Health andMedical focused on reconstructive and aesthetic breast surgery and is in the process of completing a 6th textbook on abdominal wall reconstruction. He is the Section Editor for Breast Surgery with the Journal of Plastic and Reconstructive Surgery (PRS), serves on the editorial board for 3 other journals, and has reviewed manuscripts for 23 different journals. Dr. Nahabedian currently serves on the clinical symposia committee and the instructional course committee for the American Society of Plastic Surgery, is the PRS representative to the Joint Business Operations Committee, and is a frequent oral board examiner for the American Board of Plastic Surgery. In 2012, Dr Nahabedian chaired three national symposia that included the 4th Annual Abdominal Wall Reconstruction Conference, the Santa Fe Breast and Body Contouring Symposia, and the Challenging Complications in Plastic Surgery Conference. Dr. Nahabedian has also been a visiting professor 55 times over the past 8 years at various universities and hospitals around the country.
Exercise, Liposuction or Abdominoplasty
Abdominal liposuction is ideal for women with a localized area or areas of excess fat. It is an excellent way to improve abdominal contour and proportion in a much less invasive manner. Although liposuction has been shown to be safe and effective for fat removal, it should not be perceived as a substitute for weight loss, good eating habits, and regular exercise or as a treatment for obesity. Individuals considering liposuction should consult a board certified plastic surgeon to determine if you are a good candidate. Ideal candidates for abdominal liposuction are in good physical and mental health and are within 30% of their ideal body weight. Good candidates for abdominal liposuction will typically have firm, elastic skin with good muscle tone. As is the case with all patients seeking cosmetic surgery, avoidance of tobacco products is strongly recommended to reduce the risk of complications. During your consultation, the plastic surgeon will typically assess your expectations and what you hope to achieve, obtain a comprehensive history, perform a physical examination, review the treatments options, discuss complications, and take photographs. As technology has made a big splash in our everyday lives, so have the options for liposuction. Traditional liposuction is still the most common and involves the insertion of a blunt tip cannula into the area of localized fat in order to suction out the fat. This is achieved using a negative pressure apparatus to generate the suction
force. Newer technologies will use ultrasound or radiofrequency waves to dissolve or breakup the localized fat followed by the suction phase. Still newer technologies will utilize external devices that will cool or freeze the localized fat resulting in fat dissolution. Your plastic surgeon should review these options and determine which is preferable for you. Whenever considering liposuction, you should be aware of the potential complications. Fortunately, liposuction is considered a relatively simple procedure and the vast majority of patient do very well and are very happy with the outcome; however, there are situations when things may not go as expected. Adverse events are related to various factors that include but are not limited to the length of the procedure, the amount of fat removed, and whether or not additional procedures are performed. Some of these adverse events include irregular contour, waviness of the skin, fluid collections, infection, and the need for a “touchup� or additional procedures. More serious adverse events include blood clots (deep venous thrombosis) with dislodgment of these clots to the heart and lungs (pulmonary embolus). Most liposuction procedures are performed as an outpatient; however, in some situations, an overnight stay in a hospital like setting is recommended. Some of the reasons for an overnight hospitalization include removal of more than 5 liters of fat or it the operation requires more than 5 hours. Fluid and electrolyte imbalances may occur in these situations. Performing simultaneous operations such as breast surgery and abdominal contouring procedures may also increase the chances of a complication.
The steps of the traditional liposuction operation are relatively straightforward. Liposuction is sometimes performed under general anesthesia (completely asleep) or twilight anesthesia (light sleep) with the addition of a local anesthetic agent. Your plastic surgeon may recommend one or the other. Small incisions will be made at specific locations on your abdomen followed by the instillation of a tumescent fluid into the fat compartment. This fluid is comprised of saline, lidocaine, and epinephrine and is used to constrict the blood vessels in the area, to minimize intraoperative and postoperative bleeding, and to expand the fat compartment. About 20 minutes later, a thin hollow tube or cannula is inserted and attached to a suction device to remove the fat. This is performed using back-and– forth movements either manually or with a power-assisted device. The suctioning is continued until the desired contour is achieved. The small incisions may be closed or left open and bandages are applied. Recovery following liposuction of the abdomen is usually easier than abdominoplasty. Patients should refrain for strenuous activities or exercise for about 1 month. Compression garments
Maurice Nahabedian, MD, FACS Professor: Plastic and Reconstructive Surgery Georgetown University Washington DC
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are essential. I explain to all patients considering liposuction that removal of the fat completes about 60% of the task and that adequate postoperative compression completes the rest. For this reason, compression garments are recommended and should be worn continuously for several weeks. Failure to do so will result in prolonged swelling and a less desirable outcome. Showering is permitted 3 days following liposuction. Pain medication and antibiotics are prescribed as indicated. Most patients are able to resume normal activities after 4-6 weeks.
In summary, both abdominoplasty and liposuction are safe and effective methods to achieve improvement in abdominal appearance. That said, dieting and exercise are highly recommended both before and after these procedures. When considering these options, it is recommended to consult with a board certified plastic surgeon to determine which may be the most appropriate.
202-444-2000 DrNahabedian@aol.com www.MauriceNahabedian.com 3800 Reservoir Road, NW Washington, DC 20007
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