The abdomen is the most targeted area for liposuction. It far exceeds all other treatment areas by a significant margin. This is primarily because this area concerns both men and women, which is not the case for the thighs or buttocks, where male demand is almost non-existent. Secondly, due to post-pregnancy effects, android obesity, and hereditary factors, women are often affected by excess fat in the abdomen. Fortunately, the skin of the abdomen is of exceptional quality, especially in women, so the aesthetic results are impressive, as the skin can naturally retract afterward.
Liposuction provides an effective solution for individuals struggling with excess fat in this area, even in older individuals who have accumulated significant abdominal fat over the years. I even recounted a case where I had to perform the procedure in two phases, operating on the left side first and then the right side two months later, removing about four liters of fat each time. Additionally, there is another, less anecdotal way to perform the procedure in two phases on the abdomen. First, the area below the navel, or the hypogastrium, is treated, followed by the area above the navel, or the epigastrium. This is done, of course, when the abdomen is too large to be treated in one session, which is very rare.
It is important to note that the abdomen is a unique area that requires specific anatomical knowledge, both superficially and deeply. Superficially, the abdomen is divided into four regions that the liposculptor must understand well, especially to explain them clearly to the patient.
The epigastrium or upper abdomen, which patients often refer to as the stomach;
The hypogastrium or lower abdomen, which most people call the “belly,” and which can sometimes be complicated by an apron of fat;
The periumbilical region, which must be well sculpted, otherwise it may look like a donut;
The central part, which can be called the waist; this part connects the upper and lower abdomen.
Why are these anatomical considerations important? To know exactly which area is being discussed: sometimes liposuction will only target the lower abdomen, more rarely only the upper abdomen, but most of the time, the entire abdomen will be the focus of the procedure.
It is very important to emphasize here that liposuction cannot correct a large belly caused by loss of muscle tone. It is equally important, during the consultation, to make a proper diagnosis and to clearly explain the ins and outs of the procedure. The surgeon’s honesty is always extremely important, especially in liposuction. A patient will always be very grateful for being fully informed before the procedure, allowing them to make an informed decision.
As I have already mentioned, the diagnosis here is very important, especially in cases of very prominent abdomens known as “hard belly.”
Indeed, this prominence is caused by visceral fat, located behind the muscle, which, being extremely acidic, accentuates this belly. Of course, the liposculptor has no access behind the muscle. It could be said that this muscle no longer contracts, like an overstretched elastic band. Therefore, liposuction is impossible in the case of a hard belly.
It is easy to understand the importance of muscles in the shape of the abdomen, particularly those that form the abdominal belt, often called the abdominal girdle.
When these muscles are too weak, the weight of the viscera plus the surrounding fat pushes the belly forward, excessively increasing the “hollow” of the spine, often causing back pain, specifically in the lumbar region.
With liposuction, possible when the fat is located between the skin and the muscle, the relaxation caused by the weight of the fat is corrected, and at the same time, the spine is relieved.
It is common that immediately after abdominal liposuction, when the patient stands up for the final check, a straightening of the spine is immediately noticeable, which is a pleasure to see.
Some people come to the consultation with a very significant fatty apron, sometimes even covering the pubic area. What will happen to the skin after the procedure? Well, believe it or not, thanks to the superficial liposuction technique already described, the skin will retract. Of course, it may not retract completely, but there will always be a noticeable improvement. I have observed aprons of 8 inches (20 cm) in length reduced to just half an inch (1 cm) after liposuction, as it is important to reiterate that it is not the skin that causes the fat to sag, but the fat that causes the skin to sag: if this fat is removed, the skin will return to the place it should have always been.
In the past, a lipectomy (surgery for the fatty apron) was performed immediately in such cases, but today, with the development of liposuction, most professionals agree to start with liposuction, and if the skin does not retract enough afterward, which is rare, it would be easy, during a second procedure, to remove this slight excess of skin.
Liposuction is a benign procedure compared to lipectomy, which is a more invasive surgery and therefore more prone to side effects. Moreover, lipectomy, which involves removing a large block of fat and skin with a scalpel, often leaves an unsightly scar, an artificial navel, and cannot remove fat as effectively as liposuction.
Another noteworthy fact is that the abdominal skin, especially below the navel, is of exceptional quality. Let’s not forget that this skin stretches multiple times during pregnancies and retracts perfectly after childbirth. You often see women who have had four or five children and still have a beautiful belly.
Therefore, this abdominal distension is often strictly due to the volume of fat, which, once treated by liposuction, will allow the skin to retract very adequately.
Often, a horizontal fold can be seen at the level of the navel, dividing the abdomen into two parts, the upper and lower, due to a local anatomical peculiarity, the Camper’s fascia. I then warn the patient that this fold will persist after liposuction, but less deeply.
In fact, as I have already explained, and I will repeat because it is so important, the abdomen consists of three layers or levels:
The fat located between the skin and the muscle, the target of liposuction;
The muscle, which is sometimes in very poor condition, having lost its tone;
The omental or visceral fat, located behind the muscle, at the level of the intestines.
When faced with a large belly, the liposculptor must perform an examination to assess the importance of each of the three layers. The more significant the first layer is (e.g., b), the better the liposuction results will be. In other words, if your fat is in the right place for liposuction (i.e., just under the skin), the results will be positive.
Very often, a large belly is a function of the three layers, for example, 50% first layer (that’s where the action is), 25% due to weak abdominal muscles, and a final 25% due to fat located behind the muscle. In such a case, in addition to liposuction, abdominal muscle exercises will be needed for the second layer and a diet for the third layer. This way, optimal results can be achieved.
If the large belly is 100% due to fat located between the skin and the muscle, then liposuction will give you a flat belly, like a pancake. It is during the consultation that the importance of the “first layer” must be well evaluated in relation to the other two. The patient must know in advance what kind of belly they will have after the procedure. This belly will be reduced by half, three-quarters, or completely, depending on the importance of the first layer. And the surgeon must not only say it but also write it on the consent form. Why? Memory, as we know, is a faculty that forgets. And a disappointed patient will quickly blame their liposculptor, rightly or wrongly. Or perhaps rightly if the pre-operative explanations were incomplete.
Liposculpture is a precision job that requires a lot of concentration and inner peace, which does not go well with patient complaints. However, good news, I have sometimes achieved surprising results, even with a less significant first layer, because aspirating this first layer of fat relieves the muscle, which is less stretched forward. Understand the situation of the abdominal muscles. Caught, so to speak, between two fires, they are pushed forward by the intestines and visceral fat, and in addition, they are pulled forward by the subcutaneous fat. This push-and-pull effect exerts tension on the spine, seeking to pull it forward as well, and consequently, to hollow the back, causing uncomfortable and sometimes painful lordosis.
Some patients prefer to wait until after childbirth to get rid of their abdominal fat, mistakenly believing that this is better. What a pity for them! All those years lost before achieving the waistline they desire. Waiting only increases fat deposits, and liposuction will only be more significant after the second or third child.
If, on the other hand, liposuction is done early, the fat cells, once aspirated, will not return, and the new waistline will be more easily achieved after each childbirth.
In short, liposuction can significantly contribute to restoring the body’s natural contours, without performing miracles. This discipline involves transforming the contours without changing the bone and muscle structure. Thanks to microcannulas and tumescence, this art has reached a very high level of refinement, offering much hope to those who suffer from disproportions related to fatty tissue.
