseudolipomas may result from a traumatic tear in Scarpa’s fascia, with herniation of deeper fat through Scarpa’s layer.1

Penetration. Liposuction surgeons may have difficulty penetrating Scarpa’s fascia with larger cannulas. By squeezing or gripping and tenting the lower abdominal skin and fat with the sensory hand, sub-Scarpa’s fat is easily accessible with a microcannula, which readily penetrates fascia.

Pfannenstiel’s Incision. Scarpa’s fascia does have cosmetic significance. Pfannenstiel’s incision refers to the transverse lower abdominal incision typically used for cesarean sections and abdominal hysterectomies. The surgeon advances the incision down through the external sheath of the recti muscles, then splits or separates the muscles in the direction of the fibers. The peritoneum is opened at the sagittal midline.

A common complication of Pfannenstiel’s incision is a persistent focal transverse bulge of subcutaneous fat proximal to the incision. Although liposuction can repair this annoying but harmless deformity, it might be preventable. The pseudolipoma may result partly from traction on the skin when the incision is made and partly from not approximating and suturing the transverse incision through Scarpa’s fascia when repairing a surgical wound. The elastic recoil of the fascia produces a cephalad migration of subcutaneous fat.

Layered closure of the subcutaneous fat at the level of Scarpa’s fascia may reduce the incidence of this iatrogenic pseudolipoma (Figure 31-7).

Abdominal Blood Vessels

Blood vessels located within abdominal subcutaneous fat may be traumatized by liposuction (Figure 31-8).

The anterosuperior epigastric veins originate near the junction of the respective saphenous and femoral veins and course through the medial lower abdomen. The veins are bilateral, travel in a cephalad and medial direction toward the umbilicus, and are located above Scarpa’s fascia (Figure 31-6, D).

The lateral circumflex veins are also bilateral and originate near the saphenofemoral junction. They travel in a cephalad and lateral direction, extending toward the superior and lateral aspect of the iliac crest. The lateral circumflex vein penetrates Scarpa’s fascia at a point approximately half the distance between the pubis and the anterior iliac crest and terminates in the superficial subcutaneous abdominal fat (Figure 31-6, F).

The other important vascular structures are the paramedian neurovascular bundles that penetrate the rectus muscle of the median abdominal wall near the lateral extent of the linea alba. These arteries supply the skin and fat of a transverse rectus abdominis myocutaneous (TRAM) flap used for breast reconstruction after mastectomy. With the use of microcannulas, these vessels rarely are traumatized by liposuction.

Bleeding and Hematoma. The anterosuperior epigastric or lateral circumflex veins may be either punctured during tumescent infiltration with spinal needles or lacerated by a liposuction cannula. Bleeding from these veins during tumescent liposuction seems to cause no significant problem.

Infiltration with a spinal needle in the region of these veins rarely causes minor bleeding from a cutaneous entrance site. To stem this slight amount of bleeding, the clinician simply infiltrates an additional volume of tumescent anesthetic solution into and around the immediate area.

Similarly, focal bleeding during liposuction may be evidenced by increased redness of the aspirate. If an unusual degree of bleeding occurs during liposuction of a localized area of fat, the surgeon simply ceases further liposuction in that area. Occasionally, brief application of direct pressure might be required. If additional liposuction in the area is needed, it can be accomplished on another day.

Two of my patients had clinical evidence of a hematoma after liposuction. In both the bleeding probably resulted from a cannula-induced injury either to a small artery associated with one of the paramedian neurovascular bundles or to the rectus muscle.

In an obese male with adult-onset, non-insulin-dependent diabetes mellitus, I noticed the bleeding during surgery and terminated the procedure before completion. Preoperatively the patient denied taking aspirin; postoperatively he admitted taking “baby” aspirin. The bleeding stopped with direct pressure. After surgical consultation the patient was monitored overnight. Although not evident immediately, the patient eventually developed a small area of necrosis in the left lower periumbilical area (see Chapter 8).

Case Report 31-1 describes my second bleeding case.

