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ab
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J. M. Avelar and R. C. Ribeiro
Fig. 7.20 A 51-year-old patient underwent full lipoabdominoplasty without panniculus undermining combined with mastopexy with mammary implant. Photos (a, c, e) before surgery operation;
photos (b, d, f) after full lipoabdominoplasty with creation of the new umbilical region
The operation starts with two types of liposuction: a bilateral one on the full
thickness of the panniculus on the submammary areas that have crescent-shaped
demarcation where skin resection will be performed and a deep level one below the
fascia supercialis and over all the areas presenting with localized adiposities
(Figs.7.1b, c, and 7.2c). Only connective tissue and some perforator vessels remain
attached to the musculoaponeurotic level. Usually, a depression may be noticed just
below the submammary folds after full-thickness liposuction (Fig.7.2b). Through
the same area below the breasts, deep liposuction is carried out on the lamellar layer
(below the fascia supercialis) over all the regions presenting with localized adiposities on the abdominal wall. The cannula must be introduced below the fascia
supercialis, from the top downward (Figs.7.1b, c, and 7.2c) (Avelar 1999a, b).
After liposuction, full-thickness skin resection is performed bilaterally on the
crescent-shaped areas. Usually, this operation doesn’t cause any bleeding, because
no vessels are damaged. The remaining panniculus slides over the musculoaponeurotic level because no fat appears below the fascia supercialis, and all the perforator vessels are preserved, which work as multiple pedicles to the abdominal
panniculus. In selected cases, the plication of the musculoaponeurotic wall is performed when indications are present. Finally, the wound is sutured according to
anatomical plans, where the fascia supercialis is the most important for reinstating
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the full thickness of the panniculus (Fig.7.2d). Afterward, the subdermal level and
the dermis are sutured. The nal scar lies naturally on the submammary areas,
which are postoperatively inconspicuous (Figs.7.3 and 7.4).
Upper and lower abdominoplasty is a type of combined procedure that is indicated when both segments (the superior and the inferior) of the abdomen need to be
simultaneously repaired and is performed on patients presenting with a very high
navel, which makes the transposition of the umbilicus impossible (Figs.7.14, 7.15,
7.16, and 7.17). This procedure requires adequate surgical demarcation before sur-
gery, and it should be carried out after meticulous measurement (Figs.7.14, 7.15,
7.16, and 7.17). The areas for skin resection are inferiorly marked on the suprapubic
region and on the superior abdomen; here, two crescent-shaped areas are drawn
bilaterally below the submammary fold. Also, the areas for liposuction are marked
on the abdominal wall.
The operation may be performed while the patient is under general anesthesia or
is administered an epidural combined with local inltration. Two levels of local
inltration must be carried out: a deep inltration on the supramuscular areas in all
regions for liposuction and a supercial inltration on areas for skin resection. The
solution is determined by each surgeon.
The rst step of the operation is to perform two types of liposuction: one on the
full thickness of the panniculus where skin resection will be performed and one at
deep level over all the areas presenting with localized adiposities (Figs.7.14 and
7.15). Afterward, the connective tissue and all the perforator vessels remain attached
to the musculoaponeurotic plane without any fat, which creates a depression on the
suprapubic area and below the submammary fold.
Afterward, deep liposuction is carried out on the lamellar layer (below the fascia
supercialis) on all the regions of the abdominal wall presenting with localized
adiposities where skin resection will not be performed (Figs.7.15, 7.16, and 7.17),
according to my previous publications (Avelar 1999a, b, 2000a, b). Also, preserving
the areolar layer yields a smooth and harmonious surface to the areas where skin
resection is not performed.
Following the operation, skin resection is carried out on the local depressions
corresponding to the areas of liposuction performed on the full thickness of the panniculus. The remaining panniculus easily slides over the musculoaponeurotic wall
because there is no fat below the fascia supercialis, and all the perforator vessels
are preserved, which work as multiple pedicles to the abdominal panniculus. The
plication of the musculoaponeurotic wall may be performed, and it is a useful procedure during abdominoplasty if it’s part of the surgical plan or when indications
show up on a computerized tomography (CT) scan (Fig.7.6). By following these
technical steps, the nal scar will be smooth on the submammary sulcus and the
suprapubic region (Figs.7.15, 7.16, and 7.17).
Full abdominoplasty is performed when there is an indication to perform conventional abdominoplasty because there are abnormalities on the superior and inferior segments of the abdomen, and the transposition of the umbilicus must also be
performed. It is the most complex type of abdominoplasty without panniculus
undermining and resection, in that it requires resecting the entire skin of the
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infraumbilical area. The complete description of this procedure appears in the
following chapters (Figs.7.18, 7.19, and 7.20).
