about the abdomen liposculpture procedure
The abdomen (referred to generally as the “stomach”) is a common area for targeted abdomen liposculpture procedures. This area can have very stubborn fat deposits and losing fat through diet and exercise from the abdomen may be difficult in some people. The abdomen is the most common body part in which women tend to gain more fat as a result of pregnancy and natural hormonal changes following menopause.
Many women find their abdomen to be a problem area for fatty deposits, particularly after pregnancy, and even more so after menopause. It may make fitting clothing difficult in some women and they may become frustrated that this area may not respond to diet and exercise as much as they want. With liposculpture, significant belly fat may be removed without the need to resort to an abdominoplasty (a surgical cosmetic operation to remove excess skin, fatty tissue and possibly repair of muscle separation), colloquially called a “tummy tuck”. An abdominal examination is required to ascertain suitability for liposuction alone of the abdomen. Abdominal liposculpture is performed from the breast line to the pubic area, and also includes the waist.
abdomen liposuction
Liposuction of the abdomen is the most commonly requested area in both men and women. Important factors that affect the success of abdominal liposuction include the amount and location of abdominal fat, pregnancy (past and future), age and sex of the patient. Liposuction of the abdomen does NOT remove visceral fat. Visceral fat may only be reduced by diet and exercise. Liposuction of the abdomen only removes subcutaneous fat (fat located between the skin and the muscle). Liposuction of the abdomen is unable to restore redundant excessive skin, nor is it able to repair separation of the abdominal muscles (that may have been separated during pregnancy). An abdominoplasty (“tummy tuck”) would be a more suitable procedure for those issues.
Abdominal fat may occur in 2 different layers for some people: superficial (subcutaneous fat) and deep (visceral fat). Careful examination of the abdomen is required before abdomen liposuction, to assess the skin quality, the abdominal muscles and the presence or absence of visceral fat, and the posture of the patient and the presence of hernias.
Abdomen liposuction extends from under the breasts to the pubic area with extension into the waist area.
The age of the patient may be variable. It is common for women and men in their 60’s to request abdomen liposuction provided they are in good health.
The upper abdomen may appear slightly wrinkled after abdomen liposuction, especially in older patients. Sometimes, if the upper abdominal fat is not suctioned or inadequately suctioned, subsequent weight gain may enlarge the upper abdomen disproportionately to the lower abdomen. It is therefore common to have whole abdomen liposuction in most individuals.
Liposuction of the abdomen typically takes approximately 4 hours to do and it is performed under mild to moderate sedation using the tumescent local anaesthetic technique and microcannulas. It may take more time to complete with microcannulas, but they are associated with less postoperative pain / soreness and allow for smoother results. Numerous 3-5mm incisions are required around the abdomen (approximately 6-8) and they do not require suturing. The open incisions allow drainage of the blood-tinged tumescent anaesthetic fluid. Compression garments are worn for a minimum of 2 weeks post operatively plus an elastic binder over the top for the first week. Liposuction of the abdomen is typically an isolated procedure. It is not common to have other areas lipo-suctioned at the same time as the surface area is large and it takes more local anaesthetic to numb the area effectively compared to other areas. It’s important to stage liposuction procedures to not exceed this local anaesthetic dose, that may lead to toxicity and subsequent serious medical risks. Liposuction of multiple areas also increases the time of the procedure and this may lead to prolonged recovery and the possibility of blood clots in the legs that could travel to the lungs. Such complications are extremely rare when liposuction of the abdomen is performed alone and using the tumescent local anaesthetic technique.
The swelling after abdomen liposuction tends to last longer than other areas of the body. The day after the liposuction of the abdomen, one is still leaking the blood-tinged anaesthetic fluid. Over the next few days, there is a gradual onset of swelling, that is maximal between the first and second week post-operatively, that decreases over the next 4-12 weeks. Bending over may be a challenge for some people. The abdominal muscles are active and contracting when one gets out of bed, rolls over in bed, or gets up from a chair, so soreness and stiffness is normal in the post-operative period after abdomen liposuction. The pubic area in women and the genital area in men, tend to become very swollen and possibly bruised, because of the effect of gravity and closeness to the area of abdomen liposuction. Firmness, lumpiness, swelling is normal for 4-12 weeks. This firmness of the abdomen skin and subcutaneous tissue gradually reduces over 3-4 months.
Liposculpture only treats sub-cutaneous fat
(under the skin) and not visceral
What is visceral body fat? Visceral body fat, also known as ‘hidden’ fat, is fat stored deep inside the abdomen, wrapped around the organs, including the liver and intestines. It makes up about one tenth of all the fat stored in the body. Most fat is stored underneath the skin and is known as subcutaneous fat. That is the fat that is visible and that you can feel by pinching the skin and the underlying fat. Only subcutaneous fat may be removed with liposculpture. The rest of the fat in the body is hidden. That is visceral fat. Visceral fat makes the abdomen stick out or gives a person an ‘apple’ shape. It also produces chemicals and hormones that can be toxic to the body. Visceral fat produces more toxic substances than subcutaneous fat, so it is more dangerous. Even in thin people, having visceral fat carries a range of health risks. Visceral fat is more common in men than in women. Diet and exercise are required to reduce visceral fat or to have weight loss surgery, often called bariatric surgery.
