Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 262 - файл
.pdf
106
https://t.me/medicina_free
J. M. Avelar
are not damaged during the operation, the blood supply to the remaining abdominal
panniculus is maintained, whose multiple pedicles avoid dead space (Figs.5.9 and
5.10). This is my surgical contribution, and it comes with a minor rate of complica-
tions because the operation can be carried out without panniculus undermining and
without resection.
Those surgical principles are essential in order for the lipoabdominoplasty procedure to improve body contouring (Avelar 1999a, b, c, 2000a, b) and for it to
include several other regions, as long as my original descriptions on aesthetic surgeries on the axillary regions are followed (Avelar 1999d, e), even for ankplasty
and torsoplasty (Avelar 1999f) and for medial tight lifting (Avelar 1999g). Also, I
employ similar surgical principles to perform face lifts, ear reconstruction, reverse
lower blepharoplasty, and surgeries on other segments of the human body. Such a
combined approach is so important in plastic surgery because it doesn’t cut the arterial, venous, and lymphatic structures, thus yielding smooth and aesthetic results.
Finally, I was able to solve the problems that I identied 50years ago in the eld
of abdominoplasty and surgeries on other regions to improve body contouring.
Therefore, I described a new method to create the umbilical region during abdominoplasty (Avelar 1976a, b, 1979, 1983a, b). Also, I introduced new concepts to solve
the problems of the unaesthetic aspect of the abdominal wall from the accumulation
of local adiposities after liposuction combined with cutaneous resection (Avelar
1985a, b, 1986b). My recent contribution to abdominoplasty came in the last year of
the twentieth century, which was a new procedure for lipoabdominoplasty (Avelar
1999a, b, c, d, e, f, g, 2000a, b). Following this technique, there are minimal local
and systemic complications thanks to its maintaining normal blood supply to the
remaining abdominal panniculus coming from the perforator vessels, which are preserved in this technique (Figs.5.6, 5.9, and 5.10).
References
Avelar JM (1976a) Umbilicoplasty– a technique without external scar (Umbilicoplastia uma téc-
nica sem cicatriz externa). 13rd Bras Cong of Plast Surg and First Brazilian Cong of Aesthetic
Surgery. (13° Congresso Brasileiro de Cirurgia Plástica e 1° Congr Bras Cir Estética), Porto
Alegre– RS (Brazil) 81–82
Avelar JM (1976b) Umbilicoplasty – A istema without external scar. Cahiers de chirurgie
Esthétique. Journees internationals de Chirurgie Esthetique. Vendredi 21– Paris (France) mai.
Avelar J (1978) Abdominoplasty– systematization of a technique without external umbilicalscar.
Aesthet Plast Surg 2:141
Avelar JM (1979) Umbilical scar– its importance and technique for creating during abdomino-
plasty (Cicatriz umbilical– da sua importância e da técnica de confecção nas istemalasties).
Rev Bras Cir 1(2):41–52.
Avelar JM and Padovez JC (1982)– Mamoplasty combined with Abdominoplasty– Analises of
40 consecutive cases. (Mamaplastia e Abdominoplastia Combinadas – Análise de 40 Casos
Consecutivos) In: Annals of Brazilian Symposio of Abdominoplasty. (Anais do Simpósio
Brasileiro de Abdominoplastia), ed. by Juarez M. Avelar, Sponsored by Brazilian Society
of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia
Plástica– Regional São Paulo). 1:141–148. Editora Cidade, Rio de Janeiro– Brazil.
5 The Beginning, Development, and Current Status of Lipoabdominoplasty: New…
https://t.me/medicina_free
Avelar JM (1983a) Abdominoplasty: technical renements and analysis of 130 cases in 8 years
follow-up. Aesthetic Plast Surg 7:205–212.
Avelar JM (1983b) Submentonean and Submandibular Adiposity– Liposuction X Lipectomy
(Adiposidade Submentoniana e Submandibular – Lipoaspiração X Lipectomia). Brazilian
Symposium on Facial Contouring, organized and edited by Dr. Juarez Avelar. Sponsored by
Brazilian Society of Plastic Surgery (Section of São Paulo), September pag. 69–72
Avelar JM (1985a) Combined liposuction with traditional surgery in abdomen Lipodystrophy.