J. M. Avelar and R. C. Ribeiro
Discussion
Before performing any procedure for body contouring, the appropriate technique
for the specic patient must be chosen. In fact, the decision to opt for upper and
lower abdominoplasty is a matter of selection according to the correct criteria:
1. When a patient presents with only isolated accumulations of fat on the anterior
aspect of the abdominal wall without skin accidity or any other abnormality,
isolated liposuction is the appropriate procedure.
2. In the case of accumulated fat on the anterior side of the abdominal wall plus
skin accidity with a redundant panniculus localized only on the lower segment
of the abdomen that presents with a high navel implantation and without the
enlargement of the musculoaponeurotic abdominal wall, the adequate technique
is lower abdominoplasty combined with liposuction without reinforcing the
abdominal muscular structures (Fig.7.11).When the patient presents with accidity in the muscular wall, plication may be combined with lower lipoabdominoplasty (Figs.7.6 and 7.12).
3. If a patient presents with accumulated fat on the upper abdominal wall plus skin
accidity with redundant panniculus and without accidity in the musculoaponeurotic abdominal wall, the appropriate technique is upper abdominoplasty
(Figs.7.1, 7.2, 7.3, and 7.4).
4. When a patient presents with accumulated fat on the lower and upper abdominal
wall plus skin accidity with a redundant panniculus and with accidity in the
musculoaponeurotic abdominal wall, the appropriate technique is lower and
upper abdominoplasty combined with reinforcing the muscular wall (Figs.7.15
and 7.16).
5. In cases where the patient presents with indications for full conventional abdom-
inoplasty, the appropriate technique is full lipoabdominoplasty.
In early 1983, when I watched Illouz perform liposuction and I started performing my rst operations, I noticed that the cannula worked in an unknown anatomical
subcutaneous compartment of the abdominal wall. For this reason, I dedicated considerable research to the anatomy of the panniculus, even performing liposuction on
cadavers, which yielded substantial knowledge about the area (Avelar 1986a, b, c,
1989). After performing some operations on the abdominal wall, I noticed that some
patients had unwanted redundant skin. To solve that problem, a new approach
involving the resection of the excess skin combined with liposuction was developed
(Avelar 1985a, b, 1986a, b, c).
Some complications, particularly seroma formation and other circumstances,
dissatised me and my patients. Although I used to have a very high incidence of
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139
seroma formation after abdominoplasty, I never had any severe consequences during its treatment, which was performed via syringe aspiration once a week.
After a few years, I decided not to no longer perform both procedures simultaneously (Avelar 1988). I also decided to look for a solution to those uncomfortable
complications. I suspect that these problems could be solved by studying the anatomy of the panniculus. Therefore, I dedicated considerable time to reviewing my
previous anatomical dissections on cadavers and also my perioperative photos of
my patients, hoping to nd a way to determine the cause of those complications.
After some years, I concluded that I could perform liposuction with abdominoplasty
because the perforator vessels would not be cut in this way, unlike what occurs
when wide undermining is performed all over the abdominal wall. My conclusion
was based on technical recommendations that liposuction must be performed on the
lamellar layer when the perforator vessels are regularly preserved (Figs.7.7, 7.9,
and 7.10) (Avelar 1999a, b, 2000a, b). In my publications, I recommended perform-
ing abdominoplasty in association with liposuction without panniculus undermining, which is the lipoabdominoplasty that would later performed and published by
other authors (Erfon 2002; Leão 2000).
As my patients presented with wide variations in their respective accumulations
of adiposities, I used to perform the combined operation to remove specic areas of
localized adiposities, which allowed me to classify four types of abdominoplasty:
lower, upper, lower and upper, and full.
Conclusion
The nomenclature of this classication is very useful in that the operation may be
indicated and performed to repair the anatomical alterations on one segment, on the
other segment, or on both. The correct choice of technique is essential because the
selection determines the level of aesthetic improvement to all regions of the abdomen as a whole. For this reason, each patient must undergo a physical examination
to evaluate all their deformities as part of their surgical planning before undergoing
abdominoplasty.
References
Avelar JM (1976a) Umbilicoplasty– a technique without external scar. (Umbilicoplastia– uma
técnica sem cicatriz externa). 13th Braz. Congr. of Plastic Surgery and First Braz. Congr.
of Aesthetic Surgery (13° Congr Bras Cir Plast, 1° Congr Bras Cir Estética). Porto Alegre,
pp81–82.