Some individuals may not be suitable for abdomen liposculpture alone. Separation of the abdomen muscles may cause a protrusion of the abdomen. This rotundness may require a “tummy tuck” (abdominoplasty) to repair the weakened muscles, even if there is subcutaneous fat. A combination procedure of abdominoplasty and liposculpture may be a preferred option. Rectus abdominis diastasis (RAD; diastasis recti, divarication of the rectus abdominis, abdominal muscle separation) is an anatomic term describing a condition in which the two rectus muscles are separated by an abnormal distance.
In some people, there may be excessive skin over the abdomen, and an “apron” of fat and skin, where abdominal liposculpture alone may not be suitable, despite an expected level of skin retraction.
Tumescent liposculpture is a cosmetic surgery procedure that removes subcutaneous fat from the abdomen in women to reduce the size and to reshape. It takes approximately 4 hours to perform liposculpture / liposuction of the abdomen.
What are the benefits of Liposculpture?
Liposculpture is a refinement in the technique of liposuction. Firstly, liposculpture is performed under local anaesthetic which makes it easier to achieve a regular, more even result, by assessing the patient at a later stage of the procedure. This is because it is possible to move into different positions and to stand up toward the end of the procedure which allows the effect of gravity to be seen on the areas that had liposculpture. This enables a much more predictable result to be achieved as more liposculpture is done to refine the areas and try to establish symmetry.
Secondly, as no general anaesthetic is needed for liposculpture, the inherent risks associated with a general anaesthetic are avoided.
Thirdly, liposculpture involves the injection of fluid into the fatty tissues before the procedure is performed. This fluid contains the local anaesthetic (lignocaine) and also a medication which effectively constricts blood vessels (adrenaline). Adrenaline vastly decreases the amount of bruising that occurs with liposculpture while the local anaesthetic produces effective relief of discomfort during the procedure and for up to 12 hours afterwards (and longer).
Fourthly, liposculpture is day surgery. There is usually no need for the person having liposculpture to stay overnight in hospital or to have blood transfusions. You are encouraged to remain active following the procedure, walking soon after, and often returning to work after a few days to a week. Time off work and normal or vigorous activities is usually kept to a minimum. A week off work is advisable for most individuals.
What is the difference with Liposculpture under local anaesthetic?
Liposculpture takes time to achieve the desired outcomes. The average procedure lasts 4 hours, especially when liposculpture of a few areas is performed. Smaller areas may only take up to 2 hours to do. In contrast, liposuction performed under general anaesthesia must be done in a shorter time as longer anaesthetic time increases anaesthetic risks. The recovery period is usually shorter with usually less bruising and less discomfort. However, due to different procedures, different patients will heal differently, and have different pain thresholds and will therefore experience different recovery times for different activities. The subcutaneous fatty tissue is thoroughly anaesthetised (numbed) and vasoconstricted when using the tumescent local anaesthetic technique and this generally contributes to a reduction of pain after the procedure. Liposculpture is performed by many doctors from many specialties.
Dr Heckenberg is specifically trained in liposculpture. She is dedicated and will take the necessary time to strive for the desired results and performs only liposculpture and no other cosmetic surgery procedures. It is important to have these procedures performed by doctors who do the same procedures often, as with any surgery. Allowing enough time, using microcannulas and having patience are the most important factors when performing liposculpture.
What is the safety profile and risks of Liposculpture?
Risks associated with liposculpture are reported in international peer reviewed medical journals. These are made available to you and may be accessed below:
Boeni, R., & Waechter-Gniadek, P. V. (2021). Safety of Tumescent Liposuction Under Local Anesthesia in 9,002 Consecutive Patients. Dermatologic Surgery, 47(5), e184–e187.
This recent 2021 study comprising of 9,000 cases, also concluded that liposuction using the tumescent local anaesthetic technique “is a reliable and safe procedure if it is performed by an experienced surgeon and the guidelines of care are strictly followed”.
Dixit, V., & Wagh, M. S. (2013b). Unfavourable outcomes of liposuction and their management. Indian Journal of Plastic Surgery, 46(2),377.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901919/
This detailed 2013 article compiles unfavourable outcomes, possible risk factors and their management associated liposuction and the importance of appropriate training in this procedure.
Hanke, C. W., Bernstein, G. S., & Bullock, S. (1995b). Safety of Tumescent Liposuction in 15,336 Patients. Dermatologic Surgery, 21(5), 459–462.