Neither patient required direct surgical intervention for hemostasis. Both were managed conservatively, and surgical consultation was obtained. Bleeding was controlled by direct manual pressure over the apparent site of bleeding for approximately 1 hour. Then, for another 24 to 36 hours, continuous firm pressure was applied to the affected area by absorption-compression pads and abdominal binders.

Preoperative Evaluation

The preoperative evaluation for patients contemplating abdominal liposuction must include an assessment for the following:

Diastasis recti abdominis Umbilical, periumbilical, and ventral hernias Prior obesity and subsequent weight loss Degree of intraabdominal, visceral, or omental fat Previous abdominal surgeries. Any history of abdominal liposuction Breast augmentation with prosthesis or by injection of silicone into tissues

The consequences and relevance of these findings must be thoroughly documented and discussed with the patient.

The preoperative physical examination should always document the presence or absence of a periumbilical or ventral hernia. A hernia may increase the risk of inadvertent penetration of the peritoneal cavity during liposuction.

An abdominal hernia may require repair by a general surgeon at least 8 weeks before abdominal liposuction. Typically a ventral hernia repair is a simple procedure accomplished under local anesthesia.

The curvature of the abdominal wall musculature largely determines the “flatness” of the abdomen after liposuction. Separation of the abdominal rectus muscles as a result of pregnancy limits the degree of improvement. Nevertheless, the vast majority of patients with diastasis recti abdominis are ultimately very satisfied with results obtained by liposuction alone. Most patients, including those with some diastasis, do not “need” an abdominoplasty to achieve a gratifying cosmetic improvement.

The prospective patient should be questioned about prior abdominal surgery, including laparoscopic procedures. The location and extent of scars from prior surgery should be noted.

Prior abdominal liposuction using inadequate tumescent vasoconstriction and sutured incisions increases postoperative inflammation, causing interstitial fibrosis within the treated fat.2 Subsequent liposuction will be more difficult because of this excessive fibrosis.

Abdominoplasty

Tumescent liposuction with microcannulas has proved to be so effective that abdominoplasty is now rarely indicated. After an abdominal liposuction, very few patients require or desire abdominoplasty, even those who have had 2 L or more of supranatant fat suctioned from the abdomen. In the vast majority of patients who have a pendulous lower abdominal panniculus, tumescent liposuction provides a better and more natural cosmetic result than an abdominoplasty.

Indications for abdominoplasty are subjective. A surgeon might recommend an abdominoplasty for the following three reasons:

Extensive diastasis or spreading of the abdominal rectus muscles as a result of pregnancyExcessive striae or stretch marksSurgeon’s unawareness of the excellent results from liposuction without abdominoplasty

Liposuction alone will not always provide complete satisfaction. Ultimately the patient’s opinion of the cosmetic results depends on multiple factors, including (1) the patient’s expectations, (2) the patient’s preoperative cosmetic deficiencies, and (3) the surgeon’s technical skills and technique. Thus the results are never completely predictable.

Two-stage Procedure

When an abdominoplasty is indicated, it is safer to separate the traditional surgery into a two-stage procedure. In many patients a two-stage tumescent abdominoplasty can be accomplished totally by local anesthesia.

The first stage is tumescent liposuction. Several months later the patient is reevaluated. The relative merits of abdominal skin resection and rectus muscle plication are discussed. When indicated, the second stage of abdominoplasty can usually be performed totally by local anesthesia using the tumescent technique. General anesthesia is only necessary for the most challenging cases.

The surprising aspect of using this two-stage approach to abdominoplasty is the high degree of satisfaction that patients find from liposuction alone. The vast majority of patients decide not to pursue the second-stage skin resection.

Abdominoplasty is becoming an anachronism.

Option: Tumescent Technique

“Only a tummy tuck will do justice to a patient with a pendulous apron of abdominal fat.”

This dogma is obsolete. Microcannular tumescent liposuction has largely eliminated the need for routine abdominoplasty. For many patients with a pendulous apron of abdominal fat, tumescent liposuction offers better cosmetic results, a quicker recovery, and fewer risks compared with traditional abdominoplasty under general anesthesia (Figures 31-10 and 31-11).

