ABDOMINOPLASTY AND LIPOSUCTION - CHANGE YOUR LIFE - DR MICHELE KOO, MD, FACS, BOARD CERTIFIED PLASTIC SURGEON, ST LOUIS, MISSOURI
Whether you have undergone a gastric banding or gastric bypass and have had massive weight loss or have too much skin and fat or you feel trapped by your large fat belly and overhanging skin of your abdomen, DR MICHELE KOO, MD, FACS, BOARD CERTIFIED PLASTIC SURGEON, ST LOUIS, MISSOURI, can help you get out of your own way and get rid of all that skin and fat that you have never been able to do for yourself.
If you’ve never had a skinny waist or waist and want a flat tummy and want to get rid of all that fat around your midriff or just want to be able to wear clothes normally, you can achieve a flat stomach with an abdominoplasty and body contouring by Dr Michele Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis, MO, 314-984-8331.
Dr Michele Koo wants you to know that this is possible for you and is not just a dream. Dr Koo makes sure that her office helps you uphold your end of the bargain which is that you must eat sensibly and start on a regular walking routine. You do not need to feel frustrated if you can’t jog or lift weights or have the time or money to go to exercise classes or hire a trainer or a cook. What you must do are common sense tasks of cutting your portions that you eat and walking at least 3 times a week. You should not deny yourself the kinds of food you like to eat but you must not eat as much of it.
Eating sensibly and increasing your activity level an essential part of achieving weight loss and maintaining shape after a tummy tuck - abdominoplasty and body contouring (liposuction). While Dr Koo does not require you to lose weight prior to your surgery, she does encourage you to start good habits prior to your surgery so that they will become second nature after the surgery thereby changing your lifestyle for the long term. You will then be able to maintain a much healthier life after the surgery when she removes all the skin and fat that you couldn’t possibly do for yourself.
Dr Koo wants you to understand some of the techniques that she uses for your body contouring. According to Dr Daniel Brauman of Cornell University, liposuction abdominoplasty-liposuction of abdominal subcutaneous tissue deep and superficial to Scarpa’s fascia, with excision of excess abdominal skin and, when indicated, plication of the anterior rectus sheath without undermining-is an effective, low-risk approach to minimizing abdominal flap undermining. The technique allows aggressive thinning and sculpting of full-thickness abdominal subcutaneous tissue and achieves a natural (not featureless) abdominal contour. It minimizes the creation of dead space, which often leads to postoperative complications, as well as preserves sensory nerve and blood supply to the abdominal skin. The operation may be performed with the patient under local anesthesia, which probably diminishes the risk for deep vein thrombosis. Moreover, additional procedures can be conducted safely and the postoperative course is short, uneventful, and without restrictions; patients return to normal activity within a week or so. New evaluation criteria for abdominoplasty are discussed in this article, the most important of which is the assessment of intraabdominal fat content and its impact on surgical outcome and the decision to perform anterior rectus sheath plication. The concept of a sliding, mobile, sensate abdominal flap, created by liposuction and sustained by multiple neurovascular mesenteries, is also offered.
Traditional abdominoplasty is associated with the potential for several problems. The procedure has been identified as a specific risk factor for deep vein thrombosis by Daane and Rockwell, Reinisch et al., and Stuzin et al. Dillerud found that wide undermining causes skin necrosis. In addition, undermining necessitates prolonged postoperative suction drainage to avoid seroma, which is the most frequent complication of abdominoplasty. It has also been reported by van Uchelen et al. to produce sensory changes of the abdomen and thigh. Further, incisions are often long and geometrically designed, and tension may cause excessive scarring. In contrast, limited abdominal flap undermining, which has resulted in less morbidity, fewer complications, and shorter scars than the classic procedure, has been advocated for appropriate cases by Wilkinson and Swartz, Greminger, Eaves et al., Zukowski et al., Shestak, and Lockwood.
Liposuction abdominoplasty is a safe and highly effective alternative to traditional abdominoplasty in appropriate patients. Dr Koo feels that the procedure has consistently and significantly reduced many of the problems that have been associated with classic abdominoplasty. Other related concepts are also offered: The successful outcome of abdominal wall surgery appears to depend on the preoperative evaluation of the intraabdominal fat content, and a sliding abdominal flap, created by liposuction, is mobile and has unique advantages in comparison with undermining.