XXIV Instructional Course of Aesth Plast Surg of ISAPS, Madrid (Spain) May.
Avelar JM (1985b) Fat-suction versus abdominoplasty. Aesthetic Plast Surg 9:265–276.
Avelar JM (1985c)– Fat-Suction of the Submental and Submandibular Regions. Aesth Plast Surg
9:257–263
Avelar JM (1986a) Surgical anatomy and distribution of the cellular tissue on human organ-
ism. (Anatomia cirúrgica e distribuição do tecido istema no istema humano). In: Liposuction
(Lipoaspiração). Ed; by Avelar JM and Illouz IG.Editora Hipócrates, São Paulo, pp45–57.
Avelar JM (1986b)– Liposuction of the Abdominal Wall. (Lipoaspiração da Parede Abdominal).
In: Liposuction (Lipoaspiração), ed. by Avelar and Illouz, Ed. Hipócrates, São Paulo (Brazil)
27:157–176.
Avelar JM (1986c) – Photograc standardization as Method for Cientic Documentation
(Padronização fotográca como Método de Documentação Cientíca). In: Liposuction
(Lipoaspiração), ed. by Avelar and Illouz, Ed. Hipócrates, São Paulo (Brazil) 13:80–86.
Avelar JM (1987) Study of the subcutaneous adipose tissue applied for fat-suction technique.
In: Manesksha RJ (ed) Trans. IX Int. Congr. Plast. Reconstr. Surg, New Delhi, 1–6 Mar,
pp377–379.
Avelar JM (1988) Abdominoplasty – Reections and bio-psychological perspectives
(Abdominoplastia– reexões e perspectiva biopsicológicas). Revista Soc Bras Cir Plast 3(2)
Avelar JM (1989) Regional distribution and behaviour of the subcutaneous tissue concerning
selection and indication for liposuction. Aesthetic Plast Surg 13:155–156.
Avelar JM (1999a) New concepts for abdominoplasty. (Novos conceitos para abdominoplastia).
Paper presented at the 36th congress of the Brazilian Society of Plastic Surgery, Rio de Janeiro,
November.
Avelar JM (1999b) A new technique for abdominoplasty– closed vascular system of subder-
mal ap folded over itself combined to Liposuction. (Uma nova técnica de abdominoplas-
tia– istema vascular fechado de retalho subdérmico dobrado sobre si mesmo combinado com
lipoaspiração). Rev Bras Cir 88/89(1/6):3–20.
Avelar JM (1999c) Abdominoplasty: new concepts for a new technique (Abdominoplastia: Nuevos
conceptos para una nueva técnica). XXVI annual international symposium of aesthetic plastic
surgery, Chairman: Prof. Jose Guerrerosantos– Puerto Vallarta, pp10–13.
Avelar JM (1999d) Aesthetic Plastic Surgery of the Axilla (Cirurgia Plástica e Estética de Axila)
Rev Bras Cir 88/89(1/6):41–54
Avelar JM (1999e) Aesthetic Plastic Surgery of the Axilla. Presented at the XV Congress of the
International Society of Aesthetic Plastic Surgery (ISAPS, Tokyo (Japan) April 2.000
Avelar JM (1999f) Flankplasty and torsoplasty – a new surgical approach. (Flancoplastia e
Torsoplastia– Nova Abordagem Cirúrgica). Rev Bras Cir 88/89(1/6):21–35
Avelar JM (1999g) Plastic Surgery in Internal Medial Thigh (Cirurgia Plástica de Face Interna de
Coxas) Rev Bras Cir 88/89(1/6):57–67
Avelar JM (2000a) Abdominoplasty: a new technique without panniculus undermining and with-
out panniculus resection. 57th Instructional Course of ISAPS, Chairman: Lloyd Carlsen, in
Montreal, Canada.
Avelar JM (2000b) Abdominoplasty: a new technique without undermining and fat layer removal
(Abdominoplastia: uma nova técnica sem descolamento e remoção da camada de gordura). Arq
Catarinense de Med 29:147–149
Avelar JM (2001a) The new abdominoplasty and derived technique. ISAPS and ASERF Annual
Meeting. The Aesthetic Meeting, NewYork.
