Orlando, Fla. — Compared to the standard tummy tuck, the Avelar abdominoplasty offers advantages including greater fat removal and better results, according to an expert.
The Avelar abdominoplasty, pioneered by Juarez M. Avelar, M.D., of Brazil, actually represents two common procedures — the tummy tuck and liposuction of the abdomen — that had not previously been combined so extensively, says E. Antonio Mangubat, M.D., medical director, Southcenter Cosmetic Surgery, Seattle.
"We're traditionally taught that tummy tuck and liposuction should not be done at the same time. The standard tummy tuck as we are taught today cuts both the inferior abdominal blood vessels and those that perforate through the muscle to the skin," leaving only the intercostal blood vessels, he explains.By the time blood flows to the midline after a traditional abdominoplasty, Dr. Mangubat adds, "It ends up being more of a random type of flap more prone to avascular necrosis."
Blood vessels preserved
Traditional teaching held that performing liposuction at the same time as a standard tummy tuck would further disrupt the blood supply, creating a significantly greater risk of necrosis toward the inferior (distal) ends of the flap, he tells Cosmetic Surgery Times. However, Dr. Mangubat says, "Dr. Avelar noticed back in the 1990s that when one performs liposuction, the blood vessels remain intact and functional even though the fat is removed."
Liposuction moreover leaves the abdominal skin extremely loose, just as undermining does during a standard tummy tuck, he says. But with the Avelar abdominoplasty, Dr. Mangubat says, "There's no need to undermine, because one has removed the fat from the interstitium, leaving essentially an empty space." Because the skin overlying this empty space remains extremely mobile, he says, "We can remove as much skin as with a standard tummy tuck — perhaps even more — without the danger of losing blood supply."
Regarding surgical technique, Dr. Mangubat says, "The umbilicoplasty is virtually identical in both procedures, and incisions and the amount of skin removed are similar." Muscle plication also can be performed with either procedure.
However, Dr. Mangubat says with the Avelar tummy tuck, the amount of fat one can remove is greater. Because the Avelar tummy tuck incorporates significant abdominal liposuction, it improves abdominal contour by thinning the fat layer considerably more than one can with the traditional tummy tuck.
Furthermore, Dr. Mangubat says with the Avelar technique, "I believe one decreases the risks of skin necrosis because the original blood supply remains intact."
Additionally, he says while patients universally require suction drains during a standard tummy tuck, they are not needed with the Avelar abdominoplasty. The technique also creates far less potential for bleeding because tumescent anesthesia is routinely used, he says.
"And, frankly, my results are better with the Avelar. One achieves a better contour — the abdomen is smaller, and there's less fat," he says.
Begins with liposuction
The Avelar technique begins with standard tumescent liposuction, Dr. Mangubat says.
"And one can perform this under pure tumescence alone, if one wishes," he says. "The patient can be wide awake, as in a standard liposuction of the abdomen. That's virtually unheard of with a standard tummy tuck," which requires meticulous hemostasis throughout the procedure, Dr. Mangubat says. Accordingly, he says the Avelar abdominoplasty can be a simple extension of abdominal liposuction in patients who have excess abdominal skin, and, because of the tumescence, electrocautery is rarely needed.
As for operating times, he says that in his hands, a standard tummy tuck takes about two hours; the Avelar technique, 45 minutes, because no bleeding is involved. Potential complications for both the Avelar technique and the standard tummy tuck include bleeding, scarring and infection.