Abdominoplasty and/or liposuction offer effective techniques for abdominal contouring to meet the needs of a range of cosmetic surgery patients, depending on the extent of their localized adiposity and skin flaccidity. While conventional abdominoplasty can provide excellent cosmetic results, it is also associated with a fairly high rate of serious wound complications, and there remains a sizeable subgroup of patients seeking body contouring for excess fat accompanied by mild skin laxity who may not benefit sufficiently from liposuction alone.
Recognizing these limitations, cosmetic surgeon Peter Lisborg, M.D., medical director, Privatklinik Lisborg & Partner, Klagenfurt, Austria, has been performing alternate procedures for abdominal contouring. When abdominoplasty is indicated, he operates with a modified Avelar technique that avoids wide undermining of the abdominal flap and reduces or eliminates the serious complications associated with traditional abdominoplasty. Liposuction combined with radiofrequency treatment fills the gap for patients who need some skin tightening in addition to fat removal, and as an added benefit, this combination has been associated with less post-treatment morbidity compared with liposuction alone, Dr. Lisborg says.
Dr. Lisborg says he has been collecting standard outcomes data for analyses to confirm his clinical impressions about the efficacy and safety of these alternate abdominal contouring techniques. In addition, he has been performing studies using laser Doppler flowmetry to establish a scientific basis for the improved safety profiles.SAFER ABDOMINOPLASTY The Avelar technique for abdominoplasty was first introduced by Juarez Avelar, M.D., and subsequently modified by Guillermo Blugerman, M.D., who replaced general anesthesia with use of IV sedation and tumescent anesthesia. By avoiding extensive undermining, the Avelar technique helps to preserve skin flap vascularity, the nerve supply and lymphatic vessels, obviating the need for drain placement and reducing risks of seroma, necrosis and infection, Dr. Lisborg says. Dr. Blugerman's approach also allows the surgery to be performed as an outpatient procedure and with even greater safety.
"Not only are the potential risks of general anesthesia avoided using tumescent anesthesia, but post-operative comfort is significantly improved because the anesthetic effect of the lidocaine in the tumescent solution persists for up to 12 hours, providing coverage during the early post-operative period when the severity of local wound pain is greatest," Dr. Lisborg says.
Outcomes data from a series of 243 patients support the improved safety profile of the modified Avelar technique relative to conventional abdominoplasty (see "Avelar advances," September 2011, Cosmetic Surgery Times). Complications were limited to suture fistula (5.5 percent), and a single patient was treated as an inpatient for a minor wound infection. There were no cases of hematoma requiring evacuation, seroma or necrosis, and all patients but one returned to normal activity within one week.
DOPPLER MEASUREMENTS These data are consistent with the idea that the modified Avelar procedure preserves skin flap perfusion. However, in order to obtain scientific proof, Dr. Lisborg has been performing laser Doppler studies to measure blood flow in patients before and after surgery. Data from a small group of patients followed to three months after surgery show blood flow is barely reduced, he says.
"The minimal reduction is remarkable considering the modified Avelar procedure still involves a large incision with resection of the whole lower skin flap. And even with data from a small group of patients undergoing the modified Avelar technique, the difference is highly statistically significant when the results are compared with the 75 percent decrease in blood flow reported by Graf in a series of patients undergoing conventional abdominoplasty (Graf R, de Araujo LR, Rippel R, et al. Aesthetic Plast Surg. 2006;30(1):1-8)," Dr. Lisborg says.
While comparison based on randomized study groups would be ideal, he says he considers it unethical to perform a prospective study assigning patients to undergo traditional abdominoplasty.