Liposuction of the AbdomenWhen Norma came to me to find out whether liposuction could help her, she was almost in tears. Like many women of her age who have borne children, she had-to put it bluntly-a pot belly. Fat underneath the skin in her lower abdomen gave her a drooping, unattractive look. She was embarrassed to wear straight skirts. Even an A-line dress tended to bulge across her protruding belly.
1-2. At top, male,- center, female, "beer bellies."
Norma was far from fat. In fact, except for her problem with bulges, she was an attractive woman. She watched her weight carefully, and was only five or six pounds above the ideal for her age. But, as she put it, APretty soon I'll be forty. I'm afraid things are going to get worse.
At The Liposuction Institute, we see many patients like Norma. In fact, she is typical of many women who have fat accumulations under the skin below the navel. Usually a patient with this condition has borne at least one child, is not seriously overweight, and is approaching menopause.
A second cause of abdominal protrusion-also more prevalent in women-is weak abdominal muscles. When this condition is combined with fat bulges under the skin, the muscles prolapse, causing the abdomen to protrude even more.
3. At bottom, an extreme example.
Young people who have protruding abdomens often suffer with lordosis, an excessive curve of the spine in the lumbar, or lower back, region. Both men and women are affected by this condition.
A BEER BELLY
Not so common, but potentially more serious, is a condition called Abeer belly, in which a patient typically male, has an extremely large abdomen that hangs over his belt. Surprisingly, these men often have very thin arms and legs, despite their huge bellies. Often the abdominal fat causing the problem in this condition lies not only under the skin, but also in the internal cavity of the abdomen itself . A much more serious situation, and one that is more difficult to help with liposuction surgery.
Men who have this problem often have high levels of triglycerides in their blood, and are at a very high risk of having coronary problems. Before such a patient can be a candidate for liposuction, it is best for the surgeon to confer with the man's primary care physician. Together they can work out a plan for treatment that takes all factors into account.
1-3. At top, male,- center, female, "beer bellies." At bottom, an extreme example.
At The Liposuction Institute, my usual practice for most . patients is to perform liposuction surgery Ê without making them go on a diet first. With men who have Abeer bellies, however, there must be an extremely thorough, comprehensive medical assessment before liposuction can be planned. Often, I advise such men to bring their weight down substantially before they can be considered appropriate candidates for liposuction.
1. Illustration shows front Lipper female abdomen, with abnormal fat deposit before liposuction.
2. The same patient as in 1., showing the fat accumulation on lower abdomen
3. The profile of a female patient shows protruding upper and lower abdomen.
4. The protruding abdomen seen from the front.
5. Male abdomen exhibiting a very unhealthy fat situation, with bulging "pot belly."
6. Another male "beer belly" shows heavy central accumula- tion of fat.
AN APRON OF FAT
One last condition-fortunately, not too common, is a protruding abdomen caused by large amounts of fat that seem to hang down under the skin in almost an apron-like form. Men and women who have this condition are often very heavy.
Patients like Norma, who are close to their ideal weight and whose main problem is the pot belly under the navel, can almost always be helped significantly by liposuction. Norma was pleased to learn that the surgery could benefit her, and made plans to go ahead with her operation as quickly as it could be scheduled.
1. This female patient's abdomen, seen from the front, before liposuction surgery.
2. After surgery, note the normalized contour.
3 -4. At left, the female patient's profile before surgery; at right after.
In her case, as with almost all liposuction of the lower abdomen, I made a small incision in her pubic hair area. Since the small cut was only 3 mm. long (approximately 1/8 inch), it would easily be hidden.
In fact, I told Norma beforehand, Ayou can wear a string bikini after the operation, and no one will see your tiny scar. If Norma had had a larger amount of fat, I might have made two small incisions, one on each side, but this was not necessary. During surgery, I removed 500 cc (nearly 17 oz.) of fat from Norma's lower abdomen. Today, she can easily wear the tighter skirts and dresses called for by today's fashions without being embarrassed. No longer does she feel uncomfortable when she sits down, because her clothes are no longer tight over her tummy.
Norma feels liposuction was a success. She is recommending the procedure to several friends who have similar problems.
This kind of case is a common one, in which liposuction is a very appropriate solution. Since Norma had already developed a normal body weight and she was basically in good health, her problem was limited to a very small, specific area.