A landmark article in the prestigious Dermatographic Surgery Journal reported the survey results of over 15,000 cases of liposculpture performed in America between 1994 and 1995. Authors concluded that complications during the procedure were few, as were problems following the procedure, and the level of complications was much less. Bruising is minimal, but does occur in most cases. It usually lasts for 10 to 14 days. Infections may occur with any surgery, but are fortunately quite rare and antibiotics are given before and after the procedure. Local areas of numbness may occur, although these usually resolve within a few months but may take up to a year.
What are the Doctor's Qualifications?
At Be Sculptured, Dr Heckenberg is trained specifically in liposculpture and she has a medical fellowship from The Australasian College of Cosmetic Surgery and Medicine (ACCSM) and a Lipoplasty Fellowship. Dr Heckenberg is dedicated to the procedure of liposculpture. It is the only cosmetic procedure she performs. Performing the same procedure often is necessary to acquire appropriate skills for any procedure. Dr Heckenberg has Specialist Registration in General Practice after gaining her Fellowship in 1997 (FRACGP) and a Diploma in Obstetrics and Gynaecology in 1996 (DRANZCOG) and has been performing contraceptive and reproductive out-patient gynaecological procedures since 1998. Her medical registration number is MED0001158434.
What actually is Liposculpture?
Liposculpture is a body changing tool. Liposculpture is performed using Dr Klein’s “tumescent local anaesthetic” with micro-cannulas. The administration of the tumescent local anaesthetic makes it possible for the patient to stand up at the later stage of the procedure, allowing the effect of gravity to be visualised. Patients are also able to move themselves into the appropriate positions to adequately remove the fat from specific areas to change the body shape. It is this ability to visualise the patient’s body that provide a more predictable/favourable results.
As no general anaesthetic is needed, risks associated with a general anaesthetic are avoided. Sedation has its risks, such as excessive drowsiness, or inadvertent and unexpected deeper levels of sedation, but recommended dosing and monitoring during the procedure reduces these risks.
Liposculpture involves the injection of fluid into the fatty tissues before the procedure is performed. This saline solution contains the local anaesthetic drug (lignocaine) and also a medication which constricts blood vessels (adrenaline). Adrenaline decreases the amount of bleeding and bruising while the local anaesthetic reduces discomfort during the procedure and for up to 12 hours afterwards. These effects may last longer in some individuals.
Do I need to stay overnight in Hospital?
Liposculpture is performed as a day procedure. There is rarely a need for the person having liposculpture to stay overnight in hospital, or to have blood transfusions. A half to ¾ of a day is required to perform the procedure and to stay in the hospital recovery. You are encouraged to remain active following the procedure, gentle walking soon after, and often returning to work after 1 week or possibly after a few days. Time off work and normal activities is usually kept to a minimum. More vigorous exercise may be resumed 3- 4 weeks after the procedure.
How long does Liposculpture take?
Liposculpture takes time. Taking the time to do the procedure is paramount. Small calibre cannulas (micro-cannulas) are used. The average procedure takes 2-4 hours. Liposculpture of the abdomen and waist takes approximately 4 hours.
What support garments are required?
Special lycra bodysuit compressive garments are used for about two weeks after the procedure. Double suits for the first week and a single suit for the second week. It is important not to wear jeans or belts for 4 weeks post procedure in order to prevent indentations in the skin. An elastic binder may also be used over the 2 compression garments for the first week.
Please take note
Liposculpture isn’t suitable for everyone. Only patients with a Body Mass Index of under 35 will be considered but only after they have been properly assessed during the consultation. Your BMI can be checked using the following online calculator:
Smoking increases the level of carbon monoxide in the blood, which deprives tissues of oxygen. Blood supply is a major concern during any surgical procedure. Combining smoking and cosmetic surgery can categorically result in increased pain, loss of skin, infections, death of tissue or fat cells, delayed healing, thick scarring, permanent vessel damage, or blood clots. Smokers should cease smoking 6 weeks prior to the procedure or consider to not have the procedure at all.
Patients with body dysmorphia disorder (BDD) are inappropriate for liposuction / liposculpture or any type of cosmetic surgery or procedure. Body dysmorphic disorder (BDD) is a mental illness. People who have this illness constantly worry about the way they look. They may believe an inconspicuous or non-existent physical attribute is a serious defect. They respond to this by performing repetitive acts such as mirror checking or comparing their appearance with others. The severity of BDD varies. For example, some people know their feelings and / or perceptions aren’t rational or justified, while others are almost delusional in their conviction. BDD causes severe emotional distress. It is not just vanity and is not something a person can just ‘forget about’ or ‘get over’.
The preoccupation of their appearances can be so extreme that the affected person has trouble functioning at work, school or in social situations. People who suffer from BDD can target any part of the body. They may seek out numerous cosmetic procedures to try to “fix” their perceived flaw. Afterward, they may feel temporary satisfaction or a reduction in their distress, but often the anxiety returns and the search for other flaws may resume, along with ways to “fix” them. Treatment of BDD may include cognitive behavioural therapy and medication after an assessment by a Psychiatrist.