107
108
https://t.me/medicina_free
Avelar JM (2001b) Abdominoplasty without lipectomy. Mini Course of ISAPS with Aesthetic
Plastic Surgery Congress of Spain, Valladolid.
Callia WE (1965) Contributions for the surgical correction of the pendulous and globose abdomen:
original technique. Doctor’s thesis, Medicine Medical School, São Paulo University, Sao Paulo.
Cavalcanti MA and Cavalcanti M (1982) Abdominoplasty on Corrections of Severe Cases
(Abdominopastias nas Correções de Casos Graves). In: Annals of the Brazilian Symposio
of Abdominoplasty (Simpósio Brasileiro de Abdominoplastia), organized and ed. by Juarez
M.Avelar, Sponsored by Brazilian Society of Plastic Surgery-Regional São Paulo, (Patrocinado
pela Sociedade Brasileira de Cirurgia Plástica– Regional São Paulo), pág. 185–192. Editora
Cidade, Rio de Janeiro– Brazil.
Daher JC (1982) Onphaloplasty in Abdominoplasty (Onfaloplastias nas Abdominoplastias).
In: Annals of the Brazilian Symposio of Abdominoplasty (Simpósio Brasileiro de
Abdominoplastia), organized and ed. by Juarez M.Avelar, Sponsored by Brazilian Society
of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia
Plástica– Regional São Paulo), pág. 68–70. Editora Cidade, Rio de Janeiro– Brazil.
D’Assumpção EA (1982) Three Common Complictions in Abdominoplasty: Infeccion, Deiscence
and Seroma Formation. (Três Complicações Comuns em Abdominoplastias: Infecção,
Deiscência e Seroma). In: Annals of the Brazilian Symposio of Abdominoplasty (Simpósio
Brasileiro de Abdominoplastia), organized and ed. by Juarez M.Avelar, Sponsored by Brazilian
Society of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de
Cirurgia Plástica– Regional São Paulo), pg. 77–82. Editora Cidade, Rio de Janeiro– Brazil.
Erfon JA (2000) Resection of the lower abdominal fascia to improve plication of infraumbili-
cal aponeurosis during lipoabdominoplasty without panniculus undermining (Ressecção da
fascia abdominal inferior para plicatura infra umbilical em lipoabdominoplastia sem descola-
mento do panículo). Second Courese of Abdominoplasty at the Heart Hospital (2° Curso de
Abdominoplastia), Hospital do Coração –, São Paulo (Brazil)
Gonzales-Ulloa, M (1959) Circular Lipectomy wirh Transposition of the umbilicus and aponeu-
rotic Technique. Cirug Y Ciruj 27:394–409
Gonzales-Ulloa M (1982) Circular Abdominoplasty (Abdominoplastia Circular) Presented at the
Brazilian Symposio of Abdominoplasty (Simpósio Brasileiro de Abdominoplastia), organized
and ed. by Juarez M.Avelar, Sponsored by Brazilian Society of Plastic Surgery-Regional São
Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia Plástica– Regional São Paulo).
Section “I” Round Table. Editora Cidade, Rio de Janeiro– Brazil.
Grazer FM, Goldwyn RM (1977) Abdominoplasty assessed by the survey, with emphasis on com-
plications. Plast Reconstr Surg 59(4):513–517
Guerrerosantos J, Spaillat L, Morales F, Dickeheet S (1980) Some problems and solutions in
abdominoplasty. Aesthetic Plast Surg 4:227
Guerrerosantos J (1982a) Necrosis of Abdominal Wall Post-Abdominoplasty – Etiology,
Prolaxis and Treatment (Necrose de Parede Pós-Abdominoplastia– Etiologia, Prolaxia e
Tratamento). Presented at the Brazilian Symposio of Abdominoplasty (Simpósio Brasileiro
de Abdominoplastia), organized and ed. by Juarez M. Avelar, Sponsored by Brazilian
Society of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de
Cirurgia Plástica– Regional São Paulo). Section “E” Round Table. Editora Cidade, Rio de
Janeiro– Brazil.