Norma's body was dearly not obese; her fat was deposited in the area just below the navel, where it could be all-too-easily seen in various kinds of clothes. Removal of only 500 cc of fat made a great deal of difference in the contour of her body, and in her feelings about her appearance.
Beverly was in her late 50s. She was a successful administrative assistant and executive secretary for a large corporation, who prided herself on looking and dressing the part. Beverly was a self-assured, confident woman who was at ease in most situations-whether it was setting up a meeting for her busy vice president, or being wined and dined on dates in fancy restaurants.
1-2. Female abdomen before liposuction surgery, showing. fat accumulated centrally. Front and side views.
3-4. Same patient's, after liposuction surgery.
But Beverly was not happy. At the end of the evening, when she took off her foundation garments and looked in the mirror, she saw rolls of fat. Some years ago, she said, there had been one roll above her navel, just below the rib cage. When she came to The Liposuction Institute, there were two.
Beverly was worried, because her fat rolls seemed to be increasing. As if this were not enough, she also had fat under the skin of her lower abdomen. Beverly felt discouraged. She wondered if liposuction could help. I listened to Beverly's concerns while I examined her carefully. Fortunately I was able to reassure her.
Although liposuction cannot totally turn the clock back, I told her, Anevertheless the surgery can make it possible for you to regain an attractive figure.
Beverly's actual surgery was similar to Norma's. However, because of Beverly's condition, two tiny incisions were made in the pubic hair area, one on each side, and fat was removed from the lower abdomen. With the incisions made in this area, not even tiny scars would be visible .
For the upper abdomen, one tiny incision 3 mm. long (1/8 inch) was made in the area right above the navel. A total of cc of fat (nearly 34 oz.) was removed from the upper and lower abdomen.
When my patients have liposuction of the abdomen, at the conclusion of the surgery, while they are still on the operating table, they are bandaged tightly with a special tape from France. The purpose of the tape is to help compress the skin, binding it tightly over the area from which fat cells have been removed.
In addition, patients wear a special garment, much like an elastic panty, over the tape. The Apanty is six or eight inches long. It is put on them while they are still on the operating table.
Norma and Beverly, then, were taped, and were given the Apanty.
As I do with all my patients after liposuction surgery, I saw each of them in my office three or four days after the operation. I examined them, checking to be sure healing was proceeding normally.
I ask my patients who have had liposuction of the abdomen to leave the tape on until one week after surgery.
One week after surgery, the patient takes a shower. The water loosens the tape, and it can easily be removed at that point. The Apanty is worn for two weeks after surgery. It stays on day and night, and is removed only long enough for the patient to go to the bathroom.
1. Male abdomen before surgery showing fat accumulated centrally and laterally.
2. The same patient as I., above, after surgery.
3. Same patient as 1, from the side, before surgery.
4. The same patient's side view after the liposuction surgery.
For best results after liposuction of the abdomen, it is extremely important to begin massage one week after surgery, unless your surgeon has other specific instructions, and to continue it throughout the healing period. The gentle massage helps to disperse the interstitial fluid that has resulted from the trauma of surgery, and has caused a bloated, swollen appearance after the operation. This fluid will be gradually absorbed into your cells, and the massage speeds the absorption process.
Light rubbing. Starting one week after surgery, using one hand only, stroke your upper and lower abdomen gently with a small, circular motion. Rub lightly, using the tips of your fingers, changing the position of your hand until you have covered the whole abdomen. Do not hurry the massage. Repeat two or three times a day.
Two-handed massage. Two weeks after surgery, unless your surgeon has different instructions, you may begin two-handed massage. Again, make small, circular, stroking motions with your fingers; but this time, rotate your hands simultaneously in opposite directions. Continue until you have Acovered the entire abdominal area.
Knuckle massage. No earlier than two weeks after surgery, as the discomfort subsides and you can tolerate more vigorous massage, you may begin using your knuckles to massage the abdomen. This massage should be done simultaneously with two hands. One hand presses the knuckles into the abdomen, starting at the top of the abdomen and moving downward, while the other hand presses the knuckles into the other side of the abdomen, starting at the bottom of the abdomen and moving upward. Do this massage only when you feel you can tolerate the more vigorous Akneading. Some patients will reach this point two weeks after surgery; others, not until several weeks later.