For patients with moderate abdominal obesity and good abdominal muscle tone, tumescent liposuction is a better choice than abdominoplasty (Figures 31-12 to 31-14).

A thin female may require an abdominoplasty only when rectus muscle laxity is excessive or when stretch marks are the major cosmetic concern. Abdominal liposuction is almost always a better option (Figure 31-15).

Liposuction of the male abdomen yields excellent results. Male patients rarely require an abdominoplasty.

Patients should be informed an option now exists to the traditional abdominoplasty that is safer and often yields better cosmetic results. Compared with microcannular tumescent liposuction, tummy tucks are associated with a relatively higher risk of dermal necrosis, fat embolism, pulmonary thromboembolism, and other serious complications of major surgery. A large, unsightly scar is often a consequence of abdominoplasty.

Intraoperative Positioning

For patient comfort and ease of access to the targeted abdominal fat, the patient is ideally placed in a reclining position, with the abdomen slightly flexed. In this supine cernuous (bowing downward) position the patient is lying on the back, bent slightly at the hips and knees, in such a way that the torso is slightly inclined forward relative to long axis of the thighs (Figure 31-18).

A flat supine position causes the patient’s lower abdominal skin and subcutaneous fat compartments to become taut, making it difficult to grip the tumescent abdominal fat. When the abdominal fat is firm and taut, it is more difficult to palpate the interface accurately between the abdominal fat and abdominal muscles, decreasing the likelihood of adequate liposuction for the deeper abdominal fat.

On the other hand, if the patient’s abdomen is flexed too much, the position of the thighs will obstruct the cannula’s in-and-out motion. Furthermore, excessive abdominal flexion compresses the subcutaneous fat, making the tissues difficult to grip and impeding accurate assessment of the uniformity of the liposuction process.

I prefer to have the patient’s abdomen slightly flexed during the initial phase of the procedure, when the cannulas are directed transversely or diagonally across the abdomen, using 16-gauge and 14-gauge Capistrano microcannulas.

Toward the end of the procedure, 14-gauge and 12-gauge microcannulas are used. At this stage the patient is placed in a flat supine position to facilitate strokes of the cannula that are parallel with the long axis of the body and to avoid interference from the thighs.

With an alert and fully awake patient, it is advisable to gently restrain the patient’s hands to prevent inadvertent contamination of the surgical field. A preferred method is to drape a towel over each side of the table and then have the patient recline on top of the towels. With the patient’s arms at the side, the towel is brought up over the arms and tucked under the patient’s hips. Patients should not feel too confined because the arms are readily extricated from this position by simply raising the hips and thus loosening the towel.

Anesthetic infiltration

The abdomen can be one of the most difficult areas of the body to infiltrate. The abdomen is sensitive, and awake patients feel more vulnerable and anxious. The periumbilical area especially requires proper infiltration technique, since this tissue tends to be more fibrous and more sensitive. Adequate liposuction demands additional effort, and insufficient anesthesia may lead to inadequate liposuction of the periumbilical area.

It is more difficult to infiltrate the abdomen adequately in a patient who has previously lost considerable weight, such as 25 pounds (11 kg) or more. After significant weight loss, residual fat compartments are potentially more capacious than might be predicted based on present physical size. Compared with a patient whose weight is at a lifetime maximum level, a patient who has lost substantial weight has flabbier skin and can accommodate larger volumes of tumescent anesthetic solution. Nevertheless, adequate anesthesia can usually be obtained without infiltrating to the point of maximum tumescence.

To ensure optimal anesthesia and vasoconstriction, the surgeon should wait at least 30 minutes after completion of tumescent anesthetic infiltration before commencing liposuction of the abdomen.

Surgical Technique

Accurate preoperative topographic contour drawings are an important prerequisite to obtaining a uniformly smooth result after tumescent liposuction (Figure 31-19).

Scarpa’s fascia can be relatively more resistant to penetration by large cannulas. Larger cannulas require greater force and thus produce greater discomfort. Microcannulas can penetrate Scarpa’s fascia without excessive force, resulting in minimal discomfort. Microcannulas thus facilitate more complete liposuction of the relatively inaccessible sub-Scarpa’s fat compartment.