Guerrerosantos J (1982b) Tecnichal Renments in Abdominoplasty (Renamentos Técnicos
nas Abdominoplastia). Presented at the Brazilian Symposio of Abdominoplasty (Simpósio
Brasileiro de Abdominoplastia), organized and ed. by Juarez M.Avelar, Sponsored by Brazilian
Society of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de
Cirurgia Plástica– Regional São Paulo). Section “B” Round Table. Editora Cidade, Rio de
Janeiro– Brazil.
Hinderer UT (1982) Treatment of the Mammary Hypoplasia Combined with Abdominal
Lypodistroa (Tratamento de la Hipoplasia Mamaria Combindo con Lipodistroa
Abdominal). In: Annals of the Brazilian Symposio of Abdominoplasty (Simpósio Brasileiro
de Abdominoplastia), organized and ed. by Juarez M.Avelar, Sponsored by Brazilian Society
J. M. Avelar
5 The Beginning, Development, and Current Status of Lipoabdominoplasty: New…
https://t.me/medicina_free
of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia
Plástica– Regional São Paulo), pág. 55–57. Editora Cidade, Rio de Janeiro– Brazil.
Illouz YG (1980) Une nouvelle technique pour çles lipodystrophies localisées. Rev Chir Esth
Franc 6:19
Illouz YG (1983a)– Liposuction– My technique and applications. First Course of Liposuction.
Organized by Dr. Juarez M.Avelar. Heled at São Paulo Hospital, Service of Prof. Andrews at
Escola Paulista de Medicina., Sponsored by Brazilian Society of Plastic Surgery (São Paulo
Section) October São Paulo (Brazil).
Illouz YG (1984)– Renements in Liposuction to improve body contour. Theory and Practical
Course with surgical demonstrations at “Nove de Julho Hospital”. Organized by Dr. Juarez
M.Avelar. Sponsored by Brazilian society of Plastic Surgery with collaboration of Regional
São Paulo. São Paulo (Brazil), May.
Illouz YG (1986a) Basic Principles of liposuction technique (Princípios básicos da técnica de
lipoaspiração). Liposuction (Lipoaspiração). Ed. by AvelarJM. & Illouz YG. São Paulo
(Brasil). Editora Hipócrates 3:22–225.
Illouz YG (1986b). Study of the Adipocite in Lipodistrophy (Estudo do Adipócito nas
Lipodistrogias). In Liposuction (Lipoaspiração). Ed. by AvelarJM. & Illouz YG.São Paulo
(Brasil). Editora Hipócrates 4:19–23.
Kelly HA (1899) Report of gynecological cases. John Hopkins Med J 10:197
Leão CF (2000a) Plication of the musculoaponeurotic wall through a tunnel on the superior
abdominal on the midline during lipoabdominoplasty without panniculus undermining
(Plicatura da parede músculo-aponeurótica por um tunel no abdômen superior na linha média
em lipoabdominoplastia sem descolamento). Presented at the 2nd Course of Abdominoplasty
at Heart Hospital (Hospital do Coração), São Paulo, October. (2° Curso de abdominoplastia, no
Hospital do Coração, outubro– São Paulo, organizado por Dr. Juarez M.Avelar) no Hospital
do Coração, São Paulo, October
Leão CF (2000b) Plicatura da parede músculo-aponeurótica por um tunel criado abaixo do paní-
culo abdominal na linha média em lipoabdominoplastia sem descolamento. 37° Congresso
Brasileiro de Cirurgia Plástica, novembro– Porto Alegre. (Reinforcement of the musculoapo-
neurotic wall through a tunnel created below the abdominal panniculus during lipoabdomino-
plasty). 37th Brazilian Congress of Plastic Surgery, Porto Alegre, November
Lockwood T (1995) High lateral-tension abdominoplasty with super cial fascial system suspen-
sion. Plast Reconstr Surg 96:603–615
Lodovici O (1982) Hypertroc or Keloidean Umbilicl Scar in Abdominoplasty (Cicatriz Umbilical
Hipertróca ou Queloidiana na Abdominoplastia) In: Annals of the Brazilian Symposio of
Abdominoplasty (Simpósio Brasileiro de Abdominoplastia), organized and ed. by Juarez
M.Avelar, Sponsored by Brazilian Society of Plastic Surgery-Regional São Paulo, (Patrocinado
pela Sociedade Brasileira de Cirurgia Plástica – Regional São Paulo), pág. 83–85. Editora
Cidade, Rio de Janeiro– Brazil.