As always, you will want to remember that each case is unique-that your experience will not be exactly like anyone else's although it will be generally similar. You will want to pay close attention to your body, report details to your doctor faithfully, and discuss your own case with your doctor regularly and carefully. You and your doctor will be able to decide best when you are ready for different kinds of activity. He or she will help you schedule your exercise and monitor your body's response.
The following exercises for men and women may be done at home, starting two weeks after liposuction of the abdomen, unless your surgeon gives you different instructions.
Within 24 hours after surgery, most patients resume their normal routine. You will probably see your doctor at least once before you go back to work, depending on your type of job, and what physical tasks you are required to perform. You should not do construction work, factory work, heavy lifting, or work with machines such as vibrators or air hammers until your surgeon specifically says you can. Be sure to discuss your job duties and activities with her or him frankly and completely, so that he or she can advise you appropriately. Follow your surgeon's specific advice and timetable on returning to full physical activity.
You will want to follow your surgeon's advice on when to begin exercising, since liposuction of the iliac area, costal fat, flanks, and "love handles" takes slightly longer to heal than some other body areas.
1. Leg raises. Lie down on the floor, on your back. Place your hands under your buttocks. Lift both legs together slowly. If this is difficult, you may do the exercise one leg at a time. Raise them as high as you comfortably can. Do not try to keep your legs straight while you do this exercise, as a slight bending of the knee is desirable. When you reach Athe top, hold the position for a second or two. Then lower your legs slowly.
Each up-and-down movement equals one repetition. Ten repetitions equal one set. Do one set of ten repetitions, two times a day.
2. Lying down leg pulls. Lie down on the floor, on your back. Put your hands under your buttocks, with palms down. Extend your legs straight out raising them off the floor.
Next, bend your knees and pull your legs as far as you can into your chest area. Return your legs to the fully-extended position. Repeat. Ten Achest-and-extend repetitions equal one set. Do one set, two times a day.
3. Elevated Aleg crunches. Lie on the floor on your back. Raise your legs so your calves and heels are resting on a chair or bench. Make fists and raise your arms above your body.
Now, slowly bring your head, shoulders, and arms as far forward as you can comfortably go. If possible, do not depend on your arms to help you lift your shoulders forward. Try to keep your legs as quiet as you possibly can. Return to the starting position.
One forward-and-back crunch equals one repetition. Ten repetitions equal one set Do one set, two times a day.
Exercises for the Gym or Health Club: Men and women can both do the following exercises, starting two weeks after your surgery, unless your surgeon has other instructions. Warm up first.
1. Leg raises while seated. Sit on the edge of a bench. Lean your weight back, so you are resting on your hands. Keep your torso as straight as is comfortable, while you pull your knees up towards your chest, as far as you can comfortably go. If this is difficult, lean back slightly. Next, supporting your weight with your hands, lift your legs as high up in the air as you can comfortably go. Hold the position a moment. Then lower your legs back to your starting position.
As you become more adept at this exercise, you may be able to bring your knees up to your chest before lifting them in the air. If your surgeon approves, this exercise can also be done wearing ankle weights.
One knees-to-chest, up-in-air, and return equals one repetition. Ten repetitions equal one set. Do two sets.
2. Machine twists. Use the Atwist machine in the health club or gym. Stand on the free-moving disk. Hold the stationary bar with your hands. Try to keep your upper body motionless while you spin your pelvis from side to side.
One side-to-side motion equals one repetition. Ten repetitions equal one set. Do two sets. If you prefer, look at the clock and do this exercise for two minutes at first, working up to three minutes at a time.
3. Crunches, with twists. Lie on the floor, on your back. Put your hands behind your neck. Raise your feet on a bench to be bent at your hips and knees. Now raise your head and body towards your knees, with a left twist, so your right elbow touches your left knee. Then return to the floor.
On the next repetition, do a right twist, so that your left elbow meets your right knee. Ten repetitions equal one set. Do two sets.
1. A male patient, showing a large lipoma on his left side.
2. Following surgery, the same patient as in Fig. 1 above, showing vastly improved lines.
3. The same patient, showing how the operation was carried out.
4. The patient's back and side, showing the extreme size of the lipoma.
5. After the surgery, the patient's side view, showing the normal contours.
6-7. Lipoma of the arms before liposuction surgery.Previous Chapter | Next Chapter