Preferably, liposuction deep to Scarpa’s fascia is initiated with a 16-gauge microcannula to minimize the force necessary to penetrate the fascia. After establishing multiple tunnels through Scarpa’s fascia, larger, 14-gauge and 12-gauge cannulas can be used with greater accuracy and less patient discomfort.

The more fibrous periumbilical fat is more resistant to liposuction than fat located 4 cm or more from the umbilicus. The surgeon must direct extra efforts toward this resistant deposit, or residual fat will result in the appearance of a periumbilical “donut.”

Epigastric fat is especially fibrous, and the overlying skin is less elastic than that of the lower abdomen. To maximize the probability of a smooth result, the surgeon can use microcannulas in crisscrossing radial patterns. The patient, especially an older patient, should be told that a postoperative crepelike or wrinkled appearance is possible.

Incisions should be placed in a somewhat random pattern to avoid the appearance of a regular or symmetric distribution. Placing three to five 2-mm adits along the inferior margin of the abdomen, followed by doing liposuction through these adits, establishes a drainage pathway, helps prevent bruising, and hastens the resolution of postoperative edema.

When incisions are limited to the suprapubic or umbilical area, liposuction of the epigastric area is usually insufficient. I prefer to place several 1.5-mm adits in the upper abdomen to permit transverse and oblique liposuction with 16-gauge (1.2-mm internal diameter [ID]) or 14-gauge (1.8-mm ID) cannulas. This tunneling with microcannulas reduces the resistance of the highly fibrous upper abdominal fat. Subsequently, liposuction with larger cannulas, using 2.0-mm adits in the lower or upper abdomen, is more effective, more complete, and more comfortable.

Liposuction Stomach Cost

When it comes to liposuction, the cost of upper abdominal surgery can vary depending on where you live and the type of procedure that you need. There are multiple factors that influence the price tag of liposuction, from what kind of hospital or office you’re in to how much fat needs to be removed from your body. In this article, we’ll take a look at what goes into setting prices for liposuction procedures and how you can save money on your medical costs if possible.

Liposuction is a cosmetic procedure that removes fat from areas of the body. The cost of liposuction depends on the area of the body being treated, and how much fat needs to be removed.

For example, liposuction around your waist will cost more than liposuction on an arm or leg because there’s more tissue to treat in those areas. If you have loose skin around your waist (from losing weight), this can also affect how much time is required for treatment and therefore increase costs.

Liposuction is a cosmetic procedure, not a weight loss procedure. Liposuction can be performed in a hospital or outpatient surgery center.

Liposuction is not a substitute for diet and exercise; it removes excess fat from specific areas of the body that have accumulated above their normal distribution. The cost of liposuction varies depending on several factors including: area treated, number of treatments required and whether any other procedures are performed at the same time (such as abdominoplasty).

Upper Abdomen Liposuction

If you’re looking to remove fat from the upper abdomen, liposuction can be a great option. Liposuction is a procedure that removes fat from areas of the body where it’s unwanted and deposits it into another area where it’s needed. In this case, liposuction can be used to remove excess fat from around your middle section and relocate it elsewhere on your body–like underarms or knees!

If you’d like more information about lipo in general or upper abdomen procedures specifically, contact us today at [email protected].

Liposuction in Upper Abdomen

The upper abdomen is the area of the body between the chest and waist. It includes everything above your navel, including your lower ribs, breastbone and upper back.

The upper abdomen is part of the abdominal region that includes all of your abdominal organs (such as liver and pancreas). When liposuction is performed on this area, surgeons remove fat from under or around these organs to improve their appearance or function.

A liposuction procedure to remove fat from your upper abdomen can cost anywhere between $7,000 and $10,000. The amount of fat that’s removed depends on how much you weigh, but most people have between 1/2 pound and 2 pounds removed during the procedure.

