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Dr. Júlio Stédile, M.D.

Facial Plastic Surgery

Facial Plastic Surgery
&
Otorhinolaringology

Abdominoplasty

ABDOMINAL DERMOLIPECTOMY
LIPOABDOMINOPLASTY

Abdominoplasty is a surgery aiming at reestablishing the body contour and harmony and the functional correction of abdominal wall abnormalities. In abdominoplasty, the excess tissue (skin and/or fat) accumulated mainly below the navel is removed and the rectus abdominis muscles are repositioned when these are separated. This is not a surgery for losing weight, but for reshaping the abdomen. Of all regions in the body, the abdominal wall is among the ones that most accumulate fat. Lipoabdominoplasty is a combination of liposuction and abdominoplasty. Liposuction is recommended if the skin presents good quality, without flaccidity. However, if there is excess skin associated with flaccidity, abdominoplasty is recommended.

  • Peridural or general anesthesia
  • Surgery time up to 6 hours
  • Hospitalization time up to 2 days

When the patient intends to lose weight, this must occur before the surgery and according to a schedule.

Patients should include a balanced diet and regular physical activity in his/her habits.

PREOPERATIVE MEASURES:

Preoperative measures are also crucial for a successful surgery:

  1. For at least 30 days prior to the surgery, drugs or alcohol must not be used.
  2. Smoking is strictly forbidden for at least 2 months before and 2 months after the procedure.
  3. In the case of diabetic and hypertensive patients, their clinical conditions must be managed.
  4. In some cases, we recommend that the patient undergo lymphatic drainage sessions before the surgery in order to detoxify his/her organism and activate blood circulation (a detoxified organism responds better to the procedure).
  5. Essential exams are requested, such as electrocardiography, total blood count, coagulogram, fasting glycemia, electrolytes, anti-HIV, and urine.
  6. The surgeon must be told about the use of any medication.
  7. Some medications may contribute to the risk of hemorrhage: acetylsalicylic acid (aspirin), non-steroidal anti-inflammatory agents, anticoagulants, vitamin E, vitamin C, ginkgo biloba, ginseng, garlic, alcoholic beverages and some homeopathic medicines used on a continuous basis.

POSTOPERATIVE MEASURES:

  1. During the stay at the hospital, the patient is allowed to change his/her position by performing slow movements, it is not necessary to remain immobilized in bed.
  2. To favor blood circulation and decrease the risk of embolism, the legs must remain semi-flexed and need to be moved slowly along with the ankles and feet.
  3. Usually, small suction drains are used, which remain for 3-10 days to prevent fluids from accumulating on the abdominal wall. In the first two weeks the dressings are replaced every other day.
  4. Patients wear a compressive elastic belt (compressive shaper) for around 3-6 months depending on each particular case. In the first days, the elastic belt should be removed only for personal hygiene purposes and after 30 days it can be taken off at night to sleep.
  5. Most of the incision stitches are internal, located under the skin and do not have to be removed, as they are absorbed by the organism within weeks. Some of these stitches may eventually be eliminated through the suture line. The external incision stitches and those at the navel are removed between the 7th and 15th day after the surgery.
  6. Patients are allowed to take a complete bath after the 2nd day or after the removal of the drain. We recommend the assistance of a physiotherapist for lymphatic drainage and physiotherapy sessions.
  7. Patients must avoid physical efforts and keep a slightly curved posture for 15 days to prevent stress on the scar, at risk of opening the sutures.
  8. After the first 2 weeks, patients may begin to resume their normal activities but with moderation and common sense, avoiding exaggeration.
  9. Intensive physical exercise must be avoided for at least 2 months, and use of the elastic belt is recommended for at least 3 months or for the period recommended by your doctor according to the progress of your case.

THE SCARRING PROCESS WILL GO THROUGH SEVERAL STAGES:

  • FIRST STAGE: In the first 30 days the scar has a good aspect and is barely visible
  • SECOND STAGE: from the 30th day to the 12th month. In this stage, the scar thickens, changing its color from red to brown and becoming progressively clearer. It is in this stage that many patients become worried, we make it clear that it is just a natural scarring process.
  • THIRD CASE: from the 12th to 18th month. In this stage, the scar becomes clearer and shows milder consistency. It is important to assess the final result of abdominoplasty only after the 16th month.