Avelar JM (1976b) Umbilicoplasty. A technique without external scar. Cahiers de chirurgie
Esthétique. Journees internationals de Chirurgie Esthetique. Vendredi 21 mai, Paris (France)
pp5–25.
140
https://t.me/medicina_free
Avelar JM (1979) Cicatriz umbilical– da sua importância e da técnica de confecção nas abdomi-
noplastias (Umbilical scar– its importance and technique for creating during abdominoplasty).
Rev Bras Cir 1(2):41–52.
Avelar JM (1983a) (Abdominoplasty: Technical Renements and Analysis of 130 cases in 8 Years
Follow-up). Aesth Plast Surg 7: 205–212
Avelar JM (1983b) Submentonean and Submandibular Adiposity– Liposuction X Lipectomy
(Adiposidade Submentoniana e Submandibular – Lipoaspiração X Lipectomia). In: Annals
of the Brazilian Symposium on Facial Contouring. Organized and ed. 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 Adipose Tissue on Human Body
(Anatomia cirúrgica e distribuição do tecido celular no organismo humano). In: Liposuction
(Lipoaspiração), ed. by Avelar and Illouz, Ed. Hipócrates, São Paulo (Brazil) 9:45–57.
Avelar J (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 J (1986c) – Liposuction of the Torso (Lipoaspiração do Dorso). In: Liposuction
Lipoaspiração, ed. by Avelar and Illouz, Ed. Hipócrates, São Paulo (Brazil) 28:177–186.
Avelar JM (1987)- Study of the anatomy of the subcutaneous adipose tissue applied for fat-suction
technique. In: Maneksha RJ (ed): Trans IX Int Congr Plast Reconstr Surg. New Delhi, India,
March 1–6, pp377–379.
Avelar JM (1988) Abdominoplasty – Reections and Bio-Psychological Perspectives
(Abdominoplastia – reexões e perspectivas biopsicológicas). Rev Soc Bras Cir Plast
3(2):152–154.
Avelar JM (1989) Regional distribution and behavior of the subcutaneous tissue concerning selec-
tion and indication for liposuction. Aesth Plast Surg 13:155–165.
Avelar JM (1999a) Abdominoplastia: nuevos conceptos para una nueva técnica (Abdominoplasty:
new concepts for a new technique). XXVI Annual international symposium of aesthetic plastic
surgery, Chairman: Prof. Jose Guerrerosantos, Puerto Vallarta, pp10–13
Avelar JM (1999b) New Concepts for Abdominoplasty (Novos conceitos para abdominoplastia).
Paper presented at the 36th Congress of the Brazilian Society of Plastic Surgery. Rio de Janeiro.
Avelar JM (1999c) A new technique for abdominoplasty– closed vascular system of subdermal
ap folded over itself combined to Liposuction. (Uma nova técnica de abdominoplastia–
sistema vascular fechado de retalho subdérmico dobrado sobre si mesmo combinado com
lipoaspiração). Rev Bras Cir 88/89(1/6):3–20.
Avelar JM (2000a) 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 (2000b) Abdominoplasty Without Undermining (Abdominoplastia sem descolamento).:
XX Jorn. Paulista Cir Plast. São Paulo (Brazil)- May
Avelar JM (2001a) Abdominoplasty without lipectomy. Mini Course of ISAPS with Aesthetic
Plastic Surgery Congress of Spain, Valladolid (Spain). September.
Avelar JM (2001b) The new abdominoplasty and derived technique. ISAPS and ASERF Annual
Meeting. The Aesthetic Meeting, NewYork
Avelar JM (2002) Upper and lower abdominoplasty without panniculus undermining and resec-
tion. In: Avelar JM (ed) Abdominoplasty without panniculus undermining and resection.
Editora Hipocrates, São Paulo, pp183–198
Babcock WW (1916) On diseases of women and children. Am J Obstet 74:596. 1916– Babcock–
xiphoid-pubic fusiform cutaneous adipose excision, including the navel (Fig.26.1) [19].
J. M. Avelar and R. C. Ribeiro
7 Surgical Principles andClassication ofLipoabdominoplasty
https://t.me/medicina_free
Callia WEP (1965) Contribuição ao estudo de correção cirúrgica do abdomen pêndulo e globus
(contribution to the study of surgical correction of the pendulum abdomen and globus). original
art. Doctoral Thesis Fac Med USP, São Paulo.
Erfon J. Abdominoplasty through a closed vascular system associated to liposuction: Avelar’s tech-
nique. In: Avelar JM, ed. Abdominoplasty. São Paulo. Hipócrates, 2002. p.299–307.
