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Three-layer anchor lipoabdominoplasty indicated in post-weight loss patients

Article-Three-layer anchor lipoabdominoplasty indicated in post-weight loss patients

Key iconKey Points

  • Combination of liposuction and abdominoplasty preserves vascular and lymphatic systems and reduces complications
  • Process said to be safer, more efficient and less traumatic to all abdomen types
  • Surgeons new to procedure should understand abdominal wall anatomy of blood and lymphatic vessels, and start with simpler cases

Lipoabdominoplasty, which combines liposuction and abdominoplasty, preserves the vascular and lymphatic systems and reduces complications. "Anatomy preservation results in a low complication rate and a quicker postoperative recovery with less swelling, bruising and pain," says Wilson Novaes Matos Jr., M.D., who is in private practice in Brazil.

In conventional abdominoplasty, there is wide undermining in the aponeurotic plane over the rectus abdominis muscles to enable dissection of the abdominal flap. This generates trauma in the anatomical structures, such as the veins, perforant vessels and lymphatics. However, "conventional abdominoplasty also has a very low complication rate," says Steve Laverson, M.D., who is in private practice in Carlsbad and Encinitas, Calif.

A 33-year-old post-bariatric patient pre-operatively (top) and six months postoperatively. This patient lost 65 kg of weight and underwent three-layer anchor lipoabdominoplasty. Photos credit: Wilson Novæs Matos Jr., M.D.
Lipoabdominoplasty is a new approach for treating the abdominal region that systemizes liposuction to enable flap undermining in a safe way. It provides improved results because the abdomen is modeled and the fat is treated, rather than being removed en bloc, as is done with the traditional method. Additionally, liposuction allows for the skin to be contoured, rather than just pulled down. Dr. Matos has been performing lipoabdominoplasty for 10 years. He has created a personal classification of nine variations of the technique, from the small resection cases in young patients to anchor lipoabdominoplasty for post-weight loss patients.

COMBINING According to Dr. Matos, traditional abdominoplasty has been performed the same way since the 1960s. In the 1980s, there were unsuccessful attempts to combine liposuction with abdominoplasty, which resulted in some complications. "At that time, the cannulae were thick, and lipoplasty was only starting," Dr. Matos says.

In subsequent years, lipoabdominoplasty was developed and perfected, and its indications and benefits became clear. "The purpose of this new technique has always been the improvement of the results of abdominal surgery to meet the demands of patients who expect more from aesthetic surgery. Through better study and understanding of the abdominal anatomy, it was possible to standardize and systematize the combination of lipoplasty and abdominoplasty in a safe way, preserving the blood and lymphatic vessels," he adds. This has resulted in a safer, more efficient and less traumatic approach to treat all types of abdomens.

Dr. Laverson notes that one downside to the technique is that there may be limits of undermining in these procedures.

ANCHOR LIPOABDOMINOPLASTY According to Dr. Matos, three-layer anchor lipoabdominoplasty is indicated in post-weight loss patients and in patients who have a large amount of vertical and horizontal skin excess, flaccidity, previous abdominal scars and secondary abdominoplasties. This procedure is performed in three planes:

1. Superficial and deep fat plane: Lateral abdomen and abdominal fat dissection is accomplished through liposuction, which has been called "lipoundermining." In contrast to the bistoury undermining in the aponeurotic plane, liposuction does not cut the blood and lymphatic vessels.

2. Scarpa's fascia plane: Superficial liposuction of the lower lateral abdomen is performed under Scarpa's fascia to preserve the deep fat where the lymphatic vessels are located, thus avoiding seroma.

3. Aponeurotic plane: Vertical dermolipectomy is performed at the xiphoid-pubic line for diastasis plication and excess skin resection. "This is the only region where we use the aponeurotic plane, due to the low incidence of perforators and lymphatics, thus reducing necrosis, seroma and hematoma," Dr. Matos says.

The excess skin horizontal resection is performed overlying the Scarpa's fascia in the lower lateral abdominal region. The Scarpa's fascia is closed over the plication in the lower abdomen. The navel is fixated on the aponeurosis and is transpositioned, and omphaloplasty is performed.

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