Dr Koo almost always repairs the lax abdomen by repairing the split between the abdominus recti muscles that can be a result of weight gain, pregnancy, or simply present congenitally (at birth). She will determine if your anatomy will allow her to be able to tighten the abdominal musculature and help tighten the rib cage even more.
Liposuction creates sliding flaps by dissecting free their fibrous/neurovascular mesenteries. Abdominal flap mobility is obtained by fat removal, the transection of the cutaneous ligaments, and the stretching of the neurovascular mesenteries. The concept of a sliding flap, tethered by a subcutaneous pedicle, is not new; these flaps are used extensively in reconstructive surgery. Liposuction sliding flaps possess a rich blood supply, evident by the rarity of skin necrosis in the procedure; however, they are not safer than undermined traditional flaps. Clinical judgment should be exercised regarding the extent of liposuction, the thickness of the flap, and the degree of tension. Sliding flaps possess several advantages: they eliminate dead space, can be contoured, and are sensate.
Anterior abdominal wall-tightening procedures such as rectus plication are performed to achieve a flat, nonprotuberant abdominal appearance. The intraabdominal contents consist of intraabdominal fat and organs; the fat includes both visceral fat and a substantial amount of retroperitoneal fat. Normally, there are marked variations in the volume and position of the abdominal contents. Visceral position is affected by posture, respiratory excursions, and body build. Therefore, a postural increase in lumbar lordosis predisposes to a protruding abdomen even in a thin person.
With the exception of the anterior abdominal wall and the diaphragm/rib cage, most of the abdominal cavity has rigid and nonyielding boundaries. The superior boundary of the abdominal cavity is the diaphragm/rib cage; the inferior boundary is the pelvis. Lateral boundaries are the fleshy parts of obliqui, transverses, and the ilium and iliacus. The anterior boundary is the recti and aponeuroses of obliqui and transversi abdominis, and the posterior boundary is the lumbar vertebrae, crura of the diaphragm, psoas, and quadrati lumborum. Thus, only the anterior abdominal wall and diaphragm/rib cage-and to a much lesser extent the waist between L-3 and L-5-are pliable and can accommodate an increase in the intraabdominal volume. Furthermore, the abdominal cavity encloses a finite intraabdominal volume. Tightening of the pliable anterior wall pushes the intraabdominal contents (volume) against the only other pliable boundary, the diaphragm.
Traditional abdominoplasty is associated with the potential for several problems. The procedure has been identified as a specific risk factor for deep vein thrombosis by Daane and Rockwell, Reinisch et al., and Stuzin et al. Dillerud found that wide undermining causes skin necrosis. In addition, undermining necessitates prolonged postoperative suction drainage to avoid seroma, which is the most frequent complication of abdominoplasty. It has also been reported by van Uchelen et al. to produce sensory changes of the abdomen and thigh. Further, incisions are often long and geometrically designed, and tension may cause excessive scarring. In contrast, limited abdominal flap undermining, which has resulted in less morbidity, fewer complications, and shorter scars than the classic procedure, has been advocated for appropriate cases by Wilkinson and Swartz, Greminger, Eaves et al., Zukowski et al., Shestak, and Lockwood.
Liposuction abdominoplasty is a safe and highly effective alternative to traditional abdominoplasty in appropriate patients. Dr Koo feels that the procedure has consistently and significantly reduced many of the problems that have been associated with classic abdominoplasty. Other related concepts are also offered: The successful outcome of abdominal wall surgery appears to depend on the preoperative evaluation of the intraabdominal fat content, and a sliding abdominal flap, created by liposuction, is mobile and has unique advantages in comparison with undermining.
Anterior abdominal wall-tightening procedures such as rectus plication are performed to achieve a flat, nonprotuberant abdominal appearance. The intraabdominal contents consist of intraabdominal fat and organs; the fat includes both visceral fat and a substantial amount of retroperitoneal fat. Normally, there are marked variations in the volume and position of the abdominal contents. Visceral position is affected by posture, respiratory excursions, and body build. Therefore, a postural increase in lumbar lordosis predisposes to a protruding abdomen even in a thin person.
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