Gonzales-Ulloa, M (1959) Circular Lipectomy wirh Transposition of the umbilicus and aponeu-
rotic Technique. Cirug Y Ciruj 27:394–409
Gonzales-Ulloa M (1967) Belt Lipectomy. Brit. J.Plast. Surg. 13:179–186
Gonzales-Ulloa M (1982) Circular Abdominoplasty (Abdominoplastia Circular) Presented at
the Brazilian Symposio of Abdominoplasty (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). Section “I”
Round Table. Editora Cidade, Rio de Janeiro– Brazil.
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), 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), 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.
Illouz YG (1980) Une nouvelle technique pour les lipodystrophies localisées. Rev Cir Esth
Franc 6(9)
Jolly (1911) – transversal infraumbilical cutaneous adipose excision, resembling a “slice of
melon” or proximal concavity crescent [87]. Jolly R Die operation des Fettbauches. Berl Klin
Wochenschr 29:1317.
Kelly HA (1899) Report of gynecological cases. John Hopkins Med J 10:197
Leão CF (2000) Plicatura da parede músculo-aponeurótica por um tunel criado abaixo do panículo
abdominal na linha média em lipoabdominoplastia sem descolamento. 37 Congresso Brasileiro
de Cirurgia Plástica, novembro - Porto Alegre. (Reinforcement of the musculoaponeurotic wall
through a tunnel created below the abdominal panniculus during lipoabdominoplasty). 37th
Brazilian Congress of Plastic Surgery, Porto Alegre.
Malbec EF (1948) Lipectomia abdominal. La Prensa Méd Arg vol. XXXV - (26) 1948. In:
Historia, Ciencia y Arte En Cirugia Estetica. Ed. by Juarez M.Avelar and Ernesto F.Malbec.
Ed. Hipócrates. Pag. 605–608, 1990.
Pitanguy I (1967a) Abdominal lipectomy: an approach to it through an analysis of 300 consecu-
tives cases. Plast Reconstr Surg 40(4):384–391
Pitanguy I (1967b) Abdominoplastias. O Hospital, Rio de Janeiro 71(6):1541–1556 105.
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), 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) Plástica abdominal: importância da sua associação com a correção de hérnia
incisional (abdominal plastic: importance of its association with the correction of incisional
hernias). Rev Bras Cir 52:8.
141
142
https://t.me/medicina_free
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.
Serson Neto D (1970) Abdominal Dermolipectomies– Geometric Approaches (Dermolipectomias
abdominais- Abordagem geométrica) Rev. CBC 10:17–20, março-abril.
Serson Neto D (1982) Abdominoplasty – Geometric Approach (Abdominoplastia - Técnica
Geométrica). 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). 2:25–30. Editora Cidade, Rio de Janeiro, Brazil.
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 (1979) Abdominal plastic surgery. (Cirurgia plástica abdominal), ed. by Sinder, Niteroi.
Rio de Janeiro, Brasil.
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.
Thorek M (1942a) Plastic surgery of the breast and abdominal wall. Charles C. Thomas. Ed,
Spring eld, III, 120
Thorek M (1942b) Modern surgical technique, one volume war edition. J.B. Lippincott Company,
Philadelphia, pp.1264–1266
Vilain R (1964) A propos de la chirurgie réparatrice de la paroi abdominale. Bul Mens Soc Chir
Paris 54:290–294Vilain R, Dubousset J.Technique et indications de la lipectomie circulaire.
150 observations. 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.
Vilain S (1986) Alternatives to the classic abdominoplasty. Ann Plast Surg 17(3):247.
J. M. Avelar and R. C. Ribeiro
Chapter 8
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Lipoabdominoplasty: Classication
JoãoErfon, ClaudioMauricioM.Rodrigues, andAleksandraMarkovic
Abstract Background: Since 2001, the author has been using a simple and didactic
classication, for patients who are candidates for liposuction and lipoabdominoplasty
surgery, based on skin accidity, lipodystrophy, and diastasis of the rectus abdominis
muscles and the extent of scars necessary for surgical correction, grouping patients
into four groups, with the respective indication of the type of surgery for each group.
Methods: A retrospective study was performed evaluating patients who underwent abdominoplasty with liposuction and minimal undermining or only liposuction from July 2001 to January 2021. A total of 2076 procedures were carried out
with 1066 using liposuction only and 1010 lipoabdominoplasty technique. Eight
hundred one patients were submitted to full lipoabdominoplasty, 112 were submitted to mini-lipoabdominoplasty, and 97 underwent mid-lipoabdominoplasty. The
mean age of patients was 36.4 years. The mean weight of skin resection was
465.48g, and the mean volume of liposuction was 2578mL in the cases of lipoabdominoplasty and 2886mL in the patients who were performed liposuction only.