Malbec EF (1948) Lipectomia abdominal. La Prensa Méd Arg 35(26)
Martins LC (1982) Respiratory Problems on Pre and Post-Operatory of the Abdominoplasty
(Problemas Respiratorios no Pré e Pós-Operatório das Abdominoplastias) In: Annals of the
Brazilian Symposio of Abdominoplasty (Simpósio Brasileiro de Abdominoplastia), organized
and ed. by Juarez M.Avelar, Sponsored by Brazilian Society of Plastic Surgery-Regional São
Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia Plástica– Regional São Paulo), pág.
86–89. Editora Cidade, Rio de Janeiro– Brazil.
Matarasso A (2000) Liposuction as an adjunct to full abdominoplasty revised. Plast Reconstr Surg
106:1197–1206
Mélega JM (1982) Thromboembolism as a complication of abdominoplasty: etiology, preven-
tion and treatment. (Tromboembolismo Como complicação de abdominoplastia: etiologia,
prevenção e tratamento) In: Annals of the Brazilian Symposium of Abdominoplasty. Ed. by
Juarez M Avelar. Sponsored by Brazilian Society of Plastic Surgery (Regional São Paulo)
pp73–76.
Pitanguy I (1967) Abdominal lipectomy: an approach to it through an analysis of 300 consecutive
cases. Plast Reconstr Surg 40(4):384–391
109
110
https://t.me/medicina_free
Pitanguy I (1977) Dermolipectomy of the abdominal wall, thighs, buttocks, and upper extrem-
ity. In: Converse JM (ed) Reconstructive plastic surgery, 2nd edn. Saundrs, Philadelphia,
pp3800–3823
Pitanguy I (1982) Phylosophic and Psychological Perspectives of the Abdomen. (Perspectivas
Filosócas e Psicológicos do Abdomen). In Annals of Brazilian Symposio of Abdominoplasty.
(Anais do Simpósio Brasileiro de Abdominoplastia), Ed. by Juarez M.Avelar, Sponsored by
Brazilian Society of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira
de Cirurgia Plástica– Regional São Paulo). 1:15–24. Editora Cidade, Rio de Janeiro– Brazil.
Planas J (1982) Abdominoplasty through upper incision (Abdominoplastia por Incisão
Superior). Presented at the Brazilian Symposio of Abdominoplasty (Simpósio Brasileiro
de Abdominoplastia), organized and ed. by Juarez M. Avelar, Sponsored by Brazilian
Society of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de
Cirurgia Plástica– Regional São Paulo). Section “C” Round Table. Editora Cidade, Rio de
Janeiro– Brazil.
Pontes R (1965) Abdominal plastic: importance of its association with the correction of incisional
hernias (Plástica abdominal: importância da sua associação com a correção de hérnia inci-
sional). Rev Bras Cir 52:8.
Pontes R (1982) Abdominal Plastic– Unsatisfactory Results (Plástica Abdominal– Resultados
Insatisfatórios). In: Annals of Brazilian Symposio of Abdominoplasty. (Anais do Simpósio
Brasileiro de Abdominoplastia), Ed. by Juarez M.Avelar, Sponsored by Brazilian Society
of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia
Plástica– Regional São Paulo). 2:47–51. Editora Cidade, Rio de Janeiro– Brazil.
Rebello C, Lion P, Franco T (1972) Abdominopalsty through submammary incision. International
Congress of ISAPS.Rio de Janeiro. Ed. Publicaciones Comntroladas, 58, Madrid
Rebello C (1982) – Abdominoplasty through submammary approach (Abdominoplastia por
incisão submamária In: Annals of Brazilian Symposio of Abdominoplasty. (Anais do Simpósio
Brasileiro de Abdominoplastia), Ed. by Juarez M.Avelar, Sponsored by Brazilian Society
of Plastic Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia
Plástica– Regional São Paulo). 52–53. Editora Cidade, Rio de Janeiro– Brazil.
Ribeiro R (2016) Modied Lipoabdominoplasty: Updating Concepts. Plat Recont Surg
138(1):38e-47e DOI:https://doi.org/10.1097/PRS.0000000000002321.
