Abdominal Contouring – Combined abdominoplasty and liposuction contouring techniques get a data boost

When patients have excess belly fat with or without skin laxity, do you opt for liposuction, a tummy tuck, or a combination of the two? Depends on the patient… and the physician’s experience and comfort level with a growing number of available techniques. One European expert recently shared his alternative approaches, and research initiatives, to tighten tummies with Cosmetic Surgery Times (CST).

CST reports that Peter Lisborg, MD, a cosmetic surgeon based in Klagenfurt, Austria, creates safe and effective contours by using a combination of cosmetic tools and techniques:

  • A modified Avelar abdominoplasty helps to avoid those complications that can accompany a traditional tummy tuck.
  • Combining radiofrequency with liposuction adds a skin tightening result to fat removal.

But more than just making observational claims, Dr. Lisborg has approached the outcomes of these specific techniques scientifically by using laser Doppler flowmetry to better understand safety, and by collecting data that will allow him to analyze effectiveness, according to the CST article.

Risks with a traditional tummy tuck include seroma, delayed healing, infection, reaction to anesthesia, and blood clots. The widely popularized Avelar technique with IV sedation, however, minimizes these risks by eliminating general anesthesia and preserving vascularity. There’s no need for a drain, infection rates drop, and patients can return home the day of the procedure.

“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 told CST.

Avelar Advances
In a previous CST article (“Avelar Advances,” September 2011), 243 patients who underwent the Avelar technique demonstrated an improved safety profile compared with the traditional tummy tuck. Only one of 243 patients was unable to return to normal activity after one week, and there were zero incidences of seroma or necrosis.

While data supports vascular perfusion of the Avelar technique, Dr. Lisborg is taking his examination one step closer with laser Doppler to measure specific amounts of blood flow, according to the CST article. What he has been able to show is that there is not a significant drop in blood flow within 3 months post procedure.

“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 Graf1 in a series of patients undergoing conventional abdominoplasty,” CST quotes Dr. Lisborg as saying.

What do you get when you add radiofrequency to liposuction? According to CST, Dr. Lisborg is getting better results and enhanced safety, too, compared with liposuction alone. He told CST that he’s been combining bipolar radiofrequency and liposuction (BodyTite, Invasix) for 18 months with results that include fat reduction, skin tightening and less swelling and bruising during the healing process.

“My current approach is to perform the combined treatment first followed by liposuction with a traditional cannula, although there is continued discussion over whether it might be better to perform liposuction first,” Dr. Lisborg said to CST.

Using the laser Doppler to study blood flow with this technique too, Dr. Lisborg told CST that his initial concern that RF could possibly affect vascularity was laid to rest: His results show no adverse effect on blood flow.

Looking more closely at the relationship between tumescent solution and blood flow, Dr. Lisborg believes his data may help physicians understand how this combined procedure minimizes swelling and bruising. While blood flow initially falls after tumescent solution is injected in response to epinephrine, circulation doubles or triples over baseline at 24 hours post-procedure. This increase, however, in patients with combined RF treatment is lower that those with liposuction alone, explains the article.

“The increase in circulation associated with the reactive hyperemia is accompanied by transudation and exudation of fluid that manifests itself as increased swelling and induration. Therefore, it appears that the radiofrequency treatment is reducing post-treatment bruising and swelling secondary to its effect on reducing the reactive hyperemia,” CST quotes Dr. Lisborg in conclusion.

Read the original story here.

Graf R, de Araujo LR, Rippel R, et al. Aesthetic Plast Surg. 2006;30:1-8.