75 High-Definition Abdominal Liposculpture with BodyBanking

Ira L. Savetsky and Douglas S. Steinbrech

Abstract

Abdominal contour techniques including selective fat reduction with or without silicone have been limited in terms of inability to achieve muscular appearance in patients with very little muscular bulk in the rectus abdominis. Here we present our technique for achieving superior results in abdominal contouring using selective lipo-contouring with fat grafting.

High definition – liposculpture – abdominal etching – fat grafting – abs

75 High-Definition Abdominal Liposculpture with BodyBanking

Key Points

Patients are interested in a fitter, more sculpted look with great definition to the musculature.
Results are maximized using a combination of selective lipo-contouring with measured structural fat grafting.

75.1 Preoperative Panning

75.1.1 Analysis

The procedure begins with a thorough preoperative analysis to identify areas of lipodystrophy along with desired muscular enhancements and shadowing.
These areas are carefully marked preoperatively with the patient standing prior to any sedative administration (Fig. 75.1).

Fig. 75.1 Preoperative markings.

75.2 Operative Steps

See Video 75.1.

75.2.1 Access Incisions and Fat Harvest

Three stab incisions are made in the underwear line to suction the central and lateral inscription as well as for V-flaring of the lower abdominal area.
Four “hidden” umbilical incisions are made for upper and lower midline contouring.
Two incisions are made under the nipples for the upper transcription.
One incision is made laterally for second and third transverse inscription, and one is made in the upper gluteal crease for all posterior lower back and posterior flank.
The tumescent solution (0.9% saline with lidocaine 0.1% and epinephrine 1:1,100,000) is given 10 minutes to take effect.
The lipectomy is then carried out using power-assisted liposuction (Power Assisted Liposuction System, MicroAire, Charlottesville, VA) or standard traditional suction lipectomy from the abdominal wall and the linea alba, lateral vertical margin, serratus, and obliques to allow visibility of the rectus sheath and inscription of the rectus abdominis as well as the lower portion of the external oblique (Fig. 75.2).
The patient is then rotated using a team approach to a prone position and liposuction of the flanks is carried out after tumescent infiltration.

Fig. 75.2 Intraoperative technique of abdominal sculpting demonstrated on a 28-year-old man. (a) Tumescence, (b) lower abdominal suctioning, (c) sculpting of inscriptions, (d) midline sculpting, and (e, f) contouring of lower abdomen.