Sinder R (1975) Plastic Surgery of the abdomen - Técnica pessoal de abdominoplastia, com
prévio deslocamento de retalho supraumbilical (antes da resseccão infraumbilical) e uso de
retalho dermoadiposo,– VI International Congress of Plastic and Reconstructive Surgery, Paris
(France) August
Sinder R (1982)– Technical Variations of Abdominoplasty -– Generalities About Plastic Surgery of
Abdomen (Variações Técnicas das Abdominoplastias Generalidades Sobre Cirurgia Plástica do
Abdome. In Annals of Brazilian Symposio of Abdominoplasty. (Anais do Simpósio Brasileiro
de Abdominoplastia), Ed. by Juarez M.Avelar, Sponsored by Brazilian Society of Plastic
Surgery-Regional São Paulo, (Patrocinado pela Sociedade Brasileira de Cirurgia Plástica –
Regional São Paulo). 2:31–40. Editora Cidade, Rio de Janeiro– Brazil.
Saldanha O R (2002) Lipoabdominoplasty. In: Abdominoplasty Without Panniculus Undermining
and Resection, ed. by Avelar J M, Ed Hipócrates Pg 315–322– São Paulo
Thorek M (1939) Modern operative technique. J.P.Lippincott-Phil, London
Vernon S (1957) Umbilical transplantation upward and abdominal contouring in lipectomy. Am J
Surg 94:490–492
Vilain R, Dubousset J. (1964) Technique et indications de la lipectomie circulaire. 150 observa-
tions. Ann Chir 18:289–300.
Vilain R (1982) Circular Abdominoplasty (Abdominoplastia Circular). In Annals of Brazilian
Symposio of Abdominoplasty (Anais do Simpósio Brasileiro de Abdominoplastia), Ed. by
Juarez M. Avelar, Sponsored by Brazilian Society of Plastic Surgery-Regional São Paulo,
(Patrocinado pela Sociedade Brasileira de Cirurgia Plástica– Regional São Paulo). 6:152–153.
Editora Cidade, Rio de Janeiro– Brazil.
J. M. Avelar
Chapter 6
https://t.me/medicina_free
Personal Experience withAbdominoplasty
Without Undermining andIts
Modications
RicardoCavalcantiRibeiro, WilsonNovaes,
andLuisFernandezde Cordova
Abstract Abdominoplasty is a very common aesthetic surgery performed world-
wide. Data from the American Society of Plastic Surgeons have shown that it ranks
as one of the most cosmetic surgical procedures performed in the United States.
With the appearance of liposuction in the 1980s, classical abdominoplasty was
modied using both techniques to improve body contour. At the end of the 1990s
and the beginning of 2000, Avelar (New concepts for abdominoplasty, 1999a, Rev
Bras Cir 88/89(1/6):3–20, 1999b, Abdominoplasty: new concepts for a new technique, 1999c) published several articles reporting a new approach called “abdominoplasty without undermine” that was proven to be safe, with good results. We have
been using this technique since 2003 with excellent outcomes; however, some
details were added because of signicant shortcomings, including the lack of treatment of the pubic area and anks, presence of a high-position scar, and, in some
cases, a bulging inferior abdomen. Thus, after a long period of performing this
technique, some improvements were made to the original surgical technique that
included deep liposuction in the lower abdomen, pubic liposuction, liposuction of
R. C. Ribeiro (*)
Plastic and Reconstructive Surgery, Federal University of the State of Rio de Janeiro,
Rio de Janeiro, Brazil
e-mail: rribeiro@centroin.net.br
W. Novaes
Plastic and Reconstructive Surgery, Carlos Chagas Institute, Rio de Janeiro, Brazil
Brazilian Society of Plastic Surgery, Rio de Janeiro, Brazil
L. F. de Cordova
Plastic and Reconstructive Surgery, Carlos Chagas Institute, Rio de Janeiro, Brazil
Division of Plastic and Reconstructive Surgery, Casa de Portugal Rio de Janeiro,
Rio de Janeiro, Brazil
Division of Plastic and Reconstructive Surgery, Global Plastic Surgery, México City, Mexico
Switzerland AG 2023
J. M. Avelar, R. Cavalcanti Ribeiro (eds.), Body Contouring,
https://doi.org/10.1007/978-3-031-42802-9_6
111© The Author(s), under exclusive license to Springer Nature
112
https://t.me/medicina_free
the anks or dorsum with power-assisted liposuction (PAL), Scarpa’s fascia removal
in the inferior abdomen, lipoplasty and Mons lipolifting, and pubic xation. We
present a retrospective study since that time on patients who underwent surgery
with these related improvements. For global harmonization of the body contour,
abdominoplasty using Avelar’s principles was routinely associated with lipoplasty
of the anks or dorsum and outer thigh and fat graft in the gluteal-trochanteric
regions. Taking into consideration these key points, a multi-pedicle ap was created, vessels were preserved, and less dead space was created, reducing the number
of most common complications. Using these advances allowed us to overcome difculties and optimize the outcomes.