Conclusions: The author concludes that lipoabdominoplasty was a great change
to the abdominoplasty technique in the last 60years. Joining two great techniques
(liposuction and abdominoplasty) with minimal undermining, preserving the main
vascularization of the superior abdominal ap and the secondary vascularization of
the lower abdomen lateral areas and skin resection in the central area up to the
muscle fascia, permitting safe plication, improving the aesthetic results, and turning
lipoabdominoplasty safer than the traditional abdominoplasty. The mid-lipoabdominoplasty is a new idea that when well indicated allows for safe surgery and more
skin resection than in mini-lipoabdominoplasty.
Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266.
J. Erfon (*) · C. M. M. Rodrigues · A. Markovic
ArtClinic, Fortaleza, Ceará, Brazil
Switzerland AG 2023
J. M. Avelar, R. Cavalcanti Ribeiro (eds.), Body Contouring,
https://doi.org/10.1007/978-3-031-42802-9_8
143© The Author(s), under exclusive license to Springer Nature
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J. Erfon et al.
Keywords Lipoabdominoplasty classication · Mid-lipoabdominoplasty · Minimal
undermining · Supercial fascia · Safe plication · Secondary vascularization
Introduction
Since 2001, the senior author has been using the abdominoplasty with liposuction
without undermining as described by Avelar (1999) to the cases of miniabdominoplasty introducing resection of the supercial fascia and subcutaneous
tissue on the central third of the lower abdomen (Erfon 2001). He later used the
same idea to perform full abdominoplasty as recommended by Saldanha that also
introduced the term lipoabdominoplasty (Saldanha et al. 2001). The author suggests, from the beginning, a simple and didactic classication, for patients who are
candidates for this surgery, based on skin accidity, lipodystrophy, and diastasis of
the rectus abdominis muscles and the extent of scars necessary for surgical correction, grouping patients into four groups, with the respective indication of the type of
surgery for each group: Group 1, liposuction; Group 2, mini-lipoabdominoplasty;
Group 3, mid-lipoabdominoplasty; and Group 4, full lipoabdominoplasty
(Table8.1). The author also suggests the possibility of safe plication and reducing
the amount of supercial fascia and subcutaneous tissue to be preserved in the lower
abdomen and the term mid-lipoabdominoplasty. He also developed his own markings, dividing the lower abdomen into three areas: in the two lateral areas, the
Table 8.1 The author classied the patients to perform liposuction alone or lipoabdominoplasty
into four groups: (a) G1, liposuction; (b) G2, mini-lipoabdominoplasty; (c) G3, midlipoabdominoplasty; and (d) G4, full lipoabdominoplasty
bc
8 Lipoabdominoplasty: Classication
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145
supercial fascia will be preserved, and in the central region, the skin resection goes
up to the muscle fascia permitting a safe muscle plication without damage of the
main and secondary vascularization of the abdominal ap. After the plication, there
is no dead space and drains are not used. Another contribution was the partial transverse pubectomy that was introduced by the senior author. When comparing the
aesthetic results using the lipoabdominoplasty with the traditional abdominoplasty
technique, the aesthetic results are better, and the number of complications is
reduced.
Methods
A retrospective study was performed in 2076 cases, where 2028 female patients and
48 males underwent lipoabdominoplasty, by the senior author from July 2001 to
January 2021. Patients were classied into four groups: Group 1 (G1) patients with
abdominal and/or ank lipodystrophy, without cutaneous accidity and without
diastasis of the rectus abdominis muscles (Fig.8.1a–c); Group 2 (G2) patients with
abdominal and/or ank lipodystrophy, with small supra-pubic skin accidity, the
navel positioned so that it is impossible to lower the upper abdominal skin ap to the
pubis, with or without diastasis of the rectus abdominis muscles (Fig. 8.2a–c);
Group 3 (G3) patients with lipodystrophy of the abdomen and/or anks and skin
sagging greater than in the previous group, including supra-pubic region or not, but
with sagging on the sides of the lower abdomen, as well as supra-umbilical, as well
as navel in an elevated position in the abdomen unable to lower the upper abdominal
skin ap to the pubis, with or without diastasis of the rectus abdominis muscles
(Fig.8.3a–c); and Group 4 (G4) patients with lipodystrophy of the abdomen and
anks with great abdominal skin accidity, diastasis of the rectus abdominis
a
Fig. 8.1 G1. (a) Liposuction planning. (b) Kind of deformity with indication for liposuction. (c)
Type of deformity with indication for liposuction (oblique view)
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