IMPORTANT CONSIDERATIONS:

  1. More and more people have postural problems and weakness of the abdominal muscles and this is one of the key points to be treated with guided physical activity and/or electrostimulation (physiotherapy) to increase abdominal muscle strength and improve posture and body image.
  2. Patients should add a balanced diet and regular physical activity (3-4 times a week) to their habits.
  3. In addition to abdominoplasty, the patient may need treatments in the field of aesthetic medicine and physiotherapy, and, occasionally, another surgery may be necessary.
  4. After a minimum period of 6 months, the surgeon may indicate complementary procedures such as liposuction in a particular region of the abdomen where fat areas could not be eliminated in the first surgery.
  5. Cases with enlargement of the scar or keloid must await from 6 months to 1 year to undergo a surgical retouch to treat the scar.
  6. With aging, a second procedure may be necessary to improve the body contour. The abdomen can remain firm and smooth for many years, as long as there is no weight gain or pregnancy.
  7. The swelling (edema) in the region of the lower abdomen and waist lasts 2 months. Above the pubis, a hardening reaction along with lack of sensitivity will take place. This is a natural process and no cause for any concern and will gradually be resolved by the 6th month. A triangular skin area below the navel may remain insensitive for one year.
  8. Skin striae above the navel are less visible when the skin is stretched. Striae located below the navel can have their appearance improved because part of the skin will be removed.

ABDOMINOPLASTY COMPLICATIONS:

Possible complications include: hematoma (immediate postoperative period), seroma (late postoperative period), infection, necrosis and skin ailment (more common in smokers, obese and diabetic patients), opening of the suture (dehiscence), keloid, thrombosis, embolism, pulmonary embolism (obesity is a major risk factor), and in very rare cases, death. Complications are more common in smokers, obese, diabetic and hypertensive patients.

COMPLICATIONS

  1. Infections: may take place after any surgical procedure. In general, they are caused by Streptococcus pyogenes or in synergism with anaerobic bacteria. Suitable antiseptic measures, transoperative care and antibiotic therapy for at least 7 days can prevent infection in liposuction.
  2. Deep venous thrombosis and pulmonary embolism: these are possible severe complications of this type of surgery and can even be fatal. For prevention, a preoperative examination is necessary to identify risk factors such as thrombosis, and elastic compression stockings and an intermittent pneumatic pressure system for the lower limbs should be used in the transoperative and immediate postoperative periods, and good hydration and early immobilization are necessary postoperatively. These measures help prevent severe complications. Symptoms are shortness of breath and difficulty breathing. If these symptoms appear the patient must seek medical emergency care at once and then tell his/her surgeon about it.
  3. Cardiorespiratory arrest: many cases do not have an apparent reason, are of difficult reversion and may occur in any type of surgery, cosmetic or not. Hence, it is important to carry out the surgical procedures in a hospital facility with all available resources.
  4. Skin necrosis: the skin above the liposuctioned area may die. In particular, this may occur when liposuction is carried out on a very superficial layer, causing damage to vessels in the subdermal plexus. The compression mesh can also lead to necrosis due to the ischemia caused by excess compression, especially in the skin fold region.
  5. Irregularities and depressions: may occur as a result of adherences to the subcutaneous tissue and very superficial liposuction near the skin surface.
  6. Skin hyperpigmentation: typically occurs at the aspired sites due to deposits and fixation of hemosiderin by ultraviolet rays, derived from the breakdown of hemoglobin present in surface ecchymoses. In order to prevent this it is fundamental to avoid sun exposure and to apply sunscreen to the operated areas. Depigmenting agents can be used if necessary.
  7. Anesthetic intoxication: complications derived from anesthetic drugs.
  8. Irregularities and depressions: these may occur as a result of subcutaneous tissue adherences and very superficial liposuction near the skin surface.
  9. Unaesthetic scars.
  10. Hematoma: the accumulation of blood that may occur in the immediate postoperative period (first days).
  11. Seroma: is the accumulation of serohematic fluid that may take place at a liposuctioned site in the late postoperative period (many days or weeks after the surgery). These can usually be aspirated with syringes at the office. The compression meshes worn postoperatively help prevent seromas and minimize pain.
  12. More and more people have posture problems and abdominal muscle weakness and this is one of the key points to be worked on with guided physical activity and/or electrostimulation (physiotherapy) to increase muscle strength in the abdomen and improve posture and body image. This is an important factor to be remembered by all patients undergoing a cosmetic surgery and who want to improve their body image.

Liposuction ALONE will not provide the desired resultS. Patients must carry out a physical conditioning program before and after the procedure in order to work on their muscles and body posture. In liposuction, the surgeon works on a fat (adipose) layer and it is also necessary to treat the quality of the skin.

THE COMBINATION OF MEASURES LEADS TO BETTER END RESULTS. REMEMBER YOU MUST TREAT YOUR NEW BODY SHAPE PROPERLY AND FOR THIS IT IS IMPORTANT TO STICK TO A HEALTHY DIET AND TO EXERCISE REGULARLY.