Keywords Abdominoplasty · Liposuction · Body contour · Flanks · Abdomen
R. C. Ribeiro et al.
Introduction
Demars and Marx reported the rst dermolipectomy in France in 1890; they reported
it as an isolated procedure (Gemperli etal. 1992). Later, in 1899, Kelly, a gynecologic surgeon at Johns Hopkins University (Baltimore, MD, USA), published the
rst attempt to correct excess abdominal skin and fat, making a horizontal wedge
resection that included the umbilicus (Kelly 1899). Although abdominoplasty is a
very common procedure, few modications have been observed over the last
50years. Most publications related to the subject have referred to the scar position,
as well as the changing of its size and direction (Ribeiro 2010).
In 1965, the modern era of abdominoplasty began with the contribution of Callia
(1965), who described the scar at the pubic area and lateral extension of the down
crural arcades. Later, in 1967, Pitanguy indicated treatment of the abdominal rectus
muscle without the approach to the aponeurosis. He published 300 cases of consecutive abdominoplasty, referring to techniques, results, and complications
(Pitanguy 1967). In 1975, he published a large study, which included 539 abdominoplasty cases (Pitanguy 1975).
In the mid-1980s, with the incorporation of liposuction, a signicant improvement of body contouring was observed in abdominoplasty. Hakme (1985) and
Wilkinson and Swartz (1986), associated liposuction with abdominal plastic surgery involving a small skin resection. Avelar, in 1985, described a technique of
liposuction associated with abdominoplasty for patients who have a prominent
abdomen and muscular laxity (Avelar 1985). Bozola and Psilakis (1988) and
Matarasso (1991), created a clinical abdomen classication, suggesting a specic
treatment for each type. Later, in 1999 (Avelar 1999c), Avelar described abdominoplasty without undermining and removal of fat through liposuction, with skin and
fat resection below, in the belly button (Avelar 2000; Graf et al. 2006). In 2000,
Matarasso described liposuction in combination with abdominoplasty to preserve
the blood supply of the abdominal ap (Matarasso 1991, 2000).
Preservation of Scarpa’s fascia has been suggested in order to lower complications associated with conventional abdominoplasty; thus, Saldanha et al. have
6 Personal Experience with Abdominoplasty Without Undermining…
https://t.me/medicina_free
proposed a new name for the procedure—lipoabdominoplasty (Saldanha et al.
2001)—according to the same principles previously proposed by Avelar (1999a).
With time and learning curve, some changes could be introduced to rene the
technique. We have been performing this technique since 2003 with good results;
however, over the years, some details and problems have been found. Therefore, in
2010, important approaches and improvements were introduced to optimize the
postsurgical results, including the following: deep liposuction in the lower abdomen; power-assisted liposuction (PAL) of the pubic region, anks, or dorsum;
Scarpa’s fascia removal in the inferior abdomen; lipoplasty; Mons lipolifting; and
pubic xation, where we observed a better harmony of body contouring.
113
Selection ofPatients
In our experience, you can expect positive outcomes with women with an age ranging between 24 and 69years, and American Society of Anesthesiologists (ASA)
Physical Status I (ASA I), with an indication of classical abdominoplasty or lipoabdominoplasty. All the patients were treated using the lipoabdominoplasty technique
and the abovementioned improvements, and fat removal by liposuction ranges from
1.5 l to 2.5 l, and surgical time ranges from 2 to 3h.