The recovery period after liposuction will vary depending on your body type, but most patients find they can return to work within two weeks or so after their procedure (depending on how strenuous their job is). You’ll need someone else around for support during this time because swelling may make it difficult for you to move around easily without assistance–and if there isn’t anyone else available who can help out with things like cooking dinner or carrying groceries into the house for example then another option would be hiring an assistant through TaskRabbit or similar services like Careful Hands Home Care Services LLC which provide qualified personal care attendants who specialize in providing assistance with daily tasks such as meal preparation etc…

In terms of results from your upper abdomen surgery: when it comes down

There are many factors that influence the cost of liposuction, such as whether you plan to have the procedure performed in a hospital, the area or areas of your body you want treated and the amount of fat that needs to be removed. You should discuss your liposuction costs with your surgeon, especially if you need financing or help from your health insurance provider.

• The location of where you want to do lipo can affect how much it costs. For example, if you want to get rid of fat on your stomach but don’t feel comfortable having an operation at home or even at work (like if there’s no doctor’s office nearby), then going somewhere like a clinic could save money because they might charge less than other places would charge for doing surgery there instead.* The amount of time needed for recovery after surgery also affects pricing; longer periods require more care.* It’s important when researching prices that patients ask questions about what kind of anesthesia will be used during their procedure so they know exactly what kind–and cost–they’ll incur beforehand

upper and lower abdomen liposuction

Liposuction is an effective solution to remove excess fat in the middle section or abdomen. The abdomen is a particular area of the body that requires great surface and in-depth anatomical knowledge from the surgeon. This, combined with an impeccable surgical technique, will give you a great outcome.

On the surface, the stomach is divided into four regions:

• Epigastrium or upper abdomen.
• Hypogastrium or lower abdominal part.
• Peri-umbilical region. The area around the navel. This part must always be treated to avoid the appearance of a doughnut.
• The mesogastrium. Also called the waist. This part links the upper and lower abdomen.

When an abdomen is too large, or the patient wishes to address excess fat in other areas of the body, the surgeon needs to perform back-to-back surgeries within a reasonable period of time.

You may feel tempted to get all the fat out in one surgery. However, the maximum amount of fat that can be easily removed without increasing the risk of complications is between six and eight pounds. So, always put safety before beauty!

WHO IS A GOOD CANDIDATE FOR STOMACH LIPOSUCTION?

Liposuction is effective for patients who have an excess of fat on their belly. It is also an excellent procedure for both women and men who wish to get rid of fat deposits resistant to diet and exercise.

This phenomenon of very localized belly fat tends to increase with age. However, the patients should not have significant excess skin or marked muscle relaxation. Otherwise, it is necessary to turn to abdominoplasty (tummy tuck surgery) to obtain a flat stomach.

Excess skin can be a problem after important weight loss or pregnancy. In this case, a tummy tuck helps to remove sagging skin and excess fat from the abdomen. This method can truly sculpt the abdomen.

Unlike the tummy tuck, liposuction will not help you eliminate stretch marks or tighten the abdominal muscles. Also, remember that tummy liposuction is not a weight loss solution! Indeed, the plastic surgeon recommends this procedure when the patient is close to his ideal weight (30% at least). It can be beneficial once the person has reached his weight-loss goals.

BEFORE THE LIPOSUCTION

An initial consultation is necessary to allow the cosmetic surgeon to learn more about the patient’s history, including medical conditions that may contraindicate surgery. He will also make recommendations about certain medications or herbal supplements you may be on. Blood thinners, aspirin, alcohol, and ibuprofen should be stopped the day’s prior surgery to diminish bleeding. Also, you must quit smoking because it can slow your healing process.

It is also crucial that the surgeon knows your goals and expectations regarding the cosmetic procedure in this consultation. He will also perform a complete examination of the problematic fat areas of your body.

Depending on your weight and skin elasticity, the surgeon can discuss possible outcomes and surgical options specially tailored for you. After all, you must have realistic expectations. Otherwise, you may feel like the surgery was a complete failure.

Finally, the surgeon should walk you through the process and answer all the questions you may have. Also, he should inform you about the possible risks associated with the intervention. During this consultation, the specialist will also give you a detailed estimate of the cost.