FREQUENTLY ASKED QUESTIONS IN LIPOABDOMINOPLASTY

  1. When is Abdominoplasty recommended?After diets resulting in major weight loss, a drastic reduction occurs in the volume of abdominal fat, which leads to flaccidity and excess abdominal skin. During the period of obesity, the skin is subject to great stretching, losing part of its elasticity, and when weight is lost, the skin does not retract enough, leading to the so-called “abdominal apron”, characterized by excess skin under the bellybutton. Abdominal distension during pregnancy can cause separation to the sides of the rectus abdominis muscles and result in excess tissue (skin and fat), which builds up mainly under the navel. Most women show some degree of abdominal flaccidity after one or more childbirths, skin flaccidity being found on the amount of fat located in the area. These occurrences are generally aggravated by a sedentary lifestyle and changes in dietary habits that interferes with the tonus of the abdominal wall and also with adipose accumulations inside the abdomen and on the external abdominal wall. Fit men or women who have already lost excess pounds, have good dietary habits and practice regular physical exercise are considered the best candidates for abdominoplasty. Patients who have not reached their ideal weight yet, as well as women who intend to become pregnant again should postpone the surgery. The scar from a transverse C-section does not contraindicate the procedure and can be used as the base for the abdominoplasty scar. Previous abdominal surgeries can make abdominoplasty difficult in view of the scars that are already present and due to adherences and modifications of local tissues.
  2. Is the abdominoplasty scar quite visible? The incisions are planned to be hidden by the underwear. The scar resulting from abdominoplasty is located horizontally above the pubic hair and extends laterally depending on the abdominal size to be corrected. The scar will undergo several evolutional periods until its full maturation, which is at 24 months.
  3. Can the fat accumulated in the stomach area be corrected with abdominoplasty?A combination of abdominoplasty and liposuction is often needed to remove fat and reshape the abdomen. Patients with short torsos (chest and abdomen) show less favorable results, while those with a long torso (chest and abdomen) show better surgical results.
  4. Are there risks to this surgery?When performed within the technical criteria, rarely does abdominoplasty pose serious risks. An adequate preparation of the patient for the surgical procedure and analyzing whether or not the simultaneous combination of abdominoplasty with other surgeries is appropriate are key factors in reducing surgical risks.
  5. Is the postoperative period of abdominoplasty very painful?When abdominoplasty presents a normal postoperative evolution, considerable pain should not be experienced. Patients who are simultaneously subjected to gynecological surgeries report more pain postoperatively.
  6. Will I lose weight with abdominoplasty?This surgery is not intended for losing weight, but rather for reshaping the abdomen. In this surgery, a certain amount of fat and skin is removed and, hence, some bodyweight reduction will surely take place, depending on the volume of skin and fat removed from the patient. The aesthetic result will not depend on the pounds removed, but on the proportion that the abdomen will keep in relation with the rest of the trunk and limbs. Best aesthetic results are obtained in those patients needing to remove less skin and fat.
  7. How long will I have to wait to see the final result of abdominoplasty?The abdomen will present some insensitivity, periods of swelling and a reddish scar in the first months. In this stage, the abdomen may have a flat aspect with more rigid areas (undefined). Lymphatic drainage and other physiotherapeutic treatments help in the gradual evolution to the end result. The first 6 months should be considered a very important period of scarring, but in order to evaluate the ultimate result, we must wait for at least 18 months. Certainly, all of the patient’s concerns should be communicated at once to the surgeon or staff, so that he/she can be provided with the necessary advice. Some anxiety is natural, since the patient wants to see the end result as soon as possible. Remember that the scarring period will require at least 18 months for the maturation of the operated area.
  8. Will the bellybutton have its position changed? Typically, the bellybutton is reinserted and, if necessary, reshaped. For re-implanting the bellybutton, several techniques exist. Often, an inverted V scar is used, which avoids an evident scar line at the lower edge of the navel, preventing the circular retraction thereof.
  9. Will I be able to have children after abdominoplasty?The ideal would be to have children before abdominoplasty. The gynecologist must be consulted if you intend to become pregnant again.
  10. What kind of swimwear can I wear after the surgery?The type of swimwear will depend on your personal taste, the use of a one-piece bathing suit, bikini or thong that looks best for your body type. The abdominoplasty scar usually tends to be characterized by a curved line low in the pubic region and high laterally towards the iliac spines and with this shape it can be hidden by the bikini. In the first 6 months, the scar has a reddish aspect and may take another 6 months to look natural. Remember that, in addition to the surgical treatment, treatments in the field of aesthetic medicine and physiotherapy can and should be combined in many cases.

BE WISE WHEN YOU CHOOSE A SURGEON. Just like in all other professions (lawyers, teachers, politicians, masons, cabinetmakers, baby-sitters, plumbers, etc.), there’s also a significant difference in the quality of the medical work provided.

Remember that different surgeons have different medical BACKGROUNDS, follow different procedures, have different esthetic views and obtain significantly different surgical results.

Address

Dr. Júlio Stédile M.D.
Av. Dr. Nilo Peçanha, 2825/1403 ZIP CODE 91330-001
Bairro Três Figueiras - Porto Alegre/Rio Grande do Sul - Brasil
Phone: +55 (51) 2111-1017 / +55 (51) 2111-1018

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