Exclusion criteria were as follows: post-bariatric patients, ASA III patients, BMI
above 30, combined general or gynecological surgeries and patients with skin laxity
and stretch marks above the umbilicus.
Surgical Technique
Prior to the surgery with the patient standing, the adipose tissue disposition estimated to be liposuctioned included the hypochondrium, pubic area, and anks. A
skin fuse to be removed was calculated with the patient sitting down, and then a low
abdominal curved line was designed 6 to 8cm from the labia major vertex. If the
patient had previous scars, the size was maintained as best as possible and was
increased to the necessary amount.
Saline solution and epinephrine (1:500,000) were inltrated in all areas previously marked for lipoaspiration and undermined to help reduce bleeding.
Power-assisted liposuction (PAL) was performed increasing cannulas’ size from
3.5 to 4.0mm and, less frequently, 5mm. The liposuction began in the prone decubitus position, allowing access to the dorsal region and anks.
The patients were rotated to the supine position, and PAL was performed, reaching the medial and deep layer in the superior abdomen, including the ribcage. Deep
fat excess was removed through liposuction. Liposuction was intensied at the transition of the rectus and oblique abdominis muscles to achieve better body contour.
Pubic incision and undermining of the lower abdomen with Scarpa’s fascia
removal were performed until umbilical region. From the supraumbilical region to
114
https://t.me/medicina_free
the xiphoid appendix, narrow undermining was performed, just leaving a tunnel.
Thus, a selective area of the diastasis region along the medial margins of the rectus
muscles is undermined preserving the perforator vessels. The umbilicus was completely isolated removing the entire fat surrounding its stalk.
From the xiphoid appendix to the suprapubic area, the rectus muscle diastasis
was corrected in two lines of aponeurotic plications. The umbilicus was xated at
the midline.
In the Fowler position, the superior ap was transported down to the inferior ap,
evaluated, and then closed with sutures, trying to generate the least possible tension
between the two aps. During that surgical time, excessive skin at the lower region
was removed if required.
Prior to the closure, the pubic ap was immobilized and xed with 3-0 nylon
sutures separated to prevent its ascent. When the patient had a signicant amount of
fatty tissue on the pubis, liposuction was performed in this area, avoiding uneven
surface between the region and lower abdomen.
An aspiration drainage was placed before closure of the abdominal wall and
remained there until the collection was less than 30mL for the day. The superior and
inferior aps were closed using subcutaneous and intradermic stitches, made with
3-0 and 4-0 sutures. In the supine position, the umbilicus was exteriorized and
trimmed and placed back into the skin. The umbilical scar was closed, leaving a 3to 4-cm scar at the hypogastrium region. Omphaloplasty was performed with different sketches according to the body contouring of the patient.
Sterile Micropore tape was placed over the scar, and the patient was dressed in
a compression garment that covered the areas that were treated for 30 uninterrupted days. The patient remained hospitalized for 1day. Early ambulation within
24h was encouraged for mobilization of third-space uid shifts to expedite recovery and prevent deep vein thrombosis. Antibiotics, analgesics, and anti-inammatory medications were used for 7days after surgery.
R. C. Ribeiro et al.
Clinical Data andResults
In the last 19years, we have performed this technique in more than 800 patients, all
with indications for classical abdominoplasty or lipoabdominoplasty. The women
ranged in age between 24 and 69years (Figs.6.1 and 6.2).
The complication rates were as follows 1.00% (eight patients, skin necrosis),
1.11% (nine patients, seroma), and 0.12% (one patient, hematoma) (Table6.1). The
results improved due to correct positioning of the suprapubic scar and previously
mentioned reasons. However, scar revision and “dog ear” correction were required
in two (0.25%) patients. Late complications such as hypertrophic scars occurred in
six (0.75%) patients. Another important result was absence of sensibility loss in the
lower abdomen in all patients of the study.
Additional rare complications included fat embolism, thromboembolism, uid
imbalance, perforation of the viscera, and death, which were not present in our
patients.
6 Personal Experience with Abdominoplasty Without Undermining…
https://t.me/medicina_free
Fig. 6.1 Before and after pictures, 3 months post-op, woman in the fth decade of life
115
Fig. 6.2 Before and after pictures, 3 months post-op, woman in the fourth decade of life
Соседние файлы в папке @